EP. 21 | PHYSIOTHERAPY IN ACTION | Dr. Jean-Pierre Bleton | DDAYS 2018

In this video Dr. Jean-Pierre Bleton talks about how cervical dystonia (Cd) is the main form of focal dystonia occurring in adulthood that manifests itself in involuntary contractions of some of the cervical muscles, and which results in abnormal postures and/or movements of the head.

The recommended and widely used treatment is the injections of botulinum neurotoxin A or B (Bont) into dystonic (hyperactive) muscles. Bont helps to reduce severity of spasms of
the dystonic muscles by means of therapeutic (neuro-chemical) paresis. Physiotherapy or rehabilitation is considered to be a valuable complementary therapy (delnooz 2009). Up till now, there are no available guidelines or consensus unanimously accepted to determine the modalities of this rehabilitation (de Pauw, 2014). Nevertheless, the main contribution of rehabilitation seems to be the activation of the anti-dystonic corrective muscles, whose function is inhibited (Mezaki, 2007).

The usual way of practicing rehabilitation consists of weekly or bi-weekly sessions in hands-on and face-to-face physiotherapy sessions. it appears, in the light of studies on rehabilitation for paretic upper limb after cerebrovascular accidents (Cunningham, 2016) and impaired balance in the Parkinson’s disease (Jöbges, 2004), that the effects of rehabilitation are dependent on the amount of daily exercises and the regularity of the practice over a period of time of several weeks (dose-effect correlation). Unfortunately, the items of duration and amount of daily exercises are poorly documented for Cd.
regarding Cd, as Pr Marie Vidailhet wrote in 2014: “ the real challenge consists of favourably modifying the patient’s motor pattern, by “reprogramming” inappropriate involuntary movements, and by the use of multiple learning, sensory perception, neuronal plasticity and compensation processes”. It is now well known that under the effect of motor learning and training, the somatotopic organization of the primary motor cortex (M1) can be radically transformed. (Jeannerod, 2006). Our team has shown in a study on dystonic patients suffering from writer’s cramp that tailored rehabilitation leads to significant clinical increase and, in the cortex controlling the dystonic hand, “super normal” reorganization of the finger maps (Bleton, 2011).
although, environmental and psychosocial factors could drastically influence the quality of exercises practiced at home and scientific literature does not provide conclusive evidence, it seems useful to recommend relatively intensive self-rehabilitation in long-term ailments such as Cd.

s o c i a l m e d i a:
INSTAGRAM | @dystoniaeurope
TWITTER | @dystoniaeurope

i n q u i r i e s:

[fatimaelouazzani]

Hello how can I get contact of the doctor Bleton please?

[dianesoucy]

Very sad I try to see the exercise and they make it fuzzy 😢😢😢😢😢

[AdamBlumer]

Because the video is blurred during the practical part, we are unable to see the useful tips and methods. Informative but not overly helpful.