{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:57:14Z","timestamp":1791161834113,"version":"4.1.0"},"reference-count":85,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2009,10,16]],"date-time":"2009-10-16T00:00:00Z","timestamp":1255651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2009,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Dystonia is a disabling movement disorder with a significant impact on quality of life. The current therapeutic armamentarium includes various drugs, botulinum toxin injections, and occasionally (neuro)surgery. In addition, many patients are referred for paramedical (including allied health care) interventions. An enormous variation in the paramedical treatment is provided, largely because evidence\u2010based, accepted treatment regimes are not available. We have conducted a systematic review of studies that explored the effect of various paramedical interventions in primary dystonia. Only studies that have used clinical outcome measures were included. There were no class A1 or A2 studies and therefore, level 1 or 2 practice recommendations for a specific intervention could not be deducted. Many papers were case reports, mostly with a very limited number of patients and a clear publication bias for beneficial effects of a particular paramedical intervention. Some potentially interesting interventions come from class B studies, which include physical therapy in addition to botulinum toxin injections (BoNT\u2010A) in cervical dystonia; sensorimotor training and transcutaneous electrical nerve stimulation (TENS) in writer's cramp; and speech therapy added to BoNT\u2010A injections in laryngeal dystonia. Good quality clinical studies are therefore warranted, which should have the aim to be generally applicable. A design in which the paramedical intervention is added to a current gold standard, for example, BoNT\u2010A injections in cervical dystonia, is recommended. \u00a9 2009 Movement Disorder Society<\/jats:p>","DOI":"10.1002\/mds.22608","type":"journal-article","created":{"date-parts":[[2009,10,16]],"date-time":"2009-10-16T12:19:43Z","timestamp":1255695583000},"page":"2187-2198","source":"Crossref","is-referenced-by-count":51,"title":["Paramedical treatment in primary dystonia: A systematic review"],"prefix":"10.1002","volume":"24","author":[{"given":"Cath\u00e9rine C.S.","family":"Delnooz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin W.I.M.","family":"Horstink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina A.","family":"Tijssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart P.C.","family":"van de Warrenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,10,16]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.5_Suppl_5.S1"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(06)70574-9"},{"key":"e_1_2_7_4_2","doi-asserted-by":"crossref","first-page":"S362","DOI":"10.1016\/S1353-8020(08)70031-2","article-title":"Treatment of dystonia","volume":"13","author":"Adam OR","journal-title":"Park Relat Disord"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.CON.0000284571.81390.63"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.23.11.1241"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(90)90091-V"},{"key":"e_1_2_7_8_2","first-page":"403","article-title":"Spasmodic torticollis: treatment by feedback display of the EMG","volume":"55","author":"Brudny J","year":"1974","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_9_2","first-page":"385","article-title":"Integrated EMG feedback in the management of spasmodic torticollis and focal dystonia: a prospective study of 80 patients","volume":"55","author":"Korein J","year":"1976","journal-title":"Res Publ Assoc Res Nerv Ment Dis"},{"key":"e_1_2_7_10_2","first-page":"375","article-title":"Sensory feedback therapy of spasmodic torticollis and dystonia: results in treatment of 55 patients","volume":"14","author":"Korein J","year":"1976","journal-title":"Adv Neurol"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/026921559500900404"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00999994"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21145"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/pri.326"},{"key":"e_1_2_7_15_2","first-page":"219","article-title":"The effect of two different rehabilitation treatments in cervical dystonia: preliminary results in four patients","volume":"18","author":"Smania N","year":"2003","journal-title":"Funct Neurol"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(92)90013-B"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.69.5.658"},{"key":"e_1_2_7_18_2","first-page":"169","article-title":"Botulinum toxin and occupational therapy in the treatment of writer's cramp","volume":"12","author":"Berg D","year":"1999","journal-title":"Neurorehabilitation"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.41.7.1136"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.humov.2006.05.007"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.39.1.149"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.1223"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)92969-3"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000160390.25028.C3"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1197\/j.jht.2004.04.005"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.51.7.605"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2006.09.003"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1022239014808"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.142.2.180"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10251"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/120.12.2179"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410380206"},{"key":"e_1_2_7_33_2","first-page":"11","article-title":"Physiology of dystonia","volume":"78","author":"Hallett M","year":"1998","journal-title":"Adv Neurol"},{"key":"e_1_2_7_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.10174"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10490"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000163851.70927.7E"},{"key":"e_1_2_7_37_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20314"},{"key":"e_1_2_7_38_2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.21091\/mppa.2006.3022","article-title":"Effects of pianism retraining on three pianists with focal dystonia","volume":"21","author":"de Lisle R","year":"2006","journal-title":"Med Probl Perform Artists"},{"key":"e_1_2_7_39_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20631"},{"key":"e_1_2_7_40_2","doi-asserted-by":"crossref","first-page":"166","DOI":"10.21091\/mppa.2003.4030","article-title":"Prolonged neuromuscular rehabilitation for Musician's focal dystonia","volume":"18","author":"Tubiana R","year":"2003","journal-title":"Med Probl Perform Artists"},{"key":"e_1_2_7_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(03)00276-4"},{"key":"e_1_2_7_42_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.57.3.405"},{"key":"e_1_2_7_43_2","first-page":"247","article-title":"Limb immobilization for occupational dystonia: a possible alternative treatment for selected patients","volume":"94","author":"Pesenti A","year":"2004","journal-title":"Adv Neurol"},{"key":"e_1_2_7_44_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.35094"},{"key":"e_1_2_7_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)74865-0"},{"key":"e_1_2_7_46_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1231193100"},{"key":"e_1_2_7_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-1130(00)80021-6"},{"key":"e_1_2_7_48_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.21091\/mppa.2006.1005","article-title":"Slow\u2010down exercise for the treatment of focal hand dystonia in pianists","volume":"21","author":"Sakai N","year":"2006","journal-title":"Med Probl Perform Artists"},{"key":"e_1_2_7_49_2","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.138.11.1487"},{"key":"e_1_2_7_50_2","first-page":"179","article-title":"Biofeedback (BFB) in blepharospasm: two case reports","volume":"30","author":"Bertolotti G","year":"2005","journal-title":"Appl Psychophysiol Biofeedback"},{"key":"e_1_2_7_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00998652"},{"key":"e_1_2_7_52_2","first-page":"48","article-title":"Biofeedback treatment of blepharospasm with spasmodic torticollis","volume":"119","author":"Roxanas MR","year":"1978","journal-title":"Can Med Assoc J"},{"key":"e_1_2_7_53_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01000752"},{"key":"e_1_2_7_54_2","first-page":"331","article-title":"Successful treatment of blepharospasm with relaxation training and biofeedback","volume":"1","author":"Stephenson NL","year":"1976","journal-title":"Biofeedback Self Regul"},{"key":"e_1_2_7_55_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410030406"},{"key":"e_1_2_7_56_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.124.6.603"},{"key":"e_1_2_7_57_2","first-page":"219","article-title":"Behandeling van een patient met het syndroom van Meige","volume":"22","author":"Reinders M","year":"1989","journal-title":"Gedragstherapie"},{"key":"e_1_2_7_58_2","first-page":"433","article-title":"Oral rehabilitation using osseointegrated implants in a patient with idiopathic torsion dystonia","volume":"16","author":"Penarrocha M","year":"2001","journal-title":"Int J Oral Maxillofac Implants"},{"key":"e_1_2_7_59_2","first-page":"115","article-title":"Oral rehabilitation with osseointegrated implants in a patient with oromandibular dystonia with blepharospasm (Brueghel's syndrome): a patient history","volume":"16","author":"Penarrocha M","year":"2001","journal-title":"Int J Oral Maxillofac Implants"},{"key":"e_1_2_7_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-1997(05)80211-5"},{"key":"e_1_2_7_61_2","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198806000-00012"},{"key":"e_1_2_7_62_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870110220"},{"key":"e_1_2_7_63_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1352465806003171"},{"key":"e_1_2_7_64_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21737"},{"key":"e_1_2_7_65_2","first-page":"892","article-title":"Orthotic technique for dystonia musculorum deformans","volume":"69","author":"Hurvitz EA","year":"1988","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_66_2","first-page":"373","article-title":"Dystonia musculorum deformans: three cases treated on a rehabilitation unit","volume":"69","author":"McGuire TJ","year":"1988","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/0887-8994(87)90036-1"},{"key":"e_1_2_7_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)92946-F"},{"issue":"1","key":"e_1_2_7_69_2","first-page":"445","article-title":"The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS): assessment of validity and inter\u2010rater reliability","volume":"40","author":"Consky ES","year":"1990","journal-title":"Neurology"},{"key":"e_1_2_7_70_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awl355"},{"key":"e_1_2_7_71_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000296829.66406.14"},{"key":"e_1_2_7_72_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21081"},{"key":"e_1_2_7_73_2","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7916(91)90049-B"},{"key":"e_1_2_7_74_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20982"},{"key":"e_1_2_7_75_2","first-page":"238","article-title":"Torticollis and serendipity","volume":"63","author":"Andrews H","year":"1982","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_76_2","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(85)90147-0"},{"key":"e_1_2_7_77_2","first-page":"300","article-title":"Retrocollis: management with orthoplast adapted orthosis","volume":"57","author":"Cavanaugh JA","year":"1976","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_78_2","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(74)90124-7"},{"key":"e_1_2_7_79_2","doi-asserted-by":"publisher","DOI":"10.1080\/09593980701884816"},{"key":"e_1_2_7_80_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2005.07.003"},{"key":"e_1_2_7_81_2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1973.01750310082013"},{"key":"e_1_2_7_82_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02229221"},{"key":"e_1_2_7_83_2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.21091\/mppa.2005.2015","article-title":"Finger movement discrimination in focal hand dystonia: Case study of a cellist","volume":"20","author":"Ackermann BJ","year":"2005","journal-title":"Med Prob of Perform Art"},{"key":"e_1_2_7_84_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10647"},{"key":"e_1_2_7_85_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01000540"},{"key":"e_1_2_7_86_2","doi-asserted-by":"publisher","DOI":"10.3109\/13682829409041491"}],"container-title":["Movement Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmds.22608","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mds.22608","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:45:21Z","timestamp":1760964321000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mds.22608"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,10,16]]},"references-count":85,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2009,11,15]]}},"alternative-id":["10.1002\/mds.22608"],"URL":"https:\/\/doi.org\/10.1002\/mds.22608","archive":["Portico"],"relation":{},"ISSN":["0885-3185","1531-8257"],"issn-type":[{"value":"0885-3185","type":"print"},{"value":"1531-8257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,10,16]]}}}