Skip to main content
SpringerLink
Log in

The effectiveness of physiotherapy for cervical dystonia: a systematic literature review

  • Review
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Cervical dystonia is a form of adult-onset, focal dystonia characterized by involuntary contractions of the neck muscles, leading to a disabling, abnormal head posture. CD has a great impact on the activities of daily living (ADL) and quality of life. Currently, the most widely used and recommended first line treatment is botulinum toxin type A (BoNT/A) injections. Physiotherapy is a potentially useful adjuvant, but little is known about its effectiveness. Consequently, our objective was to investigate the effectiveness of physiotherapy alone or as an adjuvant treatment to BoNT/A injections in cervical dystonia (CD) by means of a systematic literature review. Two online databases, PubMed and Web of Science, were searched for articles describing the effectiveness of physiotherapy treatment for CD. After screening, based on predefined in- and exclusion criteria, 16 studies were retained. Their methodological quality was assessed according to Cochrane guidelines. The methodological quality of most studies was low. Examples of shortcomings are small sample sizes, lack of randomization or blinding, and diversity in therapeutic techniques and outcome measures. Only seven studies were clinical trials; the remaining were either case reports or case series. The reported physiotherapy treatments included EMG biofeedback training, muscular elongation, postural exercises and electrotherapy. Improvements in head position, pain, cervical range of motion, quality of life and ADL have been reported, which is promising. Cautious interpretation on the effectiveness of physiotherapy as an adjuvant therapy is required. Before firm conclusions can be drawn, additional high quality trials are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Berardelli A, Rothwell JC, Hallett M et al (1998) The pathophysiology of primary dystonia. Brain 121(Pt 7):1195–1212

    Article  PubMed  Google Scholar 

  2. Jinnah HA, Berardelli A, Comella C et al (2013) The focal dystonias: current views and challenges for future research. Mov Disord 28:926–943. doi:10.1002/mds.25567

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Warner T, Camfield L, Marsden CD, Collaborative T, Epidemiological S of D in E (ESDE) et al (2000) A prevalence study of primary dystonia in eight European countries. J Neurol 247:787–792

    Article  Google Scholar 

  4. Jankovic J, Tsui J, Bergeron C (2007) Prevalence of cervical dystonia and spasmodic torticollis in the United States general population. Parkinsonism Relat Disord 13:411–416. doi:10.1016/j.parkreldis.2007.02.005

    Article  CAS  PubMed  Google Scholar 

  5. Stacy M (1982) Epidemiology, clinical presentation, and diagnosis of cervical dystonia. Neurol Clin Suppl1:23–42

    Google Scholar 

  6. Fukuda H, Kusumi M, Nakashima K (2006) Epidemiology of primary focal dystonias in the western area of Tottori prefecture in Japan: comparison with prevalence evaluated in 1993. Mov Disord 21:1503–1506. doi:10.1002/mds.20986

    Article  PubMed  Google Scholar 

  7. Albanese A, Asmus F, Bhatia KP et al (2011) EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol 18:5–18. doi:10.1111/j.1468-1331.2010.03042.x

    Article  CAS  PubMed  Google Scholar 

  8. Zetterberg L, Aquilonius S-M, Lindmark B (2009) Impact of dystonia on quality of life and health in a Swedish population. Acta Neurol Scand 119:376–382. doi:10.1111/j.1600-0404.2008.01111.x

    Article  CAS  PubMed  Google Scholar 

  9. Trotti LM, Esper CD, Feustel PJ et al (2009) Excessive daytime sleepiness in cervical dystonia. Parkinsonism Relat Disord 15:784–786. doi:10.1016/j.parkreldis.2009.04.007

    Article  PubMed  Google Scholar 

  10. Martikainen KK, Luukkaala TH, Marttila RJ (2010) Working capacity and cervical dystonia. Parkinsonism Relat Disord 16:215–217. doi:10.1016/j.parkreldis.2009.07.006

    Article  PubMed  Google Scholar 

  11. Avanzino L, Martino D, Marchese R et al (2010) Quality of sleep in primary focal dystonia: a case-control study. Eur J Neurol 17:576–581. doi:10.1111/j.1468-1331.2009.02884.x

    Article  CAS  PubMed  Google Scholar 

  12. Molho ES, Agarwal N, Regan K, Higgings DS, Factor SA (2009) Effect of cervical dystonia on employment: a retrospective analysis of the ability of treatment to restore premorbide employment status. Mov Disord 24:1384–1387. doi:10.1002/mds.22574

    Article  PubMed  Google Scholar 

  13. Müller J, Kemmler G, Wissel J et al (2002) The impact of blepharospasm and cervical dystonia on health-related quality of life and depression. J Neurol 249:842–846. doi:10.1007/s00415-002-0733-1

    Article  PubMed  Google Scholar 

  14. Gündel H, Wolf A, Xidara V et al (2001) Social phobia in spasmodic torticollis. J Neurol Neurosurg Psychiatry 71:499–504

    Article  PubMed Central  PubMed  Google Scholar 

  15. Fabbrini G, Berardelli I, Moretti G et al (2010) Psychiatric disorders in adult-onset focal dystonia: a case-control study. Mov Disord 25:459–465. doi:10.1002/mds.22983

    Article  PubMed  Google Scholar 

  16. Albanese A, Barnes MP, Bhatia KP et al (2006) A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force. Eur J Neurol 13:433–444. doi:10.1111/j.1468-1331.2006.01537.x

    Article  CAS  PubMed  Google Scholar 

  17. Phukan J, Albanese A, Gasser T, Warner T (2011) Primary dystonia and dystonia-plus syndromes: clinical characteristics, diagnosis, and pathogenesis. Lancet Neurol 10:1074–1085. doi:10.1016/S1474-4422(11)70232-0

    Article  PubMed  Google Scholar 

  18. Velickovic M, Benabou R, Brin MF (2001) Cervical dystonia pathophysiology and treatment options. Drugs 61:1921–1943

    Article  CAS  PubMed  Google Scholar 

  19. Martino D, Liuzzi D, Macerollo A et al (2010) The phenomenology of the geste antagoniste in primary blepharospasm and cervical dystonia. Mov Disord 25:407–412. doi:10.1002/mds.23011

    Article  PubMed  Google Scholar 

  20. Camfield L, Ben-Shlomo Y, Warner T, ESDE (2002) Impact of cervical dystonia on quality of life. Mov Disord 17:838–841. doi:10.1002/mds.10187

    Article  PubMed  Google Scholar 

  21. Pekmezovic T, Svetel M, Ivanovic N et al (2009) Quality of life in patients with focal dystonia. Clin Neurol Neurosurg 111:161–164. doi:10.1016/j.clineuro.2008.09.023

    Article  PubMed  Google Scholar 

  22. Soeder A, Kluger BM, Okun MS et al (2009) Mood and energy determinants of quality of life in dystonia. J Neurol 256:996–1001. doi:10.1007/s00415-009-5060-3

    Article  PubMed  Google Scholar 

  23. Skogseid IM, Malt UF, Røislien J, Kerty E (2007) Determinants and status of quality of life after long-term botulinum toxin therapy for cervical dystonia. Eur J Neurol 14:1129–1137. doi:10.1111/j.1468-1331.2007.01922.x

    Article  CAS  PubMed  Google Scholar 

  24. Ben-Shlomo Y, Camfield L, Warner T (2002) What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry 72:608–614

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Delnooz CCS, Horstink MWIM, Tijssen MA, van de Warrenburg BPC (2009) Paramedical treatment in primary dystonia: a systematic review. Mov Disord 24:2187–2198. doi:10.1002/mds.22608

    Article  PubMed  Google Scholar 

  26. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. doi:10.1371/journal.pmed.1000100

    Article  PubMed Central  PubMed  Google Scholar 

  27. Schünermann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou GG (2011) Chapter 12: Interpreting results and drawing conclusions. Cochrane Handb. Syst. Rev. Interv. Version 5.1.0

  28. Postma M, Zoons E, Speelman J, de Koning-Tijssen M (2012) (Botuline) Behandel richtlijn voor Cervicale dystonie. 1–90

  29. Leplow B (1990) Heterogenity of biofeedback training effects in spasmodic torticollis: a single-case approach. Behav Res Ther 4:359–365

    Article  Google Scholar 

  30. Jahanshahi M, Sartory G, Marsden CD (1991) EMG biofeedback treatment of torticollis: a controlled outcome study. Biofeedback Self Regul 16:413–448

    Article  CAS  PubMed  Google Scholar 

  31. Smania N, Corato E, Tinazzi M et al (2003) The effect of two different rehabilitation treatments in cervical dystonia: preliminary results in four patients. Funct Neurol 18:219–225

    PubMed  Google Scholar 

  32. Tassorelli C, Mancini F, Balloni L et al (2006) Botulinum toxin and neuromotor rehabilitation: an integrated approach to idiopathic cervical dystonia. Mov Disord 21:2240–2243. doi:10.1002/mds.21145

    Article  PubMed  Google Scholar 

  33. Duddy J, McLellan D (1995) Lack of influence of EMG biofeedback in relaxation training for spasmodic torticollis. Clin Rehabil 9:297–303. doi:10.1177/026921559500900404

    Article  Google Scholar 

  34. John Spencer, Goetsch Virginia L, Brugnoli Robert J, Herman S (1991) Behavior therapy for spasmodic torticollis: a case study suggesting a causal role for anxiety. J Behav Ther Exp Psychiatry 22:305–311

    Article  Google Scholar 

  35. Ramdharry G (2006) Case report: physiotherapy cuts the dose of botulinum toxin. Physiother Res Int 11:117–122. doi:10.1002/pri

    Article  PubMed  Google Scholar 

  36. Zetterberg L, Halvorsen K, Färnstrand C et al (2008) Physiotherapy in cervical dystonia: six experimental single-case studies. Physiother Theory Pract 24:275–290. doi:10.1080/09593980701884816

    Article  PubMed  Google Scholar 

  37. El-bahrawy MN, El-tamawy MS, Shalaby NM, Abdel-alim AM (2009) Cervical Dystonia : abnormal head posture and its relation to hand function. Egypt J Neurol Psychiatry Neurosurg 46:203–208

    Google Scholar 

  38. Queiroz MAR, Chien HF, Sekeff-sallem FA, Barbosa ER (2012) Physical therapy program for cervical dystonia: a study of 20 cases. Funct Neurol 27:187–192

    PubMed Central  PubMed  Google Scholar 

  39. Boyce MJ, Canning CG, Mahant N et al (2013) Active exercise for individuals with cervical dystonia: a pilot randomized controlled trial. Clin Rehabil 27:226–235. doi:10.1177/0269215512456221

    Article  PubMed  Google Scholar 

  40. Bleton JP (1994) Spasmodic torticollis. In: Handbook of rehabilitative physiotherapy. Editions Frison-Roche, Paris

  41. Albanese A, Del Sorbo F, Comella C et al (2013) Dystonia rating scales: critique and recommendations. Mov Disord 28:874–883. doi:10.1002/mds.25579

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Birgit Daalderop for helping with the data collection.

Funding

University of Antwerp (BDHG/3449/18.12.202).

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Joke De Pauw, Kevin Van der Velden, Jill Meirte, Ulrike Van Daele, Steven Truijen & Willem De Hertogh

  2. Department of Neurology, University Hospital Antwerp, Faculty of Medicine and Health Sciences, Born Bunge Institute, University of Antwerp, Antwerp, Belgium

    Patrick Cras & Rudy Mercelis

  3. Faculty of Medicine and Health Sciences, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Joke De Pauw

Authors
  1. Joke De Pauw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin Van der Velden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jill Meirte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrike Van Daele
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven Truijen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Cras
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rudy Mercelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Willem De Hertogh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joke De Pauw.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Pauw, J., Van der Velden, K., Meirte, J. et al. The effectiveness of physiotherapy for cervical dystonia: a systematic literature review. J Neurol 261, 1857–1865 (2014). https://doi.org/10.1007/s00415-013-7220-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-013-7220-8

Keywords

Search

Navigation