Sensorimotor control in patients with idiopathic cervical dystonia
8 March 2018
UAntwerp, Campus Drie Eiken, Building O, Auditorium O6 - Universiteitsplein 1 - 2610 Wilrijk (route: UAntwerpen, Campus Drie Eiken
Joke De Pauw
Prof P. Cras and Prof W. De Hertogh
PhD defence Joke De Pauw - Faculty of Medicine and Health Sciences
Cervical dystonia is a movement disorder characterized by involuntary neck muscle contractions causing abnormal movements, postures, or both. The idea of dystonia as a pure motor disorder is now shifting towards the idea that defaulted (somato)sensory processing also plays an important role in the symptomatology of CD. Consequently, the aim of the present study was therefore to investigate whether dysfunctions in somatosensory processes of cervical sensorimotor control, seated postural control and the perception of visual verticality are present. Next to the first-line treatment of injection with the neurotoxin Botulinum Toxin (BoNT) physical therapy is sometimes adhered although specifications on treatment content and effect are absent. The findings of this thesis could provide rationale for an evidence-based approach in physical therapy.
The first part of the thesis concerns dystonia and rehabilitation. First, we aimed to describe perceived disability by linking the answers on two disease specific rating scales to the International Classification of Functioning Disability and Health (ICF). Limitations in the cervical spine as well as beyond the cervical area were found. Patients also reported problems in gait pattern function, limitations in mental functions, impairments in engaging in hobbies, social life and leisure activities.
Second, in light of physical therapy treatment, the conducted systematic literature review showed promising results for a multimodal physical therapy program additional to BoNT. It may improve quality of life, head position and reduces pain. Additional research however is needed to specify the content of the physical therapy program.
In the second part of the thesis somatosensory processing is studied by means of a cross-sectional study and the effect of one single BoNT treatment on these somatosensory processes are explored over a period of 12 weeks.
The results showed impaired cervical sensorimotor control, perception of visual verticality is intact and seated postural control is impaired. The results showed larger postural sway and increased sway velocity which is even greater in patients with dystonic head tremor compared to patients without head tremor. Additionally, dysfunctions in cervical sensorimotor and seated postural control were positively correlated. During the 12 week follow-up after a treatment with BoNT symptom severity decreased but did not lead to normalization of postural nor cervical sensorimotor control.
The results of this thesis provide rationale for a multidisciplinary approach of CD. Future research may investigate whether a tailor made training program targeting somatosensory processes decreases symptom severity and improve the patient’s functioning and quality of life.