Slow, repetitive, or twisting movements, known as dystonia, may occur after brain injury. Though the exact cause is unclear, researchers believe this results from damage to the parts of the brain that control movement, particularly the basal ganglia.
Fortunately, the brain is resilient in its ability to rewire itself through neuroplasticity. In this article we’ll further discuss the most common signs of dystonia, why it occurs, and how to manage dystonia after traumatic brain injury.
What Causes Dystonia After Brain Injury?
To firmly grasp why dystonia after brain injury occurs, it first helps to understand how movement works.
Movement is a combination of agonist muscles and antagonist muscles working together. The agonist muscles are responsible for initiating movement by contracting. The antagonist muscles inhibit movement by relaxing, which produces opposing force to the agonist muscles.
For example, in order to flex your bicep, your triceps must relax to allow the movement to occur. If both the bicep and triceps flex at the same time, coordinated movement cannot occur.
The agonist and antagonist muscles are controlled by the basal ganglia, a cluster of neurons deep inside the cerebral cortex. The basal ganglia control exactly which and when muscles need to activate or relax. This is done by sending inhibitory or excitatory signals to the appropriate muscle groups.
When areas of the brain responsible for movement are impacted by brain injury, particularly the basal ganglia, the harmonious signaling process is disrupted and an individual may begin to experience uncontrollable twisting movements, or dystonia.
It’s important to note that while there are other ways an individual can develop dystonia, such as genetics, this article will focus on acquired dystonia that occurs after a brain injury.
Symptoms of Dystonia After TBI
Acquired dystonia after brain injury is divided into three sections, depending on the number of body parts affected. For example, focal dystonia impacts only one part of the body. Segmental dystonia strikes two or more adjacent muscle groups at once, and general dystonia affects all parts of the body.
Early signs of dystonia may include trembling, foot cramping, rapid blinking, or dropping items frequently. The most common areas where repetitive twitching can occur are the eyes, jaw, mouth, neck, arms, and legs. Although less common, dystonia can also cause the torso to bend or writhe.
Oftentimes though, symptoms aren’t noticeable until several weeks or months after traumatic brain injury. This is because most symptoms of dystonia tend to be paroxysmal, meaning they occur in episodes or attacks, rather than all at once.
In this way, dystonia is similar to but distinctly different from spasticity, a condition characterized by muscle stiffening. While both conditions are caused by a disruption of signals from the brain, the onset of spasticity is often rapid and symptoms may show as early as one week.
Thus, it is essential to speak with your doctor or therapist if you’re experiencing new symptoms after a traumatic brain injury.
Managing Dystonia After Brain Injury
Dystonia causes slow, repetitive, or twisting movements which can get in the way of daily living activities. Fortunately, these movements can be effectively managed with proper treatment, when often involves a combination of methods.
The following are several options that can help manage dystonia after brain injury:
- Medications: Certain prescribed oral medications, like baclofen, help ease symptoms by affecting neurotransmitters. However, they can cause unwanted side effects and often work best in conjunction with physical therapy.
- Botox (Botulinum Toxin) Injections: This medication helps decrease muscle spasms by blocking the release of acetylcholine, which is the neurotransmitter that causes muscles to contract.
- Physical Therapy: Therapeutic exercises practiced with high repetition help stimulate neuroplasticity. As the brain strengthens its connections that control movement, conditions affected by movement like dystonia naturally improve. This is the least invasive and sometimes most effective treatment.
- Deep Brain Stimulation: An electrode can be surgically implanted into the brain to send high-frequency signals to the areas of the brain that control involuntary muscle movement. It has been used to successfully treat tens of thousands of individuals with tremors or dystonia.
- Surgery: A surgical procedure called a thalamotomy involves removing the thalamus, a part of the brain that controls some involuntary muscle movements. This is a permanent, highly invasive treatment that should be used as a last resort once all other treatments have been exhausted.
Physical therapy in particular is an attractive management technique because it helps rebuild the connection between the brain and muscles by activating neuroplasticity. Neuroplasticity is your brain’s ability to repair itself and create new neural pathways – which is best enhanced through repetitive, therapeutic exercise.
As communication is restored, dystonia slowly decreases, allowing you to move your muscles with greater ease. Some individuals need relief from the symptoms of dystonia before they can exercise comfortably, which is why a combination of treatments may be helpful.
Overcoming Dystonia After Traumatic Brain Injury
Dystonia is a movement disorder that can occur after a traumatic brain injury. It’s characterized by slow, repetitive, twisting movements that may come and go in episodes.
Partaking in physical therapy can help relieve symptoms of dystonia by promoting neuroplasticity. There are also other management techniques available, and you can talk to your therapist to find the best approach for you.
The post Dystonia After Brain Injury: Why It Occurs and How to Manage It appeared first on Flint Rehab.
