Download PDF
CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(03): s00451806822
DOI: 10.1055/s-0045-1806822
Original Article

Do patients with cervical dystonia present a greater risk and more fear of falling?

Sibele Yoko Mattozo Takeda 
1   Universidade Federal do Paraná, Setor de Ciências Biológicas, Departamento de Prevenção e Reabilitação em Fisioterapia, Curitiba PR, Brazil.
,
Ana Félix de Souza 
1   Universidade Federal do Paraná, Setor de Ciências Biológicas, Departamento de Prevenção e Reabilitação em Fisioterapia, Curitiba PR, Brazil.
,
Iara Ferreira Penteado 
1   Universidade Federal do Paraná, Setor de Ciências Biológicas, Departamento de Prevenção e Reabilitação em Fisioterapia, Curitiba PR, Brazil.
,
Djanira Aparecida da Luz Veronez 
2   Universidade Federal do Paraná, Setor de Ciências Biológicas, Departamento de Anatomia, Curitiba PR, Brazil.
,
Hélio Afonso Ghizoni Teive 
3   Universidade Federal do Paraná, Setor de Ciências da Saúde, Departamento de Clínica Médica, Curitiba PR, Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Cervical dystonia (CD) is a movement disorder characterized by involuntary contractions that affect the muscles of the cervical region, causing movements in a twisting pattern. Its chronic-progressive nature can lead to pain, impaired mobility, and greater propensity to falls.

Objective To verify gait and balance characteristics and their correlation with the risk and fear of falling in 46 CD patients.

Methods The present was a descriptive and cross-sectional study. For the assessments, we sued the Berg Balance Scale (BBE), the Tinetti Scale (also known as the Performance-Oriented Mobility Assessment, POMA), the Dynamic Gait Index (DGI), the Fall Efficacy Scale-International (FES-I), and the Functional Reach Test (FRT). The patients were recruited during their routine consultations, before the administration of botulinum toxin. For data analysis, we used the BioEstat 5.0 software (free) to verify the distribution of samples (Shapiro-Wilk test) and the correlations among variables (Spearman test) considering p ≤ 0.05%.

Results The results showed that the patients presented gait changes related to static and dynamic components of balance. Therefore, we observed a greater propensity to falls, with a correlation involving lack of balance, a greater risk of falling and, consequently, more fear of falling.

Conclusion We verified that changes in the balance of CD patients have a negative impact on gait, increase the risk and the fear of falling, and can lead the individual to restrict their activity levels.

Keywords

Dystonia - Postural Balance - Gait - Rehabilitation

Authors' Contributions

Conceptualization: SYMT, AFS, IFP; Data curation: SYMT, AFS, IFP; Formal analysis: SYMT, AFS, IFP; Funding acquisition: SYMT; Investigation: SYMT, AFS, IFP; Methodology: SYMT, AFS, IFP; Project administration: SYMT; Resources: SYMT, HAGT; Supervision: SYMT; Writing - original draft: SYMT, AFS, IFP, DALV; Writing – review and editing: SYMT, AFS, IFP, DALV. All authors approved the final version of the manuscript and agree to be responsible for all aspects of the work.


Data Availability Statement

Assessment data is made available, as long as the identity of the participant is preserved.


Editor-in-Chief: Ayrton Roberto Massaro.


Associate Editor: Vitor Tumas.




Publication History

Received: 21 August 2024

Accepted: 30 December 2024

Article published online:
27 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil

Bibliographical Record
Sibele Yoko Mattozo Takeda, Ana Félix de Souza, Iara Ferreira Penteado, Djanira Aparecida da Luz Veronez, Hélio Afonso Ghizoni Teive. Do patients with cervical dystonia present a greater risk and more fear of falling?. Arq Neuropsiquiatr 2025; 83: s00451806822.
DOI: 10.1055/s-0045-1806822
 

  • References

  • 1 BORGES V. FHB. Tremores. Rev Neurocienc 2006; 14 (01) 43-47
    CrossrefSearch in Google Scholar
  • 2 Queiroz MR, Chien HF, Barbosa ER. Quality of life in individuals with cervical dystonia before botulinum toxin injection in a Brazilian tertiary care hospital. Arq Neuropsiquiatr 2011; 69 (06) 900-904
    CrossrefPubMedSearch in Google Scholar
  • 3 Queiroz MA, Chien HF, Sekeff-Sallem FA, Barbosa ER. Physical therapy program for cervical dystonia: a study of 20 cases. Funct Neurol 2012; 27 (03) 187-192
    PubMedSearch in Google Scholar
  • 4 Albanese A, Bhatia K, Bressman SB. et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord 2013; 28 (07) 863-873
    CrossrefPubMedSearch in Google Scholar
  • 5 Bove M, Brichetto G, Abbruzzese G, Marchese R, Schieppati M. Neck proprioception and spatial orientation in cervical dystonia. Brain 2004; 127 (Pt 12): 2764-2778
    CrossrefPubMedSearch in Google Scholar
  • 6 Lin G, Zhao X, Wang W, Wilkinson T. The relationship between forward head posture, postural control and gait: A systematic review. Vol. 98, Gait and Posture. Elsevier B.V.; 2022: 316-29
    CrossrefSearch in Google Scholar
  • 7 de Figueiredo KMOB, Lima KC, Guerra RO. Instrumentos de avaliação do equilíbrio corporal em idosos. Rev Bras Cineantropom Desempenho Hum 2007; 9 (04) 408-413 . Available from https://www.researchgate.net/publication/259675327 [Internet]
    Search in Google Scholar
  • 8 NUNES M. MAC. Semiologia Neurológica. 1 edição. EDIPUCRS, editor. Porto Alegre: Editora PUCRS; 2002.
  • 9 Rodrigo SE, Lescano CN, Rodrigo RH. Application of Kohonen maps to kinetic analysis of human gait. Rev Bras Eng Bioméd 2012; 28 (03) 217-226
    CrossrefSearch in Google Scholar
  • 10 OLIVEIRA JA. Validação da versão brasileira da escala de equilíbrio e marcha (GABS) e análise do risco de quedas em indivíduos com doença de Parkinson e sujeitos saudáveis. [Ribeirão Preto]: Universidade de São Paulo; 2010.
    Crossref
  • 11 Hochman B, Nahas FX, Oliveira Filho RS, Ferreira LM. Desenhos de pesquisa. Acta Cir Bras 2005; 20 (Suppl. 02) 2-9
    CrossrefPubMedSearch in Google Scholar
  • 12 VIEIRA S. Introdução a Bioestatistica. 5th ed. Editora Campus; 2012.
  • 13 Resende S, Rassi C. Efeitos da hidroterapia na recuperação do equilíbrio e prevenção de quedas em idosas. Braz J Phys Ther 2008; 12 (01) 57-63
    CrossrefSearch in Google Scholar
  • 14 Pimentel RM, Scheicher ME. Comparação do risco de queda em idosos sedentários e ativos por meio da escala de equilíbrio de Berg. Fisioter Pesqui 2009; 16 (01) 6-10
    CrossrefSearch in Google Scholar
  • 15 Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther 1997; 77 (08) 812-819
    CrossrefPubMedSearch in Google Scholar
  • 16 Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol 1990; 45 (06) M192-M197
    CrossrefPubMedSearch in Google Scholar
  • 17 da Silva A, Almeida GJ, Cassilhas RC. et al. Equilíbrio, coordenação e agilidade de idosos submetidos à prática de exercícios físicos resistidos. Rev Bras Med Esporte 2008; 14 (02) 88-93
    CrossrefSearch in Google Scholar
  • 18 Karuka AH, Silva JAMG, Navega MT. Análise da concordância entre instrumentos de avaliação do equilíbrio corporal em idosos. Braz J Phys Ther 2011; 15 (06) 460-466
    CrossrefSearch in Google Scholar
  • 19 De Castro SM, Perracini MR, Ganança FF. Versão brasileira do Dynamic Gait Index. Rev Bras Otorrinolaringol 2006; 72 (06) 817-825
    CrossrefSearch in Google Scholar
  • 20 Miyamoto ST, Lombardi Junior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Braz J Med Biol Res 2004; 37 (09) 1411-1421
    CrossrefPubMedSearch in Google Scholar
  • 21 Camargos FFO, Dias RC, Dias JMD, Freire MTF. Adaptação transcultural e avaliação das propriedades psicométricas da Falls Efficacy Scale - International em idosos Brasileiros (FES-I-BRASIL). Braz J Phys Ther 2010; 14 (03) 237-243
    CrossrefSearch in Google Scholar
  • 22 Pereira JS. Distonias. Revista Hospital Universitário Pedro Ernesto. 2010
  • 23 Camargo CHF, Teive HAG, Becker N, Munhoz RP, Werneck LC. Botulinum toxin type A and cervical dystonia: a seven-year follow-up. Arq Neuropsiquiatr 2011; 69 (05) 745-750
    CrossrefPubMedSearch in Google Scholar
  • 24 LeDoux MS, Vemula SR, Xiao J. et al. Clinical and genetic features of cervical dystonia in a large multicenter cohort. Neurol Genet 2016; 2 (03) e69
    CrossrefPubMedSearch in Google Scholar
  • 25 Comella C, Bhatia K. An international survey of patients with cervical dystonia. J Neurol 2015; 262 (04) 837-848
    CrossrefPubMedSearch in Google Scholar
  • 26 Stacy MA. Handbook of Dystonia Second Edition. 2008.
  • 27 Ferraz HB, De Andrade LAF, Silva SM, Borges V, Rocha MSG. Tremor postural e distonia. Aspectos clínicos e considerações fisiopatológicas. Arq Neuropsiquiatr 1994; 52 (04) 466-470
    CrossrefPubMedSearch in Google Scholar
  • 28 Jiménez-Jiménez FJ, Alonso-Navarro H, Luquin Piudo MR, Burguera Hernández JA. Trastornos del movimiento (III): síndromes coreicos y distonía. Medicine Programa De Formación Médica Continuada Acreditado. 2007; 9 (74) 4741-4752
    CrossrefSearch in Google Scholar
  • 29 Jankovic J, Leder S, Warner D, Schwartz K. Cervical dystonia: clinical findings and associated movement disorders. Neurology 1991; 41 (07) 1088-1091
    CrossrefPubMedSearch in Google Scholar
  • 30 Nijmeijer SWR, Koelman JHTM, Kamphuis DJ, Tijssen MAJ. Muscle selection for treatment of cervical dystonia with botulinum toxin–a systematic review. Parkinsonism Relat Disord 2012; 18 (06) 731-736
    CrossrefPubMedSearch in Google Scholar
  • 31 Barbosa P, Warner TT. Chapter 14 - Dystonia. In: Day BL, Lord SR. editors. Balance, Gait, and Falls [Internet]. Elsevier; 2018: 229-36 . (Handbook of Clinical Neurology; vol. 159).
    CrossrefSearch in Google Scholar
  • 32 Barr C, Barnard R, Edwards L, Lennon S, Bradnam L. Impairments of balance, stepping reactions and gait in people with cervical dystonia. Gait Posture 2017; 55: 55-61
    CrossrefPubMedSearch in Google Scholar
  • 33 Mittal SO, Lenka A, Jankovic J. Cervical dystonia: an update on therapeutics. Expert Opin Orphan Drugs 2019; 7 (04) 199-209
    Search in Google Scholar
  • 34 da Silva SLA, Vieira RA, Arantes P, Dias RC. Avaliação de fragilidade, funcionalidade e medo de cair em idosos atendidos em um serviço ambulatorial de geriatria e gerontologia. Fisioter Pesqui 2009; 16 (02) 120-125
    CrossrefSearch in Google Scholar
  • 35 Mazo G, Liposcki D, Ananda C, Prevê D. Condições de saúde, incidência de quedas e nível de atividade física dos idosos. Braz J Phys Ther 2007; 11 (06) 437-442
    CrossrefSearch in Google Scholar
  • 36 Lopes K, Costa D, Santos L, Castro D, Bastone A. Prevalência do medo de cair em uma população de idosos da comunidade e sua correlação com mobilidade, equilíbrio dinâmico, risco e histórico de quedas. Braz J Phys Ther 2009; 13 (03) 223-229
    CrossrefSearch in Google Scholar