For many people with dystonia, treatment options can be frustratingly limited. Medications may have side effects that overwhelm the benefits. Botulinum neurotoxin injections typically help, but may only provide partial relief. Deep brain stimulation (DBS) is an invasive procedure, typically reserved for certain severe forms of dystonia. On the up side, physical therapy is an area in which there has been exciting progress.
Most people recognize physical therapy (PT) as the use of exercise to help people regain or improve their physical abilities. Historically, PT for dystonia and other neurological conditions relied on the same strengthening and stretching approach used for other conditions. Given the peculiarities of dystonia, however, such an approach usually only served to aggravate things, leaving both the patient and the therapist frustrated.
By comparison, the PT techniques used with dystonia today are based on a more advanced understanding of the neuromuscular system and how it is affected by dystonia. This insight has greatly changed how dystonia is approached from a PT perspective. When provided by a well trained and experienced therapist, these newer techniques can be vitally helpful to patients, especially if approached with the following in mind:
- PT is most effective when combined with other medical interventions. For example, botulinum neurotoxin injections and PT are very synergistic. That said, PT is also an option for those patients who don't respond well to botulinum neurotoxin or when the dystonia has become too widespread to be treated with these injections alone. It is also an important adjunct to deep brain stimulation and intrathecal baclofen therapy—particularly during the programming stages as patients adjust to changes in muscle control and postural alignment.
- Given the wide-ranging effects of dystonia, PT should be part of a customized, multidisciplinary approach that may include speech therapy, occupational therapy, nutritional guidance, etc.
- PT is not a "quick fix" and requires the commitment of the patient in terms of time and energy.
- Dystonia is a variable and dynamic condition, and ongoing re-evaluation and modification of a PT program is often needed. Ideally, it should be started early in the treatment process with periodic follow-up.
- Not every physical therapist possesses the necessary experience or skills to treat dystonia. Selection of a qualified therapist is extremely important. An optimum response depends upon the experience and knowledge of the physical therapist, along with a good dialogue with the patient.
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Source: Dystonia Foundation