The authors 17 suggested that different physiological mechanisms may affect what appear to be clinically indistinguishable sensory maneuvers. Altering sensory input and activating other motor programs to adjust for dystonic posturing may have been responsible for the results. However, the EMG data were not statistically analyzed. The remaining 48% of the patients required facial-finger contact for a reduction in muscle activation. The authors 17 found that 52% of the patients had a reduction in EMG activity during initial arm movement, prior to the fingers touching the facial target area. The patients demonstrated a significant reduction in head deviation (scored as described by Tsui et al 18) while performing an antagonistic gesture. Wissel and colleagues 17 examined the temporal pattern of activation of 6 cervical muscles by using electromyography (EMG) (surface electrodes placed over the sternocleidomastoid muscle and needle electrodes placed into the muscle bellies of the splenius capitis muscles bilaterally) in 25 patients with CD. The physiology of these maneuvers is unknown.

14 Finally, Krack et al 15 fitted patients with a mechanical device that provided constant contact to the occiput and shoulders all 5 patients reported reduced spasms of posterior cervical muscles (retrocollic posturing/cervical extension) during gait. Some patients have reported reduced dystonic spasms and abnormal head positioning by simply thinking of a sensory trick. However, no statistical analysis was performed on the data. In the study by Jahanshahi, 13 88.9% of patients were able to maintain a midline cervical posture by using sensory cues. Patients often can relieve symptoms by touching their chin, the top of the head, or the back of the head. вЂњSensory tricks,вЂќ also known as вЂњgeste antagonistique,вЂќ often can reduce dystonic postures or movements. 12 Jahanshahi 13 showed that stress or self-consciousness and walking/fatigue/carrying objects increased symptoms in 80% and 70% of people, respectively. 10, 11 Two thirds of patients require analgesics during their illness. 9 Pain is the primary cause of disability in patients with CD and occurs in two thirds to three quarters of patients. 8, 9 Additionally, symptoms typically worsen over the course of the first 5 years before stabilizing. Only 10% to 20% of patients have a period of remission, and these patients often experience a recurrence within several months or years. The progression of CD among people is variable, and the symptoms may vary within an individual. 2 Patients with secondary CD may have an abnormal birth or developmental history, exposure to drugs known to cause dystonia (tardive dystonia), or neurological illness. Patients with primary CD are considered to have an idiopathic cause, with no evidence from history, physical examination, or laboratory tests (excluding dystonia genetic studies) of a secondary cause for their symptoms. 2 Because generalized dystonia has a younger onset and CD typically has an adult onset, classification is based on etiology: primary versus secondary. 5, 6 The classification of dystonia is based on signs or symptoms (focal versus generalized), age of onset (childhood versus adult), and etiology. 4Д®pidemiological studies have shown ratios of occurrence in men to women of 1:1.4 to 1:2.2 and mean ages of onset of 39.2 years for men and 42.9 years for women. Additionally, the term вЂњspasmodicвЂќ is applied to describe movements that are intermittent or clonic and tremulous. 3 Dystonia involving the neck muscles is called вЂњcervical dystonia.вЂќ However, this condition also is commonly referred to as вЂњtorticollisвЂќ or вЂњspasmodic torticollis.вЂќ These terms can be misleading, because вЂњtorticollisвЂќ implies an impairment that is purely rotatory, whereas patients often have combined postures associated with flexion, extension, or side bending. 2 Dystonia can affect any voluntary muscle, and the condition is rare and often misdiagnosed. Background and DemographicsДystonia is a condition that results in sustained, involuntary muscle contractions, which often cause twisting or repetitive movements or abnormal postures. The purpose of this report is to review the clinical characteristics of CD as well as medical and physical therapist management for patients with CD. 1 This condition often results in cervical pain and disability as well as impairments affecting postural control. Cervical dystonia (CD) is the most frequently occurring focal dystonia, with an incidence of 8.9 per 100,000 people.

Tremulous cervical dystonia