Any Ideas on How to Improve Gait and Balance in an 11 Year Old with Dystonia?


GUEST BLOGGER: Kathryn Biel.

Marcia submitted this clinical question:

Any ideas on how to improve gait and balance in an 11 year old with dystonia? Backwards gait is OK but forward stepping is very ataxic and asymmetry increases with increased speed. Nothing seems to help consistently. HELP!! 

Dystonia, for me, is one of the most difficult tone issues to work with, around, through. I always feel sort of lost and like I’m grasping at straws. Here’s where I would start: muscle length and muscle strength. What’s short and tight? What’s long and weak? I would guess that the flexors are stronger in relation to the extensors, since backward walking is better than forward. Is one side more dominant than the other? Stretch what’s tight, and strengthen what’s weak. This might be a case where, to improve walking, you take a few steps back and just strengthen. Look at the hip extensors and lateral musculature specifically.

Biofeedback and the use of mirrors during treatment can help to give the patient an awareness of his or her movement patterns, which may aid in some postural corrections.

If there is a muscle imbalance due to dystonic spasms in the opposing muscle, modalities could be indicated. This could include NMES to the antagonistic muscle groups (which oppose the dystonic, spasming muscles) to increase muscle strength. Kineseotaping to both inhibit and facilitate may be a valuable tool. Although this child is a little old (for social reasons), compression and strapping garments (like TheraTogs) may also be useful.

Tone management (like Botox injections that would specifically target muscles) may be indicated, and are often prescribed in dystonia. Patient and family education on tone management is important.

Dystonia is a very difficult condition to treat. If you have other ideas or suggestions, please feel free to comment. I’d love to hear about what has been successful for you.

 

~Kathryn Biel, PT, DPT

 

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5 Responses to Any Ideas on How to Improve Gait and Balance in an 11 Year Old with Dystonia?

  1. Julie Berlin PT says:

    I treated a similar child who I had seen on and off since she was 9 months old and tried everything. She decided in junior high she wanted to run cross country. When we started she couldn’t go ten feet without falling. I decided to use the treadmill since her gait lacked cadence. We also worked hard on balance and strength on dynamic surfaces. After two months of once a week therapy she could run more than 200 feet without falling and joined the team. I think the training for the specific task was the key.

  2. mary pengelley says:

    I work with an 8 year old with severe dystonia, who is typically unable to maintain LE wt. bearing in supported standing for more than a few seconds. I tried having him stand on a vibrating platform recently and he was able to maintain standing for over 30 seconds until his feet starting vibrating off the platform and I had to reposition him. This was at the end of a home visit after I was looking at his home equipment and I have not been back to see how he is doing but the family continues to use the platform for 5-10 minutes daily with support. I have tried to find some research on WBV but so far there is little out there for children or adults with dystonia. I would love to know if others have used it for dystonia and if so what their findings are, even anecdotally. Obviously this post was regarding someone with more control, but it makes me wonder if there might be a way to use vibration during walking, perhaps even breaking down walking into some of the components, such as maintaining single leg stance on a vibrating platform, or if there might be a way to introduce vibration on the treadmill….? I am not sure what was the reason for the improved stability in standing but thinking that possibly the rapid low amplitude shifts may create a sensory stimulus that results in co-contractions which may help to dampen the dystonic muscle fluctuations. And so the question is, would it be possible to do this while walking somehow? I have used all the other suggestions that Kathryn suggested in her blog with very minimal impact, with the exception of Botox to his hip flexors which has been successful although of course temporary, and also he then tends to get stuck with hip extension and have difficulty flexing to even transfer to sitting from standing. Thanks for posting this interesting question and I will be interested to see what others have found successful.

  3. Jessica says:

    Have you tried a WalkAide? We have gotten good results with the WalkAide.

  4. Anjali says:

    have you considered visual retraining (this might not be such an issue with backwards walking)

  5. Mandy says:

    Comment from Shane:

    Could she use elliptical machine ? Or bike ? I might start there

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