Focal dystonia: Difference between revisions
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== Management / Interventions<br> == | == Management / Interventions<br> == | ||
Botulin Toxin <ref name="Ceballos-Baumann et al. (1997)">Ceballos-Baumann, A. O., Sheean, G., Passingham, R. E., Marsden, C. D., &amp;amp; Brooks, D. J. (1997). Botulinum toxin does not reverse the cortical dysfunction associated with writer's cramp. A PET study. Brain, 120 ( Pt 4), 571-582.</ref> | Botulin Toxin <ref name="Ceballos-Baumann et al. (1997)">Ceballos-Baumann, A. O., Sheean, G., Passingham, R. E., Marsden, C. D., &amp;amp;amp; Brooks, D. J. (1997). Botulinum toxin does not reverse the cortical dysfunction associated with writer's cramp. A PET study. Brain, 120 ( Pt 4), 571-582.</ref> | ||
Surgery | Surgery | ||
Ergonomic changes at the instrument (Musician's dystonia) | |||
Immobilization <ref name="Priori et al. (2001)">Priori, A., Pesenti, A., Cappellari, A., Scarlato, G., & Barbieri, S. (2001). Limb immobilization for the treatment of focal occupational dystonia. Neurology, 57(3), 405-409 (abstract only)</ref> | |||
Behavioral therapy <ref name="Berque et al. (2010)">Berque, P., Gray, H., Harkness, C., & McFadyen, A. (2010). A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians. Med Probl Perform Art, 25(4), 149-161 (abstract only).</ref> | |||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Revision as of 18:00, 28 January 2014
Original Editor - Carlos Areia
Lead Editors
Search Strategy
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Pubmed and PEDro databases
Keywords: Focal dystonia - physiotherapy
Introduction
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Dystonia is defined as an involuntary contraction of the agonistic and antagonistic muscles, which can lead to repetitive involuntary movements and/or abnormal positions, most common in the hand (known as Focal Hand Dystonia). The affected population includes individuals who require repetitive movements on their regular daily life; one of the most affected populations are the musicians and professional writers [1]. In the European and American population Focal dystonia varies its prevalence between 3 and 29.5 per 100.000 inhabitants [1][2]. Inside musicians dystonia it is estimated that of all musicans, 0.5 % to 1% suffer from some form of focal dystonia [1][3]. This figures are highly variables if we individualize each case, depending on the instrument and the effort required on each performance; for instance the difference between a rhythm and a soloist guitar player.
Mechanism of Injury / Pathological Process
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Although the pathological process of Focal Dystonia is still classified as idiopathic, increasing evidence suggested a multifactorial etiology (e.g. [4] interaction between genetic, neuromuscular, auditory, neural adaptative, anatomic, stressful, repetitive, psychosocial, traumatic, among others). An alteration in tactile discrimation was found in dystonic musicians comparing with generalized dystonias and healthy controls; this has been related with the superposition of the areas of representation of the fingers affected in musicians [1][5]. Other etiological mechanisms are also described in further literature, for instance the alteration of inhibitory spinal, trunk, and intracortical and alterations in sensorimotor integration. [1]
Many triggering factors have been described in current evidence, we can distinguish them as external and internal triggering factors, among the extrinsic some examples are the spatial, temporal and spatial contraints depending on the workload of the respective body part and the complexity of the movements used; for intrinsic triggering factors have been described the need of control, the need of perfectionism and anxiety, local pain, trauma, overuse and the deficit in inhibitory mechanisms; also predisposition factors have been considered such as genetics and sex; these triggering factors combined can affect the manifestation of Dystonia[6].
Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions
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Botulin Toxin [7]
Surgery
Ergonomic changes at the instrument (Musician's dystonia)
Immobilization [8]
Behavioral therapy [9]
Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 Aranguiz, R., Chana-Cuevas, P., Alburquerque, D., &amp;amp;amp; Leon, M. (2011). Focal dystonia in musicians. Neurologia, 26(1), 45-52. doi: 10.1016/j.nrl.2010.09.019
- ↑ Defazio, G., Abbruzzese, G., Livrea, P., &amp;amp; Berardelli, A. (2004). Epidemiology of primary dystonia. Lancet Neurol, 3(11), 673-678. doi: 10.1016/s1474-4422(04)00907-x
- ↑ Jabusch, H. C., Zschucke, D., Schmidt, A., Schuele, S., &amp;amp; Altenmuller, E. (2005). Focal dystonia in musicians: treatment strategies and long-term outcome in 144 patients. Mov Disord, 20(12), 1623-1626. doi: 10.1002/mds.20631
- ↑ Byl, N. N., Archer, E. S., &amp;amp;amp;amp;amp;amp; McKenzie, A. (2009). Focal hand dystonia: effectiveness of a home program of fitness and learning-based sensorimotor and memory training. J Hand Ther, 22(2), 183-197; quiz 198. doi: 10.1016/j.jht.2008.12.003
- ↑ Byl, N. N., Nagajaran, S., &amp;amp;amp; McKenzie, A. L. (2003). Effect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series. Arch Phys Med Rehabil, 84(10), 1505-1514.
- ↑ Altenmuller, E., & Jabusch, H. C. (2010). Focal dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment. Med Probl Perform Art, 25(1), 3-9.
- ↑ Ceballos-Baumann, A. O., Sheean, G., Passingham, R. E., Marsden, C. D., &amp;amp; Brooks, D. J. (1997). Botulinum toxin does not reverse the cortical dysfunction associated with writer's cramp. A PET study. Brain, 120 ( Pt 4), 571-582.
- ↑ Priori, A., Pesenti, A., Cappellari, A., Scarlato, G., & Barbieri, S. (2001). Limb immobilization for the treatment of focal occupational dystonia. Neurology, 57(3), 405-409 (abstract only)
- ↑ Berque, P., Gray, H., Harkness, C., & McFadyen, A. (2010). A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians. Med Probl Perform Art, 25(4), 149-161 (abstract only).
