Abstract
Cervical dystonia (CD) is a neurological movement disorder causing the neck to move involuntarily away from the neutral position. CD is a network disorder, involving multiple brain areas and, therefore, may impair movement in parts of the body other than the neck. This study used clinical assessments to investigate walking, balance and upper limb function (UL) in people with CD; the reliability of scoring these assessments and examined for relationship between CD severity, usual exercise and clinical assessments. We conducted a prospective observational cohort study of participants with isolated, focal, idiopathic CD. Participants were assessed by experienced physiotherapists and completed three questionnaires and eight clinical assessments of fear of falling, balance confidence, walking, balance, UL function and usual exercise. Results were compared to published data from healthy adults and other neurological populations. Twenty-two people with mild to moderate CD participated. Fear of falling, gross UL function and usual exercise were worse in people with CD compared with healthy adults, while walking, balance and distal UL function were similar to healthy populations. All assessments were reliably performed by physiotherapists, and we found no correlations between the severity of dystonia or usual exercise and performance on the physical assessments. Routine performance of clinical assessment of walking and balance are likely not required in people with mild to moderate CD; however, fear of falling and gross upper limb function should be assessed to determine any problems which may be amenable to therapy.
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Data availability
The data sets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The authors wish to acknowledge the participants in this study and thank them for their time. We are grateful to the Dystonia Network of Australia for their assistance with advertising and recruitment to this study. We are also grateful to the Physiotherapy Department at Westmead hospital, specifically Ms Maria Quinlivan, Mr Stephen Harvey and Ms Katherine Maka, for their ongoing support of clinical research. Finally, we wish to thank the Westmead Charitable Trust and the Westmead Medical Research Foundation for providing funding for this study.
Funding
Melani Boyce is supported by the Westmead Charitable Trust, Allied Health Career Development grant and the Westmead Medical Research Foundation, My Westmead Early Career Research Scholarship.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MB, ABM, LVB and APV. The first draft of the manuscript was written by MJB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Boyce, M.J., McCambridge, A.B., Bradnam, L.V. et al. A cross-sectional study of walking, balance and upper limb assessment scales in people with cervical dystonia. J Neural Transm 128, 1663–1675 (2021). https://doi.org/10.1007/s00702-021-02388-y
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DOI: https://doi.org/10.1007/s00702-021-02388-y