Cervical Dystonia: A Comprehensive Guide to Learning and Coping
I am honored to share a guest blog by Apurva Zawar, PT, DPT, GCS. She is the founder and owner of BeyondRehab, a digital Neuro-Rehab & Wellness clinic. I was introduced to her not long ago after I did a presentation for the San Diego County Dystonia Support Group (you can click here to view the presentation). Dr. Zawar is a passionate neurologic physical therapist with expertise in treating movement disorders, educator, and mentor. She has a great understanding that there is so much more to a patient than physical symptoms, which is hard to find these days when it comes to most doctors we see.
Her primary focus of work involves serving and managing movement disorder conditions such as Dystonia, Parkinson’s Disease, Functional movement disorder and Chronic Pain through an integrative care & personalized evidence-based care that caters to each person’s unique needs and aspirations. Dr. Zawar’s ultimate goal is to empower you to embrace a life filled with independence and joy. You can learn more about her practice and Cervical Dystonia Care Program at https://www.beyondrehab.health/cervical-dystonia.
Author: Dr. Apurva Zawar, PT, DPT, GCS
Cervical dystonia (CD) is a complex movement disorder characterized by sustained or intermittent muscle contractions that cause repetitive movements, fixed postures, or both. As the most common form of focal dystonia, CD requires a deep understanding of its multi-component pattern and clinical diversity to provide effective care and support.
This comprehensive guide aims to empower individuals with CD by providing insights into the condition and offers strategies for learning and coping.
Exploring Multi-System Changes:
Recognizing the multidimensional nature of CD is essential to address its wide-ranging impacts. CD affects various systems, including motor control, sensory processing, the autonomic system, and physical abilities. A thorough assessment is crucial to gaining a holistic understanding of an individual’s unique challenges and tailoring treatment accordingly. Assessments should encompass:
- Motor Control: Analyzing changes in movement patterns due to positional adjustments and environmental triggers. Monitoring muscle activities through techniques like surface electromyography (EMG) to identify muscle activity and design treatment plans.
- Sensory System: Assessing sensitivities to light, sound, and somatosensory experiences (such as touch, pressure, and vibration) and vestibular changes associated with rotational or transitional movements, dizziness, and balance issues.
- Autonomic Nervous System: Observing changes in blood pressure, heart rate, exercise tolerance, and breathing patterns to address any dysregulation.
- Physical Limitations: Assessing flexibility, strength, joint mobility, nerve mobility, biomechanics, posture, and gait analysis to identify areas for improvement and develop targeted interventions.
In addition, it is essential to consider lifestyle factors such as sleep patterns, diet and nutrition, fitness routines, social engagement, coping strategies, life stressors, and psychological & cognitive changes. Taking a comprehensive approach to care ensures a well-rounded treatment plan that addresses individual needs.
Prominent Sensory – Motor Changes:
Sensory-motor changes are key features of CD and significantly impact daily functioning. These changes may manifest as sensory deficits, affecting the ability to process and integrate sensory information effectively. Abnormal muscle activity can also disrupt the brain’s signaling to the muscles. Recognizing these transformations is crucial in developing interventions that can address these challenges and improve overall function.
The Impact on Daily Life:
Living with CD presents unique challenges that can interfere with daily activities and overall well-being. However, a multifaceted approach involving collaboration with a movement disorder neurologist, a neuro-physical therapist specializing in movement disorders, and neuropsychologists can help individuals navigate these challenges effectively.
A multidisciplinary team-based approach, including treatments such as Botox injections, neurorehabilitation, and cognitive behavioral training, is recommended. Evidence-based and patient-centric care with a focus on active coping, continuous learning, collaboration, and gradual integration of positive changes into the daily routine.
Movement discovery, repetitive practice, and finding joy are essential in achieving the highest level of function and improving quality of life.
Neuroplasticity offers hope for individuals with CD. This remarkable concept refers to the brain’s ability to reorganize, rewire, and adapt by forming new neural connections. In the context of CD, neuroplasticity provides the opportunity to retrain and relearn sensory-motor pathways, facilitating functional recovery and enhancing quality of life.
Research and clinical practice have demonstrated that positive neuroplastic changes can occur in CD with persistent practice and targeted interventions. Rehabilitation approaches that emphasize task-specific functional training, sensory-motor training, and repetitive movements can stimulate positive neuroplasticity. Close collaboration with a neurorehabilitation team ensures the supervision and guidance necessary for harnessing the potential of neuroplasticity.
Continuing the Journey:
Recovery in CD is an ongoing process of learning and progress. By staying informed and exploring novel approaches, such as neuroplastic training, task-specific exercises, sensory-motor training, and repetitions, individuals can achieve meaningful gains and reach their highest level of function.
Remember, your journey with CD is unique and filled with discoveries, learning opportunities, and gradual gains. Stay committed, stay informed, and keep striving towards achieving your goals.
- Bradnam LV, Meiring RM, Boyce M, McCambridge A. Neurorehabilitation in dystonia: a holistic perspective. J Neural Transm (Vienna). 2021;128(4):549-558. doi:10.1007/s00702-020-02265-0
- Perruchoud D, Murray MM, Lefebvre J, Ionta S. Focal dystonia and the Sensory-Motor Integrative Loop for Enacting (SMILE). Front Hum Neurosci. 2014; 8:458. Published 2014 Jun 20. doi:10.3389/fnhum.2014.00458
- Prudente CN, Zetterberg L, Bring A, Bradnam L, Kimberley TJ. Systematic Review of Rehabilitation in Focal Dystonias: Classification and Recommendations. Mov Disord Clin Pract. 2018;5(3):237-245. Published 2018 Mar 13. doi:10.1002/mdc3.12574
- Kilic-Berkmen G, Pirio Richardson S, Perlmutter JS, et al. Current Guidelines for Classifying and Diagnosing Cervical Dystonia: Empirical Evidence and Recommendations. Mov Disord Clin Pract. 2021;9(2):183-190. Published 2021 Dec 1. doi:10.1002/mdc3.13376
Tom Seaman is a Certified Professional Life Coach in the area of health and wellness, and the author of 2 books: Diagnosis Dystonia: Navigating the Journey and Beyond Pain and Suffering: Adapting to Adversity and Life Challenges. He is also a motivational speaker, chronic pain and dystonia awareness advocate, health blogger, volunteer for the Dystonia Medical Research Foundation (DMRF) as a support group leader, and is a member and volunteer writer for Chronic Illness Bloggers Network, The Mighty, Brain & Life Magazine, and Patient Worthy. To learn more about Tom, get a copy of his books (also on Amazon), or schedule a free life coaching consult, visit www.tomseamancoaching.com. Follow him on Twitter @Dystoniabook1 and Instagram.