Disclosures: Cedric Magaway, MBS: No financial relationships or conflicts of interest

Case Diagnosis: A 84-year-old female with six-year history of cervical dystonia.

Case Description: The patient presented with severe retrocollis that caused significant discomfort and limited her ability to ambulate longer distances. She had received treatment with routine botulinum toxin injections, which provided temporary and limited relief. She has been on multiple medications to help improve symptoms, including baclofen, clonazepam, amitriptyline, tizanidine, quetiapine, and gabapentin. Her symptoms worsened after numerous attempts to wean off some of these medications. Additionally, she reported no relief with bracing, physical therapy, TENs, heat and cold modalities and creams. Our initial treatment included injection of 250 units of incobotulinum toxin A into the semispinalis capitis, splenius cervicis, splenius capitis, and levator scapulae bilaterally.

Setting: OutpatientAssessment/

Results: At the 4-week post-injection follow-up, the patient reported improvement of her head position and comfort. She could maintain a neutral head position at rest and walk for longer distances. When her gait was evaluated, her head would abruptly and forcefully posture into extension, causing loss of balance. To evaluate her gait more safely, a rolling walker was given. A significant and prolonged correction of her head position was observed while ambulating with the walker. Even when her head began to posture in extension, she was able to easily return to midline. She had never used any assistive device for walking in the past and thus was encouraged to use her walker as a “sensory trick”.

Discussion: Sensory tricks are specific maneuvers that have been documented as temporarily beneficial for symptomatic treatment for dystonia postures. Dystonia patients should be encouraged to identify and utilize sensory tricks as part of their treatment plan. To our knowledge, this is the first reported case of the sensory trick of ambulating with a walker to help improve retrocollis.

Conclusion: Sensory tricks are risk-free treatments that can provide benefit to patients with cervical dystonia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unexpected-sensory-trick-to-help-control-neck-position-in-a-patient-with-severe-retrocollis-a-case-report/