Special Issue| Volume 22, ISSUE 2, P125-135, April 2009

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Neuroimaging Characteristics of Patients with Focal Hand Dystonia

Published:February 13, 2009DOI:


      Narrative Review

      Advances in structural and functional imaging have provided both scientists and clinicians with information about the neural mechanisms underlying focal hand dystonia (FHd), a motor disorder associated with aberrant posturing and patterns of muscle contraction specific to movements of the hand. Consistent with the hypothesis that FHd is the result of reorganization in cortical fields, studies in neuroimaging have confirmed alterations in the topography and response properties of somatosensory and motor areas of the brain. Noninvasive stimulation of these regions also demonstrates that FHd may be due to reductions in inhibition between competing sensory and motor representations. Compromises in neuroanatomical structure, such as white matter density and gray matter volume, have also been identified through neuroimaging methods. These advances in neuroimaging have provided clinicians with an expanded understanding of the changes in the brain that contribute to FHd. These findings should provide a foundation for the development of retraining paradigms focused on reversing overlapping sensory representations and interactions between brain regions in patients with FHd. Continued collaborations between health professionals who treat FHd and research scientists who examine the brain using neuroimaging tools are imperative for answering difficult questions about patients with specific movement disorders.
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      JHT Read for Credit

      Quiz: Article # 122

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
      • #1.
        The article suggests that
        • a.
          emotional disturbances are the root cause of focal hand dystonia
        • b.
          sub clinical closed head trauma is the most common root cause of focal hand dystonia
        • c.
          the brain is at the center of the disturbances that play into the clinical manifestation of focal hand dystonia
        • d.
          the peripheral nervous system is the primary locus of the disturbances that play into the clinical manifestation of focal hand dystonia
      • #2.
        A significant factor in the cause of focal hand dystonia often is overlapping sensory representations in the
        • a.
        • b.
          peripheral nervous system
        • c.
          dorsal root ganglia
        • d.
          anterior horn cells
      • #3.
        The information presented in this paper is derived primarily from
        • a.
          CAT scans
        • b.
          X-ray techniques
        • c.
          neuroimaging techniques that will soon be able to be performed in most hand therapy clinical settings
        • d.
          neuroimaging techniques that cannot be performed in the traditional hand therapy clinical setting
      • #4.
        The most common drug intervention is injection of
        • a.
          norepinephrine to weaken forearm and hand muscles
        • b.
          epinephrine to strengthen forearm and hand muscles
        • c.
          botulinum toxin to weaken forearm and hand muscles
        • d.
          botulinium toxin to strengthen forearm and hand muscles
      • #5.
        The following technique is used to indirectly measure neural activity
        • a.
          CAT scan
        • b.
        • c.
        • d.
          enhanced X-ray
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.