The ‘Living with Dystonia’ Day, organised by the Dystonia Society, was held in London in November. This was an opportunity to talk to neck dystonia sufferers and their carers about the sensorimotor training programme that I am using in conjunction with botox treatment — see here.
We have an understanding of how the brain plans and then executes movement. This is based upon a blend of prediction, feedback from the body’s sensory systems and what has been learned (i.e. prior experience). Tests in the clinic can identify an altered sense of body, a common finding in both cases of chronic pain and dystonia, that impacts upon the precision with which we would normally move. It is an issue of ‘threat’ when the movement that actually occurs does not match with the expected pattern or blueprint that exists in the brain. Any sense of threat can be enough for protective measures to be taken by the brain, e.g./ pain, guarding. This is the neurobiology of movement, and involves many parts of the brain including the motor centres, the basal ganglia and the cerebellum.
A key point that I made during the talk, and one that I make to patients, is that not only do we need to think about how the neurobiology of movement or the pain that is manifesting, but we also must consider the array of influences upon this biology. Those that we know well include stress, anxiety, prior experience, beliefs, the environment, the context, who we are with and what we are thinking about. All of these affect movement that is an expression of our ‘self’ at any given moment — what we are doing, thinking and feeling.
Our posturing or body language represents an interface between our sense of self and the outside world. When our movement changes, so does our relationship with the World. Certainly in neck dystonia, almost all of those who come to see me will talk about how it makes them feel to experience involuntary movements whilst in public places. Many will avoid going out if possible.
The involuntary movements, the lack of control and body awareness are all manifest and emergent characteristics of ‘re-wiring’ in the brain; the dark side of neuroplasticity. To improve motor control in these cases, we need to start at the level of planning rather than practicing actual movements. However, it is not just about the movement but also the sensory aspects that inform the brain. Hence the training is ‘sensorimotor’ that develops a better body sense to then normalise how it moves. The two are so interlinked in my view, that they are in fact one and the same; an overall mechanism of expression or function.
There are specific training strategies used for improving sensorimotor action including motor imagery and tactile discrimination exercises. Concurrently we look at the individual’s lifestyle influences: stressors, thoughts that cause anxiety and other non-motor factors that impact upon the movements and muscle activity.
Tension in muscles that persists can cause pain as the blood flow changes, acids build up and nerve endings that sample the tissues become sensitised. The messages sent to the brain about the tension and chemicals can result in a pain experience and often does in neck dystonia. Imagine performing bicep curls all day, every day. It would begin to hurt. With increased muscle activity due to involuntary movements and imprecise control, this is exactly what is happening. Reducing muscle tension by developing better control of movement and using techniques that are known to promote restorative activity are effective ways of re-programming how the body is working. Mindfulness or focussed-attention training are the methods of choice.
It is a very exciting time as we better understand movement and pain from a neuroscience perspective. The research must continue as we continually seek to improve the way in which we treat dystonia. The approach, as I described, must be comprehensive in addressing the physical, cognitive and emotional dimensions of the problem. In doing so we are offering a route forward via sensorimotor training, best applied in conjunction with botox treatment that both changes the muscle activity and eases pain.
For further information or to book an appointment, please contact us on 07932 689081