Research progress in spasmodic torticollis rehabilitation treatment

Table 1 Efficacy of Botox combined with exercise therapy in neck dystonia

Ref.	Groups	Specific content of intervention	Intervention time	Evaluation indicators	Research conclusion
Hu et al[10]	C: Botox group; E: Botox group + exercise therapy group	Stretching exercises, active range of motion, and isometric exercises of the neck muscles	15 min/time, 5 d/wk for 6 wk	a, b, c	The spasticity and pain symptoms improved significantly
Tassor et al[11]	C: Botox group; E: Botox group + exercise therapy group	Massage, stretch, educate posture, strengthen axial muscles	For 60-90 min/time, for 2 wk	c, d, e	Remission of spasticity symptoms was similar in both groups, and pain and daily living ability were significantly improved in group E
van den Dool et al[12]	C: Botox + conventional PT group E: Botox + standardized PT group	Muscle stretching, passive neck activity, and training that has been found to be related to neurorehabilitation and motor learning	Family exercise: 10-15 min/time, 5-10 times/d. PT sessions twice/wk and once/wk in later stages. One year	b, c, d, f, g, h, i	Both groups were effective for spasticity and pain. Group E reduced patients' dependence on healthcare providers and reduced medical costs for this patient group
Queiroz et al[13]	C: Botox group; E: Botox + exercise therapy group	Motor stretching, passive, and active cervical loosening of the cervical spine	25 min/time, 5 d/wk for 4 wk	b, c	Group E showed significant improvement in daily living capacity and subjective pain
Stankovic et al[14]	C: Exercise therapy group, E: Botox + exercise therapy group	Increase range of motion exercise, muscle stretching, occupational and functional therapy	5 d/wk for 2 wk	c, d	Group E showed significant improvement in pain, torticollis and disability scales
Guo et al[15]	C: Botox group, E: Botox + rehabilitation treatment group	Muscle pulling and relaxation training, exercise relearning training, lateral flexion movement in each horizontal axis direction and vertical axis expansion movement in passive and active modes	757 min/time, 5 d/wk, for 4 wk	c, d	In group E, the scores of physiology, physiological function, physical pain, vitality and mental health were significantly improved compared with those before treatment

"E" represents the test group; "C" represents the control group. a: The Visual Analogue Scale; b: SF-36 Quality of Life Scale; c: Toronto Western Torticollis Rating Scale; d: Torticollis Assessment scale; e: Daily Performance Scale; f: Functional Disability Questionnaire; g: Overall Clinical Impression-Disease severity Scale; h: Overall Clinical Impression-Improvement Scale; i: Cranio-cervical Dystonia Questionnaire.

Table 2 Efficacy of rTMS therapy for dystonia

Ref.	Transcranial magnetic prescription	Evaluation method	Curative effect
Bradnam et al[24]	Five d/wk from Monday to Friday, 10 times	a, b	Cervical dystonia symptoms, pain and quality of life
Hao et al[25]	Frequency was 10 Hz, 30 min/time for 7 d	c, d, e, f	Significantly relieved muscle tension spasm and improved quality of life
Şan et al[26]	Frequency 5 Hz, 15 min/time, 10 for 2 wk	c, g, h, i	Spasticity and the frequency of the seizures improved significantly
Zhao et al[27]	Frequency 1 Hz, 1/d, 6/wk and continuous treatment for 4 wk	c, f, j	Improved limb spasm, restored limb movement function, and improved daily living ability
Cheng et al[28]	The stimulation frequency was 1 Hz, each sequence with 10 pulses at 2 s intervals for a total of 1200 pulses, 1/d, 5 times/wk, and 8 wk as 1 session	c, j, k	Improved the degree of muscle tone control, alleviated muscle spasm, and improved motor dysfunction
Yuan et al[29]	The stimulation frequency was 1 Hz with 120 stimulus trains of 2 s between 10 pulses for a total of 1200 pulses. Once/d for 5 d per wk for 8 wk	c, j, k	Effectively relieved the degree of spasm, improved the motor function and daily life activities

a: The Toronto Western Torticollis Rating Scale; b: Cranio-cervical Dystonia Questionnaire; c: Modified Ashworth Scale; d: Uniform Wilson's Disease Rating Scale; e: Dystonia Scale; f: Activities of daily living; g: Penn Spasticity Frequency Scale; h: Visual analogue scale; i: Quality of Life 54; j: Fugl-Meyer motor function rating; k: Modified Barthel quantity scale.

Table 3 Efficacy of shock wave treatment on post-stroke spasticity

Ref.	Position	Prescription	Evaluation method	Curative effect
Li et al[36]	Upper limb	5 consecutive intervals with 4 d. 6000 pulses at pressure 1.2-1.4 bar at a frequency of 18 Hz	a, b, c, d	Clearly improved upper limb flexion spasm and significantly reduced pain
Yoldas et al[37]	Lower limbs	Twice/wk for 2 wk (4 times in total), 1500 pulses, pressure of 2 bar, frequency of 10 Hz	a, b, e, f, g	A marked reduction in plantarflexor spasticity, no significant improvement in the 6-minute walk test and activity range
Mihai et al[38]	Lower limbs	Once/wk for 2 wk, 2000 pulses at 10 Hz and energy density of 60 mJ	a, c, h, i, j	The degree of spasticity and pain intensity were significantly reduced, improved ankle range of motion, balance and gait
Wang et al[39]	Upper and lower limbs	Twice/wk for 4 wk, 1500-2500 pulses/site, pressure of 2.0-2.5 bar, frequency of 5-8 Hz	a, d, i	Relieved muscle tension of hemiplegic limb and improved interjoint coordination
Li et al[40]	Lower limbs	Three times/wk (every other day) for 4 wk, 2000 pulses per site with impact intensity of 1.5 bar at 10 Hz	a, d, k	Improved the degree of muscle spasm in the lower limbs, and improved lower limb function and balance function
He et al[41]	Lower limbs	3 times/wk for a total of 3 wk. Calf muscle: 2000 shocks, shock wave strength 3 bar, frequency 6 Hz; Achilles tendon: 2000 shocks, shock wave strength 2 bar, frequency 9 Hz	a, d, l, k, m, n	Effectively inhibited calf muscle spasm, improved the active range and motor function, and improved the balance function, walking function and postural control ability
Zhao et al[42]	Upper limb	Once every 3 d, twice/wk for 3 wk at 8 Hz, pressure 1.5-2.0 bar, 1000 pulses per site	a, d, f	Improved the degree of upper limb spasm, improved the motor function and daily living ability

a: Modified Ashworth Scale; b: The modified Tardieu scale; c: Visual analog scale score; d: Fugl-Meyer Motor Function Rating Scale; e: The 6-min walk test; f: Modified Barthel Index scale; g: Measurement of ankle mobility of the affected side; h: Tinetti Assessment tool; i: Functional activity classification assessment; j: A handheld anglometer evaluated the ankle passive range of motion; k: Berg Balance scale; l: Passive and active motion of ankle dorsiflexion; m: 10 m Walking inspection; n: Time in the stand-up-walk test.

Table 4 Efficacy of vibration therapy on spasticity

Ref.	Prescription	Evaluation method	Curative effect
Bao et al[54]	The frequency was 36.7 Hz, and the total duration of treatment was 10 min, once/d, 5 times/wk for 3 consecutive wk	b, c, d	Effectively reduced the spasm muscle tension, improved its elasticity and hardness, improved limb movement function
Yin et al[55]	Frequency 12 Hz, amplitude 4 mm, each lasting 15 min, 5 times/wk for 12 wk	e, f, g	Effectively improved ankle motion, balance function and lower limb movement ability in children with spastic diplegia
Li et al[56]	Frequency 30 Hz, 0.5 mm amplitude once/d 2 min each time and 2 min rest interval. Four-week treatment course with a total of two courses	a, d, h, i	Reduced ankle plantar flexor spasm, improved walking ability, and improved activities of daily living
Katusic et al[57]	Frequency 40 Hz, 20 min each time, twice/wk for 12 wk	a, j	Reduced the level of spasticity and improved the gross motor capacity in children with spastic cerebral palsy
Cai et al[58]	Treatment frequency: First 12 Hz, second 18 Hz, and third 21 Hz. 3 min/time for 9 min, training for 5 d/wk and 2 d rest for 8 wk	f, j	Effectively reduced muscle tension, improved muscle strength, abnormal posture and postural control ability in spastic cerebral paralysis

a: Modified Ashworth scale; b: Modified Tardieu scale; c: Myoton-3 muscle state detector assessment; d: Fugl-Meyer motor function rating scale; e: Scale of ankle dorsiflexion; f: Berg, balance scale; g: Gross motor function for cerebral palsy; h: Gait analysis; i: Modified Barthel index scale; j: Gross motor function (GMFM-88).

Table 5 Efficacy of electromyography biofeedback therapy on muscle spasticity

Ref.	Disease name	Intervention study	Frequency and duration of the intervention	Outcome indicators	Curative effect
Gulseren et al[63]	Post-stroke spasm	E: EMG-BF + conventional treatment; C: Conventional therapy	1/d, 5/wk, 20 min/time for 3 wk	a, d, e	Improvements in joint mobility, muscle strength, muscle tone, and function
Xie et al[64]	Post-stroke spasm	E: EMG-BF + conventional treatment; C: Conventional therapy	2 times/d, 5 times/wk, 15-20 min/time for 12 wk	b, c	Improved neurological function, motor function and quality of life in patients
Wang et al[65]	Post-stroke spasm	E: EMG-BF + rehabilitation training; C: Rehabilitation training	1 time/d, 5 times/wk, 30 min/time for 8 wk	a, c, d	Effectively reduced wrist spasm in patients with early cerebral infarction
Shi et al[66]	Post-stroke spasm	E: EMG-BF + rehabilitation training; C: Rehabilitation training	2 times/d, 30 min/time for 8 wk	a, c	Reduced patient spasticity level and improved motor function
Xu et al[67]	Spastic cerebral palsy	E: EMG-BF + rehabilitation training; C: Rehabilitation training	20-30 min/time, once/d, 6 times/wk for 12 wk	f, j, h, i	Improved gross motor function and serological indicators in children, and improved the development quotient and self-care ability score
Zhang et al[68]	Cerebral palsy	E: EMG-BF + rehabilitation training; C: rehabilitation training	20 min/time, once/d, 5 times/wk for 12 wk	a	Significantly improved exercise capacity and quality of life

“E” represents the test group; “C” represents the control group; EMG-BF: Electromyographic biofeedback; CPM: Continuous passive movement; a: Modified Ashworth score; b: Clinical spasm index; c: Fugl-Meyer motor function score; d: Degree of active joint activity; e: Surface EMG value; f: Gross motor function assessment table (GMFM-88); g: Daily life performance scale (ADL); h: Gesell pediatric neuropsychological development scale; i: Serological index.