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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(09): 549-555
DOI: 10.1590/0004-282X20200038
Articles

The effect of cognitive task on postural stability in cervical dystonia

O efeito da tarefa cognitiva sobre a estabilidade postural na distonia cervical
Turgay DEMİR 
1   Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey.
,
Mehmet BALAL 
1   Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey.
2   Çukurova University, Faculty of Medicine, Movement Disorders Unit, Department of Neurology, Adana, Turkey.
,
Meltem DEMİRKİRAN 
1   Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey.
2   Çukurova University, Faculty of Medicine, Movement Disorders Unit, Department of Neurology, Adana, Turkey.
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ABSTRACT

Background: Cervical dystonia (CD) is the most common form of focal dystonia. It is not known exactly whether abnormal head postures in cervical dystonia cause balance problems. Dual-tasking is a common every-day life situation. Objective: We aimed to evaluate postural stability (PS) in patients with CD and the effect of cognitive task on PS. As a secondary aim, we evaluated the effect of onabotulinum toxin A (BoNT) injection on PS. Methods: A total of 24 patients with CD who were on BoNT treatment for at least one year and 23 healthy controls were included. Posturographic analyses were carried out in all the subjects on static posturography platform under four different conditions: eyes open, eyes closed, tandem stance and cognitive task. In patients, posturographic analysis was carried out just before the BoNT injections and was repeated four weeks later. Results: Before treatment, the anterior-posterior sway was significantly higher in CD patients with the eyes open condition compared to the controls (p=0.03). Cognitive task significantly affected several sway velocities. Tandem stance significantly affected many sway parameters, whereas the eyes closed condition did not. After treatment, only two parameters in tandem stance and one in cognitive task improved within the patient group, in a pairwise comparison. Conclusions: Postural control is impaired in CD patients probably due to the impaired proprioceptive and sensorimotor integration. In reference to dual task theories possibly due to divided attention and task prioritization, cognitive dual-task and harder postural task disturbes the PS in these patients.

RESUMO

Introdução: A distonia cervical (DC) é a forma mais comum de distonia focal. Não se sabe exatamente se posturas anormais da cabeça na DC causam problemas de equilíbrio. A execução de duas tarefas simultaneamente é situação comum da vida cotidiana. Objetivo: Avaliar a estabilidade postural (EP) em pacientes com DC e o efeito da tarefa cognitiva na EP. Como objetivo secundário, avaliamos o efeito da toxina onabotulínica A (BoNT) na EP. Métodos: Foram incluídos 24 pacientes com DC em tratamento com BoNT por pelo menos um ano e 23 controles saudáveis. As análises posturográficas foram realizadas em todos os sujeitos na plataforma de posturografia estática sob quatro condições diferentes: olhos abertos, olhos fechados, postura tandem e tarefa cognitiva. Nos pacientes, a análise posturográfica foi realizada imediatamente antes das injeções de BoNT e após quatro semanas. Resultados: Antes do tratamento, a oscilação ântero-posterior era significativamente maior nos pacientes com DC com os olhos abertos quando comparados aos controles (p=0,03). A tarefa cognitiva interferiu significativamente nas velocidades de oscilação. A postura tandem afetou significativamente muitos parâmetros de oscilação, enquanto a condição de olhos fechados não. Após o tratamento, apenas dois parâmetros na posição tandem e um na tarefa cognitiva melhoraram no grupo de pacientes. Conclusões: O controle postural é prejudicado em pacientes com DC, provavelmente devido à comprometida integração proprioceptiva e sensório-motora. Em referência às teorias de dupla-tarefa, possivelmente devido à atenção dividida e à priorização de tarefas, a dupla-tarefa cognitiva e a tarefa postural mais difíceis perturbam o EP nesses pacientes.

Keywords:

Botulinum Toxin - Torticollis - Cognition - Posture - Postural Balance

Palavras-chave:

Toxinas Botulínicas - Torcicolo - Cognição - Postura - Equilíbrio Postural

Ethical approval:

Cukurova University, Faculty of Medicine Ethics Committee approved the study protocol (protocol number: 78-2016.06.01_32).


Informed consent:

Informed consent was obtained from all participants included in the study.




Publication History

Received: 29 November 2019

Accepted: 24 March 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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