Motor Re-Training does not need to be task specific to improve Writer's Cramp
Identifieur interne : 000439 ( Pmc/Checkpoint ); précédent : 000438; suivant : 000440Motor Re-Training does not need to be task specific to improve Writer's Cramp
Auteurs : K. E. Zeuner [Allemagne] ; M. Peller [Allemagne] ; A. Knutzen [Allemagne] ; M. Hallett [États-Unis] ; G. Deuschl [Allemagne] ; H. R. Siebner [Allemagne]Source :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2008.
Abstract
Previous studies showed a beneficial effect of motor re-training in task-specific hand dystonia. Here we examined whether re-training needs to specifically focus on the task affected by dystonia. 21 patients with writer's cramp were randomly assigned to two types of re-training: One group of patients trained drawing and writing movements using a pen attached to the bottom of a finger splint. The second group used therapeutic putty to train finger movements without exercises of drawing and writing movements. Training lasted for eight weeks. Before re-training, affected hand and forearm were immobilized for four weeks to facilitate the responsiveness to re-training. Dystonia was assessed during handwriting using the Writer's Cramp Rating Scale. While no clinical improvement was observed immediately after immobilization, eight weeks of re-training improved task-specific dystonia relative to baseline (p=0.005). Both training modalities were equally effective. More severely affected patients benefited most. There was no correlation between disease duration and the individual treatment response. Re-training also improved hand function as indexed by the Arm Dystonia Disability Scale (p=0.008). Kinematic handwriting analysis showed that re-training lowered vertical force level and enhanced the fluency of handwriting. We conclude that re-training does not need to specifically focus on the task affected by dystonia to be clinically effective.
Url:
DOI: 10.1002/mds.22222
PubMed: 18816801
PubMed Central: 4149415
Affiliations:
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<front><div type="abstract" xml:lang="en"><p id="P1">Previous studies showed a beneficial effect of motor re-training in task-specific hand dystonia. Here we examined whether re-training needs to specifically focus on the task affected by dystonia. 21 patients with writer's cramp were randomly assigned to two types of re-training: One group of patients trained drawing and writing movements using a pen attached to the bottom of a finger splint. The second group used therapeutic putty to train finger movements without exercises of drawing and writing movements. Training lasted for eight weeks. Before re-training, affected hand and forearm were immobilized for four weeks to facilitate the responsiveness to re-training. Dystonia was assessed during handwriting using the Writer's Cramp Rating Scale. While no clinical improvement was observed immediately after immobilization, eight weeks of re-training improved task-specific dystonia relative to baseline (p=0.005). Both training modalities were equally effective. More severely affected patients benefited most. There was no correlation between disease duration and the individual treatment response. Re-training also improved hand function as indexed by the Arm Dystonia Disability Scale (p=0.008). Kinematic handwriting analysis showed that re-training lowered vertical force level and enhanced the fluency of handwriting. We conclude that re-training does not need to specifically focus on the task affected by dystonia to be clinically effective.</p>
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Department of Neurology, Christian- Albrechts- University Kiel, Germany</aff>
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NeuroImageNord Kiel-Hamburg-Lübeck, Germany</aff>
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Human Motor Control Section, Medical Neurology Branch National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA</aff>
<author-notes><corresp id="CR1"><underline>Corresponding Author:</underline>
Kirsten Zeuner, MD Department of Neurology Christian Albrechts-University Kiel Neurozentrum Schittenhelmstrasse 10 24105 Kiel Germany</corresp>
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<pmc-comment>elocation-id from pubmed: 10.1002/mds.22222</pmc-comment>
<abstract><p id="P1">Previous studies showed a beneficial effect of motor re-training in task-specific hand dystonia. Here we examined whether re-training needs to specifically focus on the task affected by dystonia. 21 patients with writer's cramp were randomly assigned to two types of re-training: One group of patients trained drawing and writing movements using a pen attached to the bottom of a finger splint. The second group used therapeutic putty to train finger movements without exercises of drawing and writing movements. Training lasted for eight weeks. Before re-training, affected hand and forearm were immobilized for four weeks to facilitate the responsiveness to re-training. Dystonia was assessed during handwriting using the Writer's Cramp Rating Scale. While no clinical improvement was observed immediately after immobilization, eight weeks of re-training improved task-specific dystonia relative to baseline (p=0.005). Both training modalities were equally effective. More severely affected patients benefited most. There was no correlation between disease duration and the individual treatment response. Re-training also improved hand function as indexed by the Arm Dystonia Disability Scale (p=0.008). Kinematic handwriting analysis showed that re-training lowered vertical force level and enhanced the fluency of handwriting. We conclude that re-training does not need to specifically focus on the task affected by dystonia to be clinically effective.</p>
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