{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:01:49Z","timestamp":1765231309765,"version":"3.41.2"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T00:00:00Z","timestamp":1691971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Dystonia"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Previous studies have found gait and balance abnormalities in patients with cervical dystonia. However, the characteristics of gait and balance in cervical dystonia with head tremors have not been ascertained. A midline constant head tremor when walking would likely render gait and balance more difficult. The pathophysiology of dystonia has also been increasingly linked with cerebellar function abnormality, commonly implicated in gait and balance disorders.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We examined the gait and balance characteristics of cervical dystonia presenting with head tremors. We used the timed up-and-go (TUG) walk test, 10\u00a0m walk test, Berg Balance Scale (BBS), and Gait and Freezing questionnaire. We then assessed the gait on an instrumented walkway system to capture spatiotemporal measures such as speed, cadence, step time, step length, stride width, swing%, stance%, single support%, double support%, and gait variability index (GVI). We also assessed whether the gait in dystonic tremor (DT) differed from essential tremor (ET) and orthostatic tremor (OT), as these tremor disorders share the cerebello-thalamo-cortical pathway as the common pathological pathway.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> 50 participants comprising DT (20 patients), ET (15 patients), and OT (15 patients) were enrolled. While the gait abnormalities were subclinical, 11\/20 DT patients (55%) walked at a slower speed on the TUG, 11\/20 (55%) had reduced scores on the BBS, 9\/20 (45%) had increased step time, 4\/20 (20%) had reduced step length, 4\/20 (20%) had wider stride width, 9\/20 (45%) spent greater time during double support and 8\/20 (40%) patients had an abnormal GVI. Comparisons of DT with healthy control data revealed a slower gait velocity (<jats:italic>p<\/jats:italic> = 0.001) and a reduced step length (<jats:italic>p<\/jats:italic> = 0.001). Compared to DT, the ET group revealed a reduced cadence (<jats:italic>p<\/jats:italic> = 0.04) and the OT group revealed an increased TUG time (<jats:italic>p<\/jats:italic> = 0.03), reduced BBS scores (<jats:italic>p<\/jats:italic> = 0.02), reduced step length (<jats:italic>p<\/jats:italic> = 0.02), reduced cadence (<jats:italic>p<\/jats:italic> = 0.03), reduced GVI (<jats:italic>p<\/jats:italic> = 0.01), and increased double support phase (<jats:italic>p<\/jats:italic> = 0.045).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> DT is accompanied by multiple abnormalities affecting gait and balance, albeit subclinical and less pronounced than ET and OT, possibly related to more effective compensatory mechanisms. Nevertheless, these abnormalities indicate that rehabilitative measures warrant consideration when managing in clinical settings.<\/jats:p>","DOI":"10.3389\/dyst.2023.11231","type":"journal-article","created":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T13:13:30Z","timestamp":1692018810000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Gait and balance in cervical dystonia and dystonic head tremor"],"prefix":"10.3389","volume":"2","author":[{"given":"Aparna","family":"Wagle Shukla","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjela","family":"Gurrala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinata","family":"Vedam-Mai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3206","DOI":"10.1093\/brain\/aws023","article-title":"Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits?","volume":"135","author":"Helmich","year":"2012","journal-title":"Brain"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.5334\/tohm.507","article-title":"Ataxic gait in essential tremor: a disease-associated feature?","volume":"9","author":"Rao","year":"2019","journal-title":"Tremor Other Hyperkinet Mov (N Y)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1007\/s11910-013-0378-8","article-title":"The pathophysiology of essential tremor and Parkinson's tremor","volume":"13","author":"Helmich","year":"2013","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.parkreldis.2020.01.007","article-title":"Gait characterization for patients with orthostatic tremor","volume":"71","author":"Opri","year":"2020","journal-title":"Parkinsonism Relat Disord"},{"key":"B5","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/B978-0-444-64189-2.00016-0","article-title":"Essential tremor and the cerebellum","volume":"155","author":"Louis","year":"2018","journal-title":"Handbook Clin Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1016\/j.jocn.2013.01.013","article-title":"Balance in essential tremor during tandem gait: is the first mis-step an important finding?","volume":"20","author":"Cinar","year":"2013","journal-title":"J Clin Neurosci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.neuroscience.2013.11.062","article-title":"Dystonia as a network disorder: what is the role of the cerebellum?","volume":"260","author":"Prudente","year":"2014","journal-title":"Neuroscience"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e1073","DOI":"10.1212\/WNL.0000000000008875","article-title":"Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor","volume":"94","author":"Tsuboi","year":"2020","journal-title":"Neurology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1093\/brain\/awz085","article-title":"Network-level connectivity is a critical feature distinguishing dystonic tremor and essential tremor","volume":"142","author":"DeSimone","year":"2019","journal-title":"Brain"},{"key":"B10","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.parkreldis.2017.07.005","article-title":"Cervical dystonia patients display subclinical gait changes","volume":"43","author":"Esposito","year":"2017","journal-title":"Parkinsonism Relat Disord"},{"key":"B11","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.gaitpost.2017.04.004","article-title":"Impairments of balance, stepping reactions and gait in people with cervical dystonia","volume":"55","author":"Barr","year":"2017","journal-title":"Gait Posture"},{"key":"B12","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1186\/s12883-015-0499-6","article-title":"Exploring factors related to physical activity in cervical dystonia","volume":"15","author":"Zetterberg","year":"2015","journal-title":"BMC Neurol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1002\/mds.27121","article-title":"Consensus statement on the classification of tremors. 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