Cervical dystonia: Disability and the value of physical therapy

    Research output: ThesisThesis fully internal (DIV)

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    Abstract

    Cervical dystonia (CD) is a neurological movement disorder characterized by involuntary muscle contractions causing abnormal postures and/or twisting movements of the head and neck.
    Patients may also experience non-motor symptoms including pain, anxiety and depression. The main treatment option is botulinum toxin (BoNT) injections in affected muscles to improve head postures and reduce pain. In addition to BoNT treatment, patients are often referred for physical therapy (PT), but there is little evidence regarding the long-term effectiveness.

    Despite remarkable improvements during the last decades, there are still many unmet needs that remain open in the treatment of cervical dystonia (CD). The first goal of this thesis was to assess clinical issues in BoNT treatment that need further improvement and to define clinical recommendations for clinicians. The second goal was to explore which determinants play an important role in disability of CD patients and the third goal was to develop a specialized PT program and to evaluate its effects on disability.

    Results showed that BoNT treatment can be further improved despite all the evidence for its effectiveness. Further research is needed towards optimal treatment intervals, dose equivalence between different BoNT formulations, the use of supportive techniques like electromyography or ultrasound and managing side effects. Secondly, we found that psychological factors are important determinants of disability. Finally, we found that PT is a valuable addition to BoNT treatment to improve disability and pain. Based on these findings, a multidisciplinary treatment approach to further improve the treatment and quality of life for CD patients is recommended.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • de Koning-Tijssen, Marina, Supervisor
    • Visser, Bart , Co-supervisor, External person
    • Koelman, J. H. T. M., Co-supervisor, External person
    • van der Woude, Lucas, Assessment committee
    • van der Schans, Cornelis, Assessment committee
    • van Hilten, J. J., Assessment committee, External person
    Award date21-Sep-2020
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-034-2532-0
    Electronic ISBNs978-94-034-2531-3
    DOIs
    Publication statusPublished - 2020

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