Case Report: Physical therapy management of axial dystonia

Multimodal Care of a Patient With Functional Movement Disorders Following a Motor Vehicle Accident: A Case Report

Objective

The purpose of this case report was to describe the multimodal care of a patient with the sudden onset of truncal tremors.

Clinical Features

A 30-year-old female patient presented for chiropractic care with truncal tremors following a motor vehicle accident. Initial outcome measures included the Neck Disability Index (50%) and Oswestry Disability Index (62). The patient's truncal tremors became worse during spinal cord compression testing that included passive cervical flexion and slouched posture. The Romberg test was positive for swaying. Assessments of active range of motions of the cervical, thoracic, and lumbar spine were moderately reduced in all ranges. Case history, physical examinations, diagnostic imaging, and neurology consultations led to a diagnosis of functional truncal tremors. The patient was being concurrently managed by other health care providers. Magnetic resonance imaging studies were ordered by a neurologist and primary medical physician, which showed no structural abnormalities in brain neuroanatomy or spine.

Intervention and Outcome

The multimodal chiropractic care included whole-body vibration therapy (WBVT), spinal manipulative therapy (SMT), and acupuncture therapy. The treatment plan included 8 weekly appointments in which the patient received WBVT and SMT. During treatment weeks 2 to 6, the patient received acupuncture therapy, which occurred immediately following their treatment appointment for WBVT and SMT. The patient practiced stress reduction techniques, as advised by the neurologist, eliminated caffeine, and performed daily yoga exercises for 30 minutes. The Romberg test was negative after the third treatment. The patient was discharged after chiropractic visit 12, 95 days post-accident, as she reached maximal medical improvement. Truncal tremors were still present, but the patient described them as "barely noticeable."

Conclusion

The patient reported improvement under a course of chiropractic care using a multimodal approach, including behavioral, pharmacological, and manual therapies. This case study suggests that WBVT, SMT, and acupuncture therapy may assist some patients with functional movement disorders.

[Short-term effect of neuromuscular bandaging on balance and gait in Parkinson's disease: Pilot study]

INTRODUCTION

Parkinson's disease is a progressive and irreversible neurodegenerative process characterized by tremor at rest, bradykinesia, stiffness, disorders in postural control, balance and gait. Kinesiology tape has a somatosensory stimulating effect, with benefits in postural control.

METHOD

A pilot study with a Physiotherapy Intervention Group and an Experimental Group (kinesiology tape was added) in gastrocnemius and lumbar spinal erectors. Outcome assessments were Berg scale, Tinetti scale (walking subscale), 10m test, TUG test, PDQ-39 and gastrocnemius electromyographic record. Three measurements were made: T0 (baseline), T1 (two days post-intervention) and T2 (one week post-intervention); PDQ-39 was administered at T0 and one month after the intervention.

RESULTS

Thirteen participants (stage III Hoehn and Yahr) were selected after applying the inclusion criteria (nine women and four men). N=7 Experimental Group and N=6 Physiotherapy Group. The intra-group contrast showed significant improvements in favor of the Experimental Group in Berg scale (T1 and T2), 10m test (T2) and in lower mean gastrocnemius muscle activity (T1). The inter-group contrast only evidenced differences in electromyographic recording of the muscle contraction of the right lower limb, after the application of kinesiology tape, in T1.

CONCLUSIONS

The application of kinesiology tape in the lumbar spinal erectors and gastrocnemius bilaterally could improve gait and balance, in subjects with Parkinson's disease in Hoehn and Yahr stage III, but its effect is not superior to conventional physiotherapy treatment.

A Short Overview of the Effects of Kinesio Taping for Postural Spine Curvature Disorders

Spine curvature disorders are very common in the population. Several therapeutic methods have been implemented over time. Kinesio Taping (KT) is a solution that is utilized for several purposes. This narrative review aims to discuss KT methodology as a valid solution for spinal curvature disorders, especially for structured and non-structured spine deviations. The matter is poorly discussed in the current literature. Nevertheless, KT seems to indirectly influence posture and spine curvature disorders through peripheral and central nervous system stimulation, but further investigations are needed to demonstrate these unknown effects clearly. The present review provides a valuable contribution to the existing literature and may represent a starting point and a useful guide for further studies in this field of research.

The effects of a laser-guided postural reeducation program on pain, neck active range of motion, and functional improvement in a 75-year-old patient with cervical dystonia

Background and Purpose: Limited research exists regarding physical therapy management for patients with cervical dystonia (CD). The purpose of this case report is to describe the clinical management of a patient with CD using manual techniques, cervical traction, and laser-guided postural reeducation. Case Description: The patient was a 75-year-old female with CD, diagnosed 40 years prior, with a 10-year history of botulinum neurotoxin injections. She reported a 1-year history of worsening neck pain and cervical range of motion loss which was significantly affecting her ability to sleep and drive. The patient was seen for 12 visits over a 6-week period. Outcomes: Discharge scores indicated marked improvements in active range of motion, neck disability index, and the CDIP-58 questionnaire. Improvement in motor control as measured during the SenMorCor™ Laser Functional Error Assessment was demonstrated in the motions of "looking right" (53%) and up (48%). Discussion: This case report indicates that a physical therapy program consisting of a daily laser-guided home program for head postural reeducation in conjunction with classic physical therapy techniques may be an option for patients with CD; however, further research is needed prior to adoption of these techniques as standard of care for patients with CD.

The phenomenology and treatment of idiopathic adult-onset truncal dystonia: a retrospective review

Background

Focal dystonia is the most common type of adult-onset dystonia; however, it infrequently affects truncal musculature. Although commonly attributed to secondary etiologies such as a neurodegenerative illness or tardive syndromes, the entity of idiopathic adult-onset truncal dystonia has only been previously described in a few case reports and small case series. Here we characterize seven cases of adult-onset primary truncal dystonia and present them within the scope of the existing literature.

Methods

Retrospective chart review of medical records and patient videos of seven adult patients with idiopathic truncal dystonia evaluated by the senior movement disorder neurologists in an urban outpatient clinic.

Results

The mean age of onset of idiopathic truncal dystonia was 47.6 years old and the majority of patients were male. Truncal flexion was the most common direction of dystonic movement and the dystonia was most frequently induced by action and could be improved by use of a sensory trick. The majority of patients were refractory to 3 or more oral treatments and only two patients exhibited significant functional improvement with botulinum toxin injections. One patient enjoyed significant benefit with bilateral internal globus pallidus deep brain stimulation.

Conclusions

Although a relatively rare presentation, patients with idiopathic adult-onset truncal dystonia can be identified by a common phenomenology. Diagnosis of this highly disabling condition is important because these patients are frequently refractory to multiple oral treatments and may benefit from early treatment with botulinum toxin or deep brain stimulation.

Electronic supplementary material

The online version of this article (doi:10.1186/s40734-016-0044-9) contains supplementary material, which is available to authorized users.