Prudente Cecília N, Zetterberg Lena, Bring Annika, Bradnam Lynley, Kimberley Teresa J
Division of Physical Therapy Department of Rehabilitation Medicine University of Minnesota Minneapolis MN USA.
Department of Neuroscience Section of Physiotherapy Uppsala University and University Hospital Uppsala Sweden.
Mov Disord Clin Pract. 2018 Mar 13;5(3):237-245. doi: 10.1002/mdc3.12574. eCollection 2018 May-Jun.
Rehabilitation interventions are rarely utilized as an alternative or adjunct therapy for focal dystonias. Reasons for limited utilization are unknown, but lack of conclusive evidence of effectiveness is likely a crucial factor.
The purpose of this systematic review was to determine the level of evidence for rehabilitation interventions in focal dystonias. Rehabilitation interventions were classified based upon the underlying theoretical basis of different approaches, and the strength of evidence for each category was evaluated to identify gaps in the field. Prospective studies using rehabilitation methods in cervical, hand, and foot dystonia were reviewed. The key elements of treatments tested were identified and studies were grouped into six categories based on the theoretical basis of the intervention: (1) movement practice, (2) training with constraint, (3) sensory reorganization, (4) normalization of muscle activity with external techniques, (5) neuromodulation with training, and (6) compensatory strategies. Quality of the body of evidence ranged from very low-to-low according to the grades of recommendation, assessment, development, and evaluation (GRADE). Despite inconclusive evidence for these rehabilitation approaches, data suggest that intensive movement practice and neuromodulation combined with motor training should be further explored.
This systematic review presents a novel approach to classify studies of rehabilitation in focal dystonias based on the theoretical basis of intervention. The proposed classification system will move toward a unified theoretical understanding of rehabilitation interventions in dystonia. Moreover, it will help provide recommendations for clinical applications and future investigations.
康复干预很少被用作局灶性肌张力障碍的替代或辅助治疗方法。使用受限的原因尚不清楚，但缺乏有效性的确凿证据可能是一个关键因素。
本系统评价的目的是确定康复干预对局灶性肌张力障碍的证据水平。根据不同方法的潜在理论基础对康复干预进行分类，并评估每类证据的强度，以找出该领域的差距。对在颈部、手部和足部肌张力障碍中使用康复方法的前瞻性研究进行了综述。确定了所测试治疗的关键要素，并根据干预的理论基础将研究分为六类：（1）运动练习，（2）约束训练，（3）感觉重组，（4）使用外部技术使肌肉活动正常化，（5）训练性神经调节，（...）
