Objective: The aim of this study is to assess the long lasting effectiveness of an integrated tailored sensory-motor rehabilitation program (TsmRP) associated with botulinum toxin treatment (BoNT) on cervical dystonia (CD).

Background: CD is characterized by involuntary, abnormal movements and postures of the head and neck. Current views on its patophysiology are faulty sensori-motor integration and impaired motor planning. Efficacy of BoNT is demonstrated and there are several data that physical therapy1 can improve treatment outcome acting on sensori-motor re-learning.

Methods: Five patients affected by CD were included in the study. All patients were evaluated before (T0) and after treatment (T1 at sixth week and T2 at three months). The treatment consisted in BoNT injection associated with an integrated TsmRP based on sensory (visual, acustic and vibratory) biofeedback2 and specific motor exercises on spatial rehabilitation (SaM Method).The TsmRP consisted in eighteen 45 minutes sessions three times a week. The outcome measures were Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), Zung Self Rating Anxiety Scale (SAS) and the following Kinematic parameters: neck position at rest with open (NPO) or closed eyes(NPC), active rotation range of motion towards the affected side (AROMd) and the contralateral (AROMc). The data were statistically analyzed before with the ANOVA test; only significant data were then analyzed with the Wilcoxon rank test.

Results: Data showed significant improvement in TWSTRS at T1 (P=0.04) and maintain the result at T2 (P=0.04). SAS, NPO and NPC were improved at T1 (p=0.04). At T2 all parameters registered a worsening but they did not return to the starting value. The AROMd had a significant improvement only at T2 (P=0.04) while AROMc did not show any changes.

Conclusions: The TsmRP has so far showed promising prolonged effects in the posture and motor skills in patients with CD by restoring motor control but also reducing anxiety. Further investigation are necessary on bigger sample of patients but the TsmRP appeared to be a useful complementary treatment for patients affected by CD. 1.DE PAUW J, VAN DER VELDEN K, MEIRTE J ET AL. J Neurol, 2014; 261: 1857- 1865. 2.SCHMIDT R.A, LEE T.D. 4th edition. Human Kinetics Publishers; Champaign, IL, 2005.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pilot-study-on-the-long-lasting-effectivness-of-an-integrated-tailored-sensory-motor-rehabilitation-program-associated-with-bonta-in-cervical-dystonia/