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