Physiotherapy of focal dystonia: a physiotherapist's personal experience

The approach of the physiotherapist to each form of dystonia is individual and has to be specific. There is not one single method but several strategies related to the different clinical forms. Although there is no standard programme applicable to all forms of cervical dystonia, we can distinguish a number of guidelines for the different clinical forms. In the myoclonic form, emphasis is placed on seeking to immobilize the head, and for the tonic form, on rehabilitating corrector muscles. Physiotherapy and botulinum toxin injections mutually interact in order to reduce the symptoms. Recent studies have shown the clinical benefits of physiotherapy. The physiotherapy of writer's cramp is designed as a re-learning process. The first step is to perform exercises to improve independence and precision of fingers and wrist movements. Then, the muscles involved in the correction of dystonic postures are trained by drawing loops, curves and arabesques. The aim of rehabilitation is not to enable patients with writer's cramp to write as they used to, but to help their dysgraphia evolve towards a fast, fluid and effortless handwriting. A reshaping of the sensory cortical hand representation appears to be associated with clinical improvement in patients with dystonia after rehabilitation.