title: Case report: Physical therapy management of axial dystonia.
abstract: Few studies have described physical therapy approaches to provide functional independence and reduce pain in individuals with dystonia. This report describes the physical therapy treatment of a 46-year-old woman diagnosed with idiopathic segmental axial dystonia. For two years, the patient was treated with kinesiotherapy (active and resisted movements and stretching of neck and trunk muscles), abdominal taping (kinesiotaping techniques), functional training, and sensory tricks. She was assessed with parts I, II and III of Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-I, TWSTRS-II and TWSTRS-III), Berg Balance Scale (BBS), Six-Minute Walk Test (6-MWT), and the motor domain of Functional Independence Measure (FIM-motor) before and after the two-year treatment and after the one year follow-up. Postural control and symmetry improved (TWSTRS-I: from 30 to 18), functional independence increased (TWSTRS-II: from 27 to 15; BBS: from 36 to 46; 6-MWT: from 0 to 480 meters (m); FIM-motor: from 59 to 81), and the pain diminished (TWSTRS-III: from 12 to 5). The functional improvement was retained after one year (TWSTRS-I: 14/35; TWRTRS-II: 12/30; TWRTRS-III: 5/20; BBS: 48/56; 6-MWT: 450 m; FIM-motor: 81/91). This program showed efficacy on providing a better control of the dystonic muscles and thus the doses of botulinum toxin needed to treat them could be reduced. Outcomes support the therapeutic strategies used to deal with this type of dystonia.
authors.affiliation: Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil and.
authors.forename: Mariana Callil
authors.initials: MC
authors.lastname: Voos
authors.forename: Tatiana de Paula
authors.initials: Tde P
authors.lastname: Oliveira
authors.forename: Maria Elisa Pimentel
authors.initials: ME
authors.lastname: Piemonte
authors.forename: Egberto Reis
authors.initials: ER
authors.lastname: Barbosa
mesh_terms: D000009:Abdominal Muscles / Q000503:physiopathology*; D000222:Adaptation, Physiological; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D055052:Athletic Tape; D064131:Back Muscles / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D001905:Botulinum Toxins / Q000008:administration & dosage; D004185:Disability Evaluation; D026241:Exercise Movement Techniques; D005080:Exercise Test; D005260:Female; D006801:Humans; D007699:Kinesthesis; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D009334:Neck Muscles / Q000503:physiopathology*; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000295:instrumentation; D011187:Posture; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D014103:Torticollis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins