The programme has been packed with talks, discussions and workshops looking at the current state of the knowledge about treating dystonia. Some have looked at the condition from a movement perspective and others have highlighted what we know about the brain and how it changes in dystonia. There is good data upon how the brain has adapted including the basal ganglia, the cerebellum and sensorimotor areas. Similar to pain though, there is not any one region of the brain to consider but rather how the cortical networks change structurally and in terms of connectivity. Additionally, it is not clear whether the changes are causative or consequential. But, we do know that they are there is defective sensorimotor integration that manifests as issues with the body schema and control of movement.
Retraining normal movement was a focus, with a range of speakers talking about their methods. They adhere to the principles of rehabilitation by breaking movements down and gradually building up the challenge and function whether it be for writing, controlling posture and head movement, playing a musical instrument or in sport (the yips). All started with simple movements, or ‘actual movements’ as I term them, as opposed to working with the planning stages of movement.
Dystonia | Cervical Dystonia | Writer’s Cramp | Musician’s Cramp
Of course the way in which the brain plans movement affects the outcome and the final quality of the movement that is emergent. Similar to a pain state when sensitivity and protection are implemented at a planning stage, this requires consideration when designing a programme for dystonia. Where do we start? Actual or motor imagery based? The assessment will guide the baseline.
The focus of our treatment programme is retraining normal sensorimotor integration and hence reconstructing a sense of self and body awareness concurrent with motor strategies. This sits alongside strategies that target some of the influences upon dystonia. At the conference there was talk of the ‘non-motor’ factors such as beliefs, anxiety, depression, stress and self-efficacy. My view is that labelling motor and non-motor is acceptable for explanatory purposes but in practical terms are so interlinked that the focus needs to be more about the person and how the condition manifests and is narrated. For example, who we are with and how we are feeling will produce different types of movement, highly relevant to a movement disorder. We have to address these factors as part of a comprehensive treatment and training programme for dystonia.
The training programmes are often implemented as part of a combined approach with Botulinum toxin. A significant part of the Congress programme is dedicated to the use of the toxin, describing its potency and specificity for dystonia but also for pain. Working out the lowest dose for the greatest effect is the challenge facing the clinician injecting. For more on the use of Botulinum, see the website of Dr Marie-Helene Marion who is a very experienced neurology consultant specialising in movement disorders.
For more details on our treatment programme for dystonia, click here or call us on 07932 689081