Unit of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium -
Unit of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
Eur J Phys Rehabil Med. 2021;57(0):710-719. doi: 10.23736/S1973-9087.21.06677-6. Epub 2021 Feb 23.
Task-specific dystonias are primary focal dystonias characterized by excessive muscle contractions producing abnormal postures during selective motor activities that often involve highly skilled, repetitive movements. Based on the idea of excessive motor excitability and aberrant sensorimotor integration in the pathophysiology of task-specific dystonia, sensorimotor retraining may hold promise. The purpose of this systematic review was to investigate the available evidence about the role of rehabilitation therapy as a treatment for task-specific dystonia.
A systematic review was performed of studies identified through Pubmed and Embase in a structured search strategy by independent author screening. The JBI (Joanna Briggs Institute) Critical Appraisal Checklist and RoB 2 were used to evaluate their methodological quality.
Twenty-one studies were included for qualitative synthesis. Most of the reports are small single group pre-/post-test study designs with a variability in the type of task-specific dystonia and the type of evaluated outcome measures. Rehabilitation interventions were grouped into six categories based upon the underlying theoretical basis of different approaches: 1) movement practice; 2) training with constraint; 3) sensory reorganization; 4) biofeedback training; 5) neuromodulation with training; and 6) compensatory strategies.
Although it appears that a number of task-specific dystonia patients may improve with rehabilitation therapy, no definitive conclusions can be drawn. More research in this field is needed, using standardized approaches and clearly defined outcome measures in larger cohorts of task-specific dystonia patients that are clinically and diagnostically well characterized.
任务特异性肌张力障碍是原发性局灶性肌张力障碍的一种，其特征是在选择性运动活动中产生过度肌肉收缩，导致异常姿势，这些活动通常涉及高度熟练、重复的运动。基于任务特异性肌张力障碍病理生理学中过度运动兴奋性和异常感觉运动整合的理念，感觉运动再训练可能有希望。本系统评价的目的是调查关于康复治疗作为任务特异性肌张力障碍治疗方法的可用证据。
通过独立作者筛选的结构化搜索策略，在 Pubmed 和 Embase 中进行了系统评价研究的检索。使用 JBI（Joanna Briggs 研究所）批判性评估清单和 RoB 2 来评估其方法学质量。
纳入了 21 项定性综合研究报告。大多数报告是小型的单组前后测试研究设计，在任务特异性肌张力障碍的类型和评估结果指标的类型上存在差异。根据不同方法的理论基础，康复干预措施分为六类：1）运动练习；2）约束训练；3）感觉重组；4）生物反馈训练；5）神经调节与训练；6）补偿策略。
尽管似乎许多任务特异性肌张力障碍患者可以通过康复治疗得到改善，但不能得出明确的结论。需要在该领域进行更多的研究，使用标准化方法，并在具有临床和诊断特征的更大的任务特异性肌张力障碍患者队列中使用明确界定的结果指标。
