Analysis and understanding
Physiotherapy treatment is based on a careful analysis and understanding of the dystonic pattern. In the case of ongoing BoNT injections, this analysis should be done in close proximity or in direct conjunction with them, so as not to be misled by any BoNT-expressed muscles.
The study identifies the different components of the pattern:
- Torticollis/caput: the neck/head twists to the right or left.
- Laterocollis/-caput: neck/head tilts to the right or left.
- Anterocollis/-caput: neck/head bends forward.
- Retrocollis/-caput: neck/head bends backwards.
- Lateroshift: the head is shifted sideways to the right or left.
- Anteroshift: the head is displaced forward.
- Shoulder raise: right or left.
- Tremor: yes-yes, no-no, coarse or fine, regular or irregular.
- Compensatory trunk posture.
In the majority of cases there is not only one component of the pattern, but a combination of several components, such as a tonic laterocollis left, laterocaput hay, height left shoulder and tremor. The pattern is inspected in sitting, standing, walking and lying position. In addition, the active movement in all directions of the neck is examined, in terms of both quality and quantity. Reduced range or difficulty in one direction may guide the identification of the pattern, as movement in the opposite direction to the dystonic one is usually limited. Overflow activity and possible decrease or increase of the tremor in the different directions are noted.
If reciprocal arm movements correct the patient's head position and reduce any tremor, this is called "stable dystonia", and if the dystonia is exacerbated by the arm movements, it is called "unstable dystonia". In stable dystonia, arm movements can be used to dampen the dystonia and correct the head position. In unstable dystonia, this should not be used as a treatment, but over time the patient should be gradually trained to make calm arm movements without aggravation.
Keskeiset käsitteet
- Agonisti: dystoninen, yliaktiivinen lihas
- Antagonisti: yliaktiivisen lihaksen vastavaikuttaja. Tekee vastakkaisen liikkeen kuin agonisti
- Motorinen ja posturaalinen kontrolli:
Perusperiaatteet servikaalista dystoniaa sairastavan terapiaan ja harjoitteluun
It is good to start training in the positions where the dystonic activity is calmest or absent, and gradually challenge in the more difficult positions. Mirror in front is recommended whenever possible, to provide feedback and increased body awareness. With an oblique position of the head for extended periods of time, it is easy to lose perception of what is straight and what is oblique. The patient is guided to motor control by distraction from the neck, and the patient is encouraged to follow the hand (their own or the therapist's) with the gaze/face.
Harjoittelu on hyvä aloittaa asennoista jossa dystoninen aktiivisuus on hyvin lievää tai sitä ei esiinny ollenkaan. Portaittain voi edetä haastavampiin alkuasentoihin. Peili on hyvä väline harjoittelun tukena. Se antaa välittömän palautteen vartalon ja pään asennosta sekä lisää kehotietoisuutta. Pitkään jatkunut pään/niskan virheellinen asento vääristää tunnetta pään suorasta asennossa.
Trunk rotations are a good tool for tonus suppression, reduction of secondary obliques and tension, and distraction from the neck. For those with stable dystonia, tonus is very effectively dampened by sweeping-swinging-oscillating arm movements, dancing and by using ball and balloon.
Hoidon vasta-aiheet
Tietyt hoitamuodot voivat lisätä dystoniaoireita. Näiden käyttöä tuleel välttää/tehdä harkiten. Näitä ovat:
- Ylävartalon voimaharjoittelu kuntosalilaitteilla
- Niska-hartiaseudun hieronta
- Niskan manipulointi
- Tukikauluri
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