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First let\u2019s start with the difference between the two as they are often confused.\u00a0 Dystonia is an abnormal twisting of the muscle and it holds its resting tone at a higher level.\u00a0 Dystonia can be the primary diagnosis or secondary to another disease such as Parkinsons.\u00a0 For people with Parkinsons it is most commonly seen in the foot.\u00a0 Dyskinesia is an overshooting and undershooting of movement and in the person with Parkinsons looks like extra movement.<\/p>\n How can you tell the difference between the two or teach your patient to know the difference? Dyskinesia is often the extra movement that occurs when a patient is \u201con\u201d or too \u201con\u201d their Parkinson’s medication.\u00a0 Dystonia is often the foot cramping or toe curling that accompanies an off state or wearing off.\u00a0 It is often exacerbated by more challenging balance tasks such as standing on foam or an incline.\u00a0 Here we can see the patient actively gripping the floor.<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n Dyskinesia can be a little trickier to manage.\u00a0 Referring the patient back to their movement disorder specialist for medication management is a great place to start.\u00a0 Then in therapy teaching them gaze stabilization or spotting techniques with their gaze while they are walking, turning, standing or attempting to maintain their balance helps significantly. Further up training of the visual and vestibular system will help the patient continue to maintain their balance.\u00a0 In addition, one to two pound ankle weights or use of sensory reweighting at the trunk can be very helpful.<\/p>\n These tips are a great place to start when dystonia and dyskinesia are symptoms of your patient’s Parkinsons.\u00a0 Join us for our Non-CE Webinar, Dystonia and Dyskinesia<\/a>, where we go more in-depth on treating and understanding the dreaded Ds.<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n Explore online continuing education courses from Meredith below:<\/p>\n Evidence-Based Techniques to Build Your Parkinsons <\/b>Disease<\/u><\/b> Toolbox<\/b><\/a><\/span><\/p>\n Optimizing Balance and Motor Control in Geriatric and Neurological Patients<\/span><\/strong><\/a><\/p>\n Implementing an Exercise-Based Approach to Treat Progressive Neurological Diagnoses<\/strong><\/a><\/span><\/p>\n Changing Your Patients Health Behavior Habits<\/strong><\/a><\/span><\/p>\n<\/div>\n![\"\"](\"http:\/\/l_new.local\/wp-content\/uploads\/iStock-884653666.jpg\")
<\/a>Dystonia and Dyskinesia; two D words that are every therapist’s worst nightmare.\u00a0 These two movement disorder symptoms can be extremely frustrating for both the therapist and the patient.\u00a0 Have no fear, there are some tips and tricks that we can use to help our patients manage these symptoms and improve their balance, gait and quality of life.<\/p>\n\u00a0<\/h4>\n
How can we help our patients?\u00a0<\/strong><\/h4>\n
<\/a>Dystonia doesn\u2019t like extension and abduction. So if we are dealing with toe curling have the patient focus on lifting and spreading their toes and gently resting them back onto the floor as a reset.\u00a0 Rhythmic rocking in weight bearing will also reset the system.\u00a0 The use of toe spreaders that can be worn inside the shoe are helpful for creating abduction and a neutral toe position throughout the day.\u00a0 Just start with a wear schedule and work up to all day as needed. Next, visual imagery is helpful during gait.\u00a0 Pretending to make perfect footprints in the sand for a Facebook photo, spreading toes as they move from stance to toe off, helps normalize the gait pattern.\u00a0 Other external focus of awareness cues that focus on extension and toe off can be helpful including \u201cshow me the sticker on your heel as you walk away\u201d.\u00a0 A simple pass of an object like a bean bag from hand to hand while completing other activities that trigger foot dystonia also helps reduce toe curling and griping of the floor.\u00a0 Patients can also talk with their movement disorder specialist about medication management and botox injections depending on the severity.<\/p>\n<\/a>Written by: Meredith Roberts Lo, DPT
Founder of Roberts Empowered Movement Center and Parkinsons Pointe in Denver, CO<\/em>
Meredith@RobertsEmpoweredMovement.com<\/p>\n