POSSIBILITIES OF USING REHABILITATION TREATMENT METHODS TO INCREASE THE EFFICIENCY OF BOTULINA THERAPY FOR CERVICAL DYSTONIA
Cervical dystonia belongs to the group of focal dystonia and is characterized by involuntary contractions of the neck muscles, leading to a pathological position of the head and neck, and may also be accompanied by head tremor. The disease significantly affects the daily activities and social life of patients, often leading to disability at a young working age. In accordance with the clinical guidelines for the diagnosis and treatment of dystonia, the first choice in the treatment of focal muscular dystonia is local injection of botulinum toxin type A into the dystonic muscles involved in the pathological position of the head and neck. The use of local injections of botulinum toxin makes it possible to eliminate pathological muscle contractions while maintaining their function. However, in real clinical practice, one has to deal with the depletion of the positive effect in some patients, and sometimes initially with a short duration of action of injections of botulinum toxin type A, which requires the search for new approaches in the treatment of cervical dystonia. The use of a combination of botulinum therapy with methods of physical rehabilitation makes it possible to increase the effectiveness of the injected botulinum toxin, with the absence of side effects characteristic of additional pharmacological methods of correction. The positive side of the combination of rehabilitation techniques, after sessions of botulinum therapy, is the possibility of their independent use by the patient, in most cases after a short training. A characteristic feature of physical rehabilitation methods is also a general healing effect on the body, which allows them to be recommended to all patients without restrictions on age or severity of the disease, with the condition of an individual approach. However, a large number of publications on rehabilitation methods used in cervical dystonia, which do not have an evidence base in their basis, leads to distrust on the part of doctors in their effectiveness and, accordingly, a low prevalence of prescriptions after the introduction of botulinum toxin. Further comparison of the effectiveness of specialized physiotherapy techniques, sets of exercise therapy exercises and other methods of physical rehabilitation is required.