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Abstract：
Introduction Cervical dystonia (CD), a rare disorder, is the most common form of dystonia, a movement disorder. Impairments in activities of daily living and quality of life may result from chronic pain, perceived stigma, difficulty walking, and/or lack of control over movements. Studies of treatments for difficulty walking in CD have been inconclusive. Osteopathic manipulative medicine (OMM) has been used to improve gait biomechanics in other health conditions. Foot progression angle (FPA) while walking indicates functional gait abnormalities that increase the risk of knee injury and osteoarthritis. Objective The aim of this study is to test if five-weekly treatments using an OMM sequence designed for CD improved abnormal gait biomechanics in individuals with CD by identifying and addressing somatic dysfunctions. Methods In this prospective case series, independently ambulating individuals with CD symptom onset before the age of 40 years, not due to traumatic injury, were evaluated utilizing validated scales for severity (Toronto western spasmodic torticollis rating scale [TWSTRsI]) and symptoms affecting quality of life (Cervical Dystonia Impact Profile [CDIP-58]), physical examination, and FPA before and after five-weekly OMM treatments. Lower body joint range of motion and angles were captured in a clinical gait lab by nine cameras collecting three-dimensional Whole-body position data during three trials of one gait cycle at participant-selected walking speed. The FPA waveforms during the gait cycle were quantified by Vicon Nexus and Polygon applications. Pretreatment and posttreatment results were compared to established healthy gait waveforms and tested by repeated measures ANOVA (α=0.05). Results Pretreatment waveforms in CD had a mean 5.13° of excess FPA during gait cycle phases requiring lower-extremity pronation compared to previously published age-gender-matched healthy waveforms. There was 96% improvement in pronation after five treatments, with a mean 0.21° (p=0.041) of excess FPA. Mean TWSTRs and CDIP-58 scores improved. On physical examination, the rotational direction of C2 vertebrae was contralateral to neck muscle hypertonicity. Vertical sphenobasilar synchondrosis strains were present in those with anterotorticollis. Participants had ipsilateral anterolateral neck muscle and anterolateral abdominal wall muscle hypertonicity. All patients had pelvic somatic dysfunctions with left-side superior relative to right-side and restriction from lower-extremity pronation (i.e., supination dysfunctions). Conclusion The FPA was significantly improved after treatment. This OMM sequence was well tolerated and may be useful for improving gait kinematics in individuals with CD. Randomized, controlled, long-term studies are needed to determine effectiveness.
摘要：
介绍颈肌张力障碍（CD），一种罕见的疾病,是肌张力障碍最常见的形式,运动障碍.慢性疼痛可能导致日常生活活动和生活质量受损，感知到的耻辱，行走困难,和/或缺乏对运动的控制。对CD中行走困难的治疗方法的研究尚无定论。整骨手法医学（OMM）已用于改善其他健康状况下的步态生物力学。步行时的足部进展角（FPA）表明功能性步态异常，会增加膝关节损伤和骨关节炎的风险。目的本研究的目的是通过识别和解决躯体功能障碍，测试使用针对CD设计的OMM序列进行的每周五次治疗是否可以改善CD患者的异常步态生物力学。方法在这个前瞻性病例系列中，在40岁之前独立走动有CD症状的个体，不是由于外伤,使用经过验证的严重程度量表（多伦多西部痉挛性斜颈评定量表[TWSTRsI]）和影响生活质量的症状（宫颈肌张力障碍影响谱[CDIP-58]）进行评估，体检,和FPA之前和之后五周的OMM治疗。在临床步态实验室中，通过九台摄像机以参与者选择的步行速度在一个步态周期的三次试验中收集三维全身位置数据，从而捕获了下半身关节的运动范围和角度。步态周期期间的FPA波形通过ViconNexus和Polygon应用进行定量。将治疗前和治疗后的结果与建立的健康步态波形进行比较，并通过重复测量ANOVA（α=0.05）进行测试。结果与先前发表的年龄-性别匹配的健康波形相比,在需要下肢内旋的步态周期阶段,CD中的预处理波形具有平均5.13°的过量FPA。五次治疗后内旋改善96%，平均0.21°(p=0.041)的过量FPA。平均TWSTR和CDIP-58评分改善。在体检时，C2椎骨的旋转方向与颈部肌肉高渗性相对。患有前斜颈的患者存在垂直的蝶骨基底软骨综合菌株。参与者具有同侧颈前外侧肌和腹壁前外侧肌张力增高。所有患者均患有骨盆躯体功能障碍，左侧相对于右侧高于右侧，并且下肢内旋受限（即，旋光功能障碍)。结论治疗后FPA明显改善。该OMM序列具有良好的耐受性,并且可用于改善患有CD的个体的步态运动学。随机化,控制,需要长期研究来确定有效性。
