Motor re-training does not need to be task specific to improve writer's cramp.
Previous studies showed a beneficial effect of motor re-training in task-specific hand dystonia. Here we examined whether re-training needs to specifically focus on the task affected by dystonia. 21 patients with writer's cramp were randomly assigned to two types of re-training: One group of patients trained drawing and writing movements using a pen attached to the bottom of a finger splint. The second group used therapeutic putty to train finger movements without exercises of drawing and writing movements. Training lasted for 8 weeks. Before re-training, affected hand and forearm were immobilized for 4 weeks to facilitate the responsiveness to re-training. Dystonia was assessed during handwriting using the Writer's Cramp Rating Scale. Although no clinical improvement was observed immediately after immobilization, 8 weeks of re-training improved task-specific dystonia relative to baseline (P = 0.005). Both training modalities were equally effective. More severely affected patients benefited most. There was no correlation between disease duration and the individual treatment response. Re-training also improved hand function as indexed by the Arm Dystonia Disability Scale (P = 0.008). Kinematic handwriting analysis showed that re-training lowered vertical force level and enhanced the fluency of handwriting. We conclude that re-training does not need to specifically focus on the task affected by dystonia to be clinically effective.
Zeuner
Kirsten E
KE
Department of Neurology, Christian- Albrechts- University Kiel, Kiel, Germany. k.zeuner@neurologie.uni-kiel.de
Peller
Martin
M
Knutzen
Arne
A
Hallett
Mark
M
Deuschl
Günther
G
Siebner
Hartwig R
HR
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D020821:Dystonic Disorders / Q000534:rehabilitation*; D005260:Female; D006236:Handwriting; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance / Q000502:physiology