• Anna Castagna, Antonio Caronni, Alessandro Crippa, Luciana Sciumè, Giulia Giacobbi, Chiara Corrini, Angelo Montesano, and Marina Ramella.
• U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy.
• Neurol. Sci. 2020 Jan 1; 41 (1): 131-138.

BackgroundIdiopathic cervical dystonia (ICD) is a focal dystonia affecting neck muscles. Botulinum neurotoxin (BoNT) is the first-line treatment of ICD and different physical therapies (including exercise) are often proposed as adjunct treatments. However, the actual effectiveness of exercise in ICD is unclear. The aim of the current work is to assess the potential effectiveness of the Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) exercise program as adjunct therapy for ICD.MethodsFifteen ICD patients received BoNT injections in the neck muscles and, 12 weeks later, received BoNT a second time and SPRInt started. SPRInt consists in 18 exercise sessions in which augmented feedback of movement (including visual and acoustic feedback) is extensively used. Dystonia burden was measured by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Patients were evaluated immediately before, 6 and 12 weeks after each BoNT injection.ResultsSix weeks after the first BoNT injection (i.e., at BoNT peak effect), TWSTRS total score was better than baseline and remained improved at 12 weeks. TWSTRS disability domain slightly improved 6 weeks after the first BoNT injection, but after 6 more weeks returned to its baseline level. Disability improved more at SPRInt end (i.e., 6 weeks after the second BoNT injection), being even lower than after toxin alone. With a single-subject analysis, 4/10 patients who did not improve disability after BoNT improved after SPRInt plus BoNT.ConclusionsSPRInt plus BoNT can be more effective than BoNT alone in improving cervical dystonia patients' difficulties in the activities of daily living.Trial Registrationwww.ClinicalTrials.gov, identifier NCT03247868 (https://register.clinicaltrials.gov).

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