颈椎强直缓解手法多样性的观察

Dystonia Pub Date : 2022-05-17 DOI:10.3389/dyst.2022.10283
L. Avanzino, F. Di Biasio, G. Bonassi, E. Pelosin, N. Cothros, R. Marchese, D. Martino
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引用次数: 0

摘要

缓解动作(AM),通常被称为“感官技巧”,是一种暂时改善反乌托邦姿势的自愿动作。尽管感觉刺激的自我诱导应用是最常见的AM,但临床经验表明,这种现象更为多样,可能反映了引起肌张力障碍的病理生理机制的复杂性。我们特别探讨了子宫颈肌张力障碍(CD)患者中五种不同类型的AM:1)纯感觉;感觉运动操纵,其中感觉输入与结合2)主动-非对抗、3)主动-对抗或4)被动运动的运动输出分量相关联;以及5)复杂的机动操作。通过一次特殊的结构化临床访谈,我们收集了关于每个亚组的频率和疗效以及与CD的一些临床特征可能的相关性的数据。本研究包括100名患者。75%的患者报告至少有一个AM。报告AM的患者中有一半承认使用了不同现象学类别的AM。不同类别的AM在CD患者中的使用率以及使用频率和疗效与患者人口统计学和临床特征的关系方面存在显著差异。我们的观察性研究支持不同AM的存在,这些AM在现象学上是不同的,可能与不同程度的感觉运动整合功能障碍有关。鉴于AM可能是改善CD和其他肌张力障碍最有效、最无创的策略,准确的表型分析和对其多样性的生理探索可能会为新的治疗策略或对现有策略的评估产生相关的见解。
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Observing the Diversity of Alleviating Manoeuvres in Cervical Dystonia
The alleviating manoeuvres (AMs), classically referred to as “sensory tricks” are voluntary manoeuvres that temporarily improve dystonic postures. Although self-induced application of sensory stimuli is the most common AM, clinical experience suggests that the phenomenon is more diverse, possibly reflecting the complexity of the pathophysiological mechanisms provoking dystonia. We specifically explored five different categories of AMs in patients with cervical dystonia (CD): 1) pure sensory; sensorimotor manoeuvres in which sensory input is associated with a motor output component incorporating 2) active non-oppositional, 3) active oppositional or 4) passive motion; and 5) complex motor manoeuvres. Using an ad hoc structured clinical interview, we collected data on the frequency and efficacy of each subgroup and the possible correlation with some clinical features of CD. One-hundred patients were included in this study. Seventy-five percent of patients reported at least one AM. Half of those reporting AMs acknowledged the use of different phenomenological categories of AMs. Different categories of AMs showed noteworthy differences in prevalence of use amongst CD patients, and in the relationship of frequency of use and efficacy to patient demographic and clinical characteristics. Our observational study supports the existence of different AMs that are phenomenologically different and could be related to different degrees of sensorimotor integration dysfunction. Given that AMs are probably the most efficacious, non-invasive strategy to ameliorate CD and other dystonias, accurate phenotyping and physiological exploration of their diversity may produce relevant insight for new therapeutic strategies or appraisal of existing ones.
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