Dystonia

cerebellar, basal ganglia

dystonia can be caused by abnormal __________ output and reduced by eliminating cerebellar drive to ____________

women

dystonia is more common in __________

sensory reorganization

focus on reorganization of the cortical sensory map to induce motor improvement

nonspecific, elevated

in those with dystonia, neuroplasticity is ________ and __________

D1, D2

increased activity of the _______ pathway that facilitates movement, reduced ______ activity *BUT NETWORK DISORDER*

movement practice

intensive motor practice and training to recover voluntary control of the affected body part

On

loss of muscle specificity = all muscles come ________ together

cerebellum, basal ganglia, sensory and motor cortices

network dysfunction involving: - - -

overactivation

people with cervical dystonia show ____________ in the cingulate cortex, postcentral gyrus, and cerebellum

spatial discrimination

people with focal hand dystonia have decreased _________ ___________ in finger somatotopic map

slow

primary dystonia has a ________ onset

temporal discrimination

reduced ______________ in eye dystonia

proprioception

reduced arm __________ in vocal dystonia

sudden

secondary dystonia has a _______ onset

ROM/strength/manual therapy

use of classic stretching and strengthening to reduce secondary MSK dysfunction

compensatory strategies

use of compensatory or new movement strategies to replace the abnormal motor program and improve movement function

motor overflow

- commonly found in dystonia, presents as unintentional muscle contraction which accompanies, but is anatomically distinct from the primary dystonic movement - agonist + antagonist fire simultaneously

focal dystonia

- isolated to one area or group of muscle - Spasmodic Torticollis/cervical dystonia - focal hand dystonia - spasmodic dysphonia

generalized dystonia

- legs and at least one other body region - whole body or hemi

segmental dystonia

- one body region or segment - arm or leg dystonia - cervical and oromandibular dystonia

secondary dystonia

- secondary *symptom* to brain damage from a specific cause/injury - cerebral palsy/stroke - brain injury - PD - Wilson's disease - Huntington's - MS - side effects of some meds - *sudden* onsent

dystonic tremor

- spontaneous, oscillatory, rhythmical, often inconsistent, patterned movement produced by contractions of dystonic muscles often exacerbated by attempt to hold "normal" posture - may be posture specific

alleviating maneuvers

- voluntary actions that specifically correct the abnormal posture or alleviate the dystonic movements - typically simple movements or tactile stimulation to body region affected

primary dystonia

- when dystonia is only clinical feature - many genetic links - environmental/personal factors? - idiopathic - * slow onset*

baclofen

GABA agonist, reduce alpha-MN excitability

sustained or intermittent

dystonia = movement disorders characterized by ___________________ muscle contractions causing abnormal, often repetitive movements, postures, or both

botox

best intervention we have for dystonia

botox

block Ach in muscle = less muscle tone

increased/disorganized

cortical drive is _____________ - abnormal muscle tone emerges or is exacerbated by voluntary movements - co-contraction of agonist and antagonist mm - overflow of mm activity - prolongation and sporadic muscle bursts

anticholinergics

decrease Ach tone, decrease DA in striatum, decrease D1 drive = less involuntary movements

hyperkinetic

dystonia = ________ movement disorder