In our treatment questionnaire, a high percentage of those who had tried physiotherapy for neck dystonia found it helpful when it was provided by specialist physiotherapists with knowledge of dystonia.

Some of the techniques used in physio are not new. In this article, one of our medical advisers Dr Marie-Helene Marion discusses one technique used in physiotherapy: psycho-motor retraining. The idea was suggested 100 years ago by one of the pioneers of the understanding of dystonia, Henry Meige. The article is taken from Dr Marion’s blog, click here to see more articles.

You should always check with your consultant before trying new therapeutic exercises including those listed below to ensure they are suitable for your dystonia. The exercises should always be supervised by a physiotherapist to ensure they are done correctly and that the total time for which the exercise is done is appropriate.

Henry Meige, a french neurologist who dedicated his research to movement disorders, advocated in 1907 a psycho-motor retraining (“discipline psycho-motrice”) for the treatment of neck dystonia. It was at the time when there was no routine use of medication and the use of botulinum toxin injections for neck dystonia were not even a blip on the horizon. I could not resist giving you the translation of this therapeutic approach that I found quite inspiring…

1. The patient becomes actor of their treatment: This treatment is based on regular immobilizations and movements in front of a mirror; the patient has to be supported by their family and doctor, as these daily exercises require a lot of effort and determination from the patient. “The goal of the treatment is to correct the abnormal postures, to put at rest the hyperactive muscles and to learn the control of the motor acts.”

2. The patient needs to have a regular life, going to bed at regular times. The patient is told that the course of the disease will be capricious, that they will have to persevere and that the exercises will be eventually beneficial.

3. The patient had to exercise in front of a mirror 3 times a day; the patient is sitting, back non supported and hands flat on a table. The mirror is divided by 1 vertical line going through the middle of the face and 2 horizontal lines, through the alignment of the eyes and through the base of the neck above the shoulders, in order for the patient to be aware of the movement of their head. The patient is asked to focus on the point of crossing of the first 2 lines.

4. Two types of exercises:

  1. Immobilization (holding the head still): hold the head still for 5 seconds. This is repeated 10 times with 15 seconds rest in between each immobilization - the amount of time the head is held still increasing 5 seconds every day.
  2. Movement: slow and smooth movement, without saccade (fast movement). The movements are in turn 
    1. head rotation 
    2. lateral flexion (moving the head towards the shoulder while facing forward) 
    3. flexion forward (bending the head forwards)
    4. extension (bending the head backwards) 
    5. also movements of the shoulders, arms and trunk and exercises of relaxation of the muscles.

Then also in front of the mirror, exercises of writing, reading, breathing and speaking.

5. Henry Meige was convinced that these exercises would help manage the dystonia. However, he did not give any figure of proportion of patients who improved, but they were patients followed for more than 5 years.

6. Since the 80s, physiotherapy for neck dystonia has been developed by Jean-Pierre Bleton in France, but still remains a French specialty despite individual effort to develop it abroad.

Botulinum toxin injections have become the first line treatment for neck dystonia. These have been very helpful but have the disadvantage that they leave the patients in the passive expectation of their injections every 3 months.

The mirror is still a very important tool in the therapeutic approach of neck dystonia as the patients are frequently very inaccurate when assessing the position of their head – for instance thinking that the head is straight when in reality the head posture has a 20 degrees tilt or rotation.

Maybe it’s the time for patients with neck dystonia to become actors of their treatment and to look for a therapeutic strategy including botulinum toxin injections and “psycho-motor retraining” without forgetting the role of the mirror.

Meige H : Les peripeties d’ un torticolis mental. Histoire clinique et therapeutique.. Nouvelle iconographie de la Salpetriere. 1907, 6:461-480


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