Physical Therapy

Physical therapy may be an important component of treating dystonia for many people.

Many forms of dystonia affect mobility, posture, balance, stamina, and the ability to complete everyday tasks, Since dystonia is a neurological disorder, physical therapy does not treat the dystonia directly but rather secondary conditions that may accompany the dystonia.

Under the guidance of a physical therapist and a physician, an individual may learn to recognize compensatory movements and habits that may have developed as a result of the dystonia. Being aware of activities that aggravate symptoms and learning beneficial substitute methods may contribute to improved motor control. Physical therapy may enhance the benefits from other medical treatments, such as oral medications and/or botulinum toxin injections.

Physical therapy is a slow process that should be approached with commitment and optimism. Results may not be immediately apparent, but a physical therapy program can influence many aspects of daily living. Under the guidance of a therapist and physician, physical therapy and stress management can help achieve increased awareness and control of one's movement, environment, and symptoms as well as address secondary complications that may result from the dystonia.

For information about locating a local physical therapist who specializes in neurological conditions such as dystonia, please contact: American Physical Therapy Association at 800-999-2782 or log on to www.apta.org.

Goals of Physical Therapy
A physical therapy program may involve visits with the therapist, a regimen of exercises to practice at home, and/or adjustments to one's schedule or surroundings. The goals of a physical therapy program are to:

  • Increase and preserve range of motion and mobility needed for function
  • Strengthen weakened muscles that may be under-utilized in the presence of dystonia movements
  • Promote awareness of posture and maintenance of individual optimal body posture

Physical therapy is tailored to the needs and circumstances of the individual. Frequent re-evaluation of the dystonia and re-assessment of the personal needs of the affected person are necessary to optimize benefits from the physical therapy program.

Tips to Help Maintain Alignment

  • Once a person has consulted with a physical therapist to learn what alignment is best, these tips may help maintain body alignment.
  • Using a full-length mirror and/or the assistance of a spouse or friend can help an individual recognize and maintain optimal posture.
  • Chairs with firm, high backs and armrests are usually ideal. As much as possible, the feet should be flat on the ground with thighs parallel to the floor. The arms should rest comfortably on the armrests. The back should be relatively straight. Soft, sunken chairs and sofas do not foster proper alignment and may affect the position of the head and neck.
  • Proper posture while relaxing and/or sleeping is also important. Sleeping with only one medium-sized pillow under the head rather than two large pillows may improve neck alignment. A pillow placed between the knees while resting on one's side will help maintain alignment of the hips and back.
  • Wearing certain shoes may also affect dystonia. High heels hinder proper posture. High-top sneakers may help maintain the alignment of the foot and ankle and therefore the knee and hip as well.
  • A supportive pair of shoes should be made of firm material, such as leather, have a definite arch to the sole, and cover most of the foot.
  • Gadgets or assistive devices may help around the house or at work. A reaching device may minimize the need to stretch or strain the muscles. Specialized utensils and dressing and bathing devices may compensate for disrupted function.

Daily Activities and Exercise
Before abandoning an activity due to dystonia, one should consider modifying the task to foster posture and muscle control. A person with trouble writing may try to use the shoulder and arm to write, rather than the wrist and fingers. Writing on a vertical surface such as a chalk/writing board or putting the table at an angle may help writing.

Sports involving asymmetrical movements of the trunk, such as golf or baseball, should generally be avoided, especially for individuals with cervical dystonia. Lower stress exercises such as water exercise, walking (if using a treadmill, it should be level), yoga, ballet, low-impact aerobics, or stationary bike riding without moving handlebars are less likely to worsen symptoms.

Rest periods during a workout or physical activity are valuable. Frequent 5- to 10-minute breaks promote muscle relaxation and proper posture. Lying down or sitting in a high-backed chair with arms supported during a break may help the muscles thoroughly relax.

Rest periods are equally important while doing chores around the house or running errands. Take one task at a time! Taking breaks and pacing oneself are important.

The physical therapist may examine a person's daily routine and make recommendations to improve efficiency and safety. A stand-up vacuum may be easier to use than a canister model. It may be more comfortable to chop vegetables while sitting in a high-backed chair with arms supported rather than while standing at a counter. Unnecessary weight should be removed from purses, briefcases, or backpacks. If possible, purses or bags should be carried on the side opposite the dystonia. Waist packs are often an ideal alternative to bags with straps or handles.

Stress Management
Elements of stress management may be incorporated into a physical therapy program, and relaxation exercises may be tailored to address specific motor problems.

Relaxation techniques may vary from deep breathing, visualization, and progressive muscle relaxation to local and generalized stretching. Stress management may also mean taking more time for leisurely activities. Yoga or a soft martial art such as Tai Chi may increase fitness and relaxation simultaneously. Meditation can create a mental refuge from stress and aggravation

Stretching and Strengthening
A physical therapist or physician is likely to demonstrate and prescribe exercises to stretch muscles and increase flexibility. Various types of strengthening exercises may be recommended to build up underused muscles and prevent weakening of the bones.

A physician or therapist may use certain equipment to activate the muscles. Neuromuscular electrical stimulation (NMES) may stimulate and strengthen the antagonist muscles (which oppose the dystonia spasm) while the overly active agonist muscles (which cause the dystonia spasm) are relaxed with botulinum toxin. Biofeedback involves using surface electrodes to identify and relax overly active muscles and to increase control and activation of the passive muscles.

Physical therapy information provided by Kathleen Albany, PT, a physical therapist practicing in New Jersey, Mark Forrest Gordon, MD of Long Island Jewish Medical Center, and William J. Schwarz, PT of New York.    

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