Abstract :

Background: Dystonia is a common movement disorder characterized by abnormal postures of the affected body part. The disabilities associated with dystonia are socially disabling and disfiguring, ranging from pain, loss of muscle strength and activities of daily living, poor quality of sleep and even depression. This article presents a case report of physiotherapy approach in the management of a patient with limb dystonia with major focus on pain management, balance control and functional independence.

Case Presentation and Treatment Outcome: A case report of the management of a 48-year old female patient with limb dystonia. Patient was referred from the neurology unit, department of Internal Medicine, University of Port Harcourt Teaching Hospital (UPTH) to the neurology unit of the physiotherapy department, UPTH as a case of lower limb dystonia with an unknown cause. Appropriate physiotherapy intervention was given for a period of 12 weeks after a thorough assessment of the patient. The Numerical Pain Rating Scale (NPRS) was used to assess the level of pain in the affect limbs. The Berge Balance Scale (BBS) was used to assess the patient’s balance while Barthel Index (BI) was used to assess the functional independence of the patient. The case report was presented in line with CAse REport (CARE) guideline for case reports. All ethical procedures were followed. Treatment Outcome revealed that the score on Berg Balance Scale increased from 25 to 45 while that of Barthel Index scale increased from 13 to 18 after 12 weeks of intervention. Pain level on Range of Motion (ROM) based on the Numerical Pain Rating Scale (NPRS) reduced from 4/10 to 0/10 on the upper limb and from 9/10 to 1/10 on the lower limbs.

Conclusion: Physiotherapy is effective in the management limb dystonia. Early referral to Physiotherapy is key to pain management, balance control and overall functional independence of the patients.

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Keywords :

Case Report, Limb dystonia management, Nigerian Hospital, Physiotherapy perspective

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References :

1. Balint B, Mencacci NE, Valente EM, Pisani A, Rothwell J, Jankovic J, Vidailhet M, Bhatia KP. Dystonia. Nature reviews Disease primers 2018; 4(1):1-23.
2. Ray S, Pal PK, Yadav R. Non-motor symptoms in cervical dystonia: A review. Annals of Indian Academy of Neurology. 2020 Jul; 23(4):449.
3. di Biase L, Di Santo A, Caminiti ML, Pecoraro PM, Di Lazzaro V. Classification of Dystonia. Life 2022; 12(2):206-207.
4. Albanese A, Bhatia KP, Bressman SB. The phenomenology and classification of dystonia. Movement Disorder 2013; 28: 863-873.
5. Steeves TD, Day L, Dykeman J, Jette N, Pringsheim T. The prevalence of primary dystonia: a systematic review and meta‐analysis. Movement Disorders 2014; (14):1789-1796.
6. Camfield L, Ben-Shlomo Y, Warner TT. Epidemiological study of Dystonia in Europe Collaborative Group impact of cervical dystonia on quality of life. Movement Disorder 2002; 17(4): 838-841.
7. Phukan J, Albanese A, Gasser T, Warner TT. Primary dystonia and dystonia-plus syndromes: Clinical features, diagnosis and pathogenesis. Lancet Neurology 2011; 10:1074-1085.
8. Geyer H, Bressman SB, Warner TT. Diagnosis of dystonia. In: Clinical Diagnosis and Management of Dystonia. Informa Press 2007; 3:1-14.
9. Jankovic J. Treatment of hyperkinetic movement disorders. The Lancet Neurology 2009; 8(9):844-56.
10. Berg k, Wood-Dauphinee S. The Balance Scale: reliability assessment with elderly residents and patients with acute stroke. Scandinavian Journal of Rehabilitation Medicine 1995; 27(1): 27-36.
11. Collin C, Wade DT, Davies S. The Barthel ADL index: a reliability study. International Disability Studies 1988; 10: 61-63.
12. Marsden CD. Blepharospasm-oromandibular dystonia syndrome (Brueghel’s syndrome). A variant of adult-onset torsion dystonia?. Journal of Neurology, Neurosurgery & Psychiatry. 1976 Dec 1;39 (12):1204-9.
13. Jinnah HA, Berardelli A, Comella C, DeFazio G, DeLong MR, Factor S, Galpern WR, Hallett M, Ludlow CL, Perlmutter JS, Rosen AR. The focal dystonias: current views and challenges for future research. Movement Disorders. 2013 Jun 15;28(7):926-43.
14. Albanese A, Di Giovanni M, Lalli S. Dystonia: diagnosis and management. European journal of neurology. 2019 Jan;26(1):5-17.
15. Fahn S. Dystonia. International Neurology. 2016 May 26:197-202.
16. Mariana Callil Voos, Tatiana de Paula Oliveira, Maria Elisa Pimentel Piemonte & Egberto Reis Barbosa. Case Report: Physical therapy management of axial dystonia, Physiotherapy Theory and Practice, 2014; 30:1, 56-61, DOI: 10.3109/09593985.2013.799252
17. Bleton JP. Physiotherapy of focal dystonia: a physiotherapist’s personal experience. European Journal of Neurology. 2010 Jul; 17:107-12.