Preamble

Research Progress on the Application of Neuromuscular Training Nursing in Spasmodic Torticollis
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.

Abstract

Spasmodic torticollis (ST), a localized dystonia, significantly impairs the quality of life of affected patients. This review focuses on the progress of neuromuscular training nursing applications in ST. Through a comprehensive analysis of relevant research, this paper elucidates the mechanisms and practical effects of neuromuscular training nursing in improving muscle function, correcting posture, and enhancing self-care abilities. This nursing model demonstrates significant advantages in assisting and promoting patient recovery, providing new perspectives and directions for the clinical treatment and nursing care of spasmodic torticollis.

Keywords

Spasmodic torticollis; Neuromuscular training nursing; Rehabilitation progress

Spasmodic torticollis is a condition characterized primarily by paroxysmal involuntary contractions of neck muscles, such as the sternocleidomastoid and trapezius, leading to the twisting or tilting of the head and neck to one side. Its etiology is complex and may be related to various factors, including genetics and basal ganglia lesions. Traditional treatments include pharmacotherapy, injections, and surgery; however, these often have certain limitations. As an emerging rehabilitation nursing method, neuromuscular training nursing has been gradually applied to the treatment of ST in recent years. By employing specific training methods to intervene in the patient's neuromuscular system, it aims to improve muscle function and alleviate muscle spasms. Numerous studies have preliminary demonstrated its positive role in ST rehabilitation, warranting a detailed review of relevant research progress.

1. Pathogenesis of Spasmodic Torticollis

The exact pathogenesis of spasmodic torticollis remains not fully understood. It is currently widely believed that neuromodulatory dysfunction in areas such as the basal ganglia, thalamus, and brainstem plays a key role. Neuroimaging studies have found structural and functional abnormalities in the basal ganglia of some ST patients, with differences in volume and signal intensity in regions such as the internal globus pallidus and the ventral intermediate nucleus of the thalamus compared to healthy individuals. Genetic factors also account for a proportion of ST cases; familial spasmodic torticollis usually follows an autosomal dominant inheritance pattern. Several pathogenic genes, such as TorsinA, have been identified. In individuals with these genetic mutations, the normal function of nerve cells may be compromised, thereby increasing the susceptibility to spasmodic torticollis.

2. Theoretical Basis of Neuromuscular Training Nursing

Neuromuscular training nursing is grounded in the theory of neuroplasticity, which posits that the nervous system possesses the capacity to undergo structural and functional changes in response to external environmental stimuli. Targeted training can promote the remodeling of neural pathways and the recovery of function. In ST patients, neck muscles remain in an abnormal state of contraction for prolonged periods, disrupting normal neuromuscular feedback mechanisms. Neuromuscular training nursing intervenes through specific movements—such as neck muscle stretching and posture control training—to restore normal motor patterns. Proprioceptive Neuromuscular Facilitation (PNF) is another critical theoretical pillar. This technique emphasizes stimulating proprioceptors to facilitate muscle contraction and relaxation, enhancing muscle coordination and joint range of motion. In ST, PNF can effectively improve the proprioception of neck muscles, correct abnormal motor patterns, and enhance muscle control.

3. Specific Methods and Application Research of Neuromuscular Training Nursing

3.1 Neck Muscle Stretching Training

Neck muscle stretching is a fundamental component of neuromuscular training nursing. Long-term muscle spasms lead to shortening and fibrosis of neck muscles, further exacerbating torticollis symptoms. Targeted stretching can elongate contracted muscles, relieve tension, and improve the cervical range of motion. Experimental studies have divided ST patients into intervention and control groups, where the intervention group received several weeks of stretching training for the sternocleidomastoid, trapezius, and other affected muscles. Results indicated that the intervention group achieved significantly better neck mobility and symptom relief compared to the control group.

3.2 Posture Control Training

Posture control training aims to help patients correct abnormal head and neck postures and restore normal body alignment. This method emphasizes postural awareness in daily life, training patients to maintain correct head and neck positions while sitting, standing, and walking to reduce the burden on neck muscles. Research utilizing postural feedback devices to monitor changes and provide real-time correction has shown that patients can better master posture control techniques, leading to significant improvements in posture scores and overall quality of life.

3.3 Breathing Training

Respiration is closely linked to neck muscle activity; abnormal breathing patterns can exacerbate neck tension. As part of neuromuscular training nursing, breathing training guides patients through deep breathing and abdominal breathing to regulate respiratory rhythm and relax neck muscles. Studies show that combined training significantly reduces muscle tension and improves respiratory function. Researchers believe that breathing training indirectly influences neck muscle tone by regulating the autonomic nervous system, thereby alleviating torticollis symptoms.

3.4 Neuromuscular Electrical Stimulation (NMES) Assisted Training

Neuromuscular electrical stimulation (NMES) uses electrical currents to stimulate nerves and induce muscle contractions. When integrated into neuromuscular training nursing, NMES enhances training effects by promoting blood circulation, increasing muscle metabolism, and stimulating nerve endings to facilitate functional recovery. Studies comparing NMES combined with stretching versus stretching alone found that the combined approach led to more significant improvements in muscle strength, endurance, and symptom relief.

3.5 Motor Relearning Program (MRP)

The Motor Relearning Program emphasizes active participation and repetitive practice to relearn normal movement patterns. In ST treatment, MRP includes active neck movement training to help patients regain voluntary control over their muscles. Research indicates that after several weeks of training, patients show significantly improved motor function scores and activities of daily living (ADL). Researchers note that MRP stimulates intrinsic learning motivation and promotes functional remodeling of the neuromuscular system.

4. Impact of Neuromuscular Training Nursing on ST Patients

4.1 Improvement of Muscle Function

Neuromuscular training nursing effectively improves muscle function through stretching and strength training, enhancing muscle flexibility and coordination. Multiple studies have shown that patients receiving this care perform significantly better in muscle strength tests and range of motion measurements, indicating a restoration of normal neck muscle function.

4.2 Pain Alleviation

ST patients often suffer from neck pain that severely impacts their quality of life. Neuromuscular training nursing alleviates pain by reducing muscle tension and intramuscular pressure through stretching and relaxation. Furthermore, improving posture and movement patterns reduces abnormal stress on muscles. Clinical observations using the Visual Analogue Scale (VAS) have shown significant reductions in pain scores following long-term training.

4.3 Postural Correction

A primary goal of this nursing intervention is the correction of abnormal posture. Through posture control and motor relearning, patients gradually learn to maintain correct alignment. Long-term adherence not only improves physical appearance but also reduces the mechanical load on neck muscles, facilitating recovery. Significant decreases in postural abnormality scores have been documented in patients undergoing these interventions.

4.4 Improvement in Quality of Life

By improving muscle function, alleviating pain, and correcting posture, neuromuscular training nursing ultimately enhances the quality of life for ST patients. Patients report improved self-care abilities (e.g., dressing, eating) and a more positive psychological state, characterized by increased confidence and social engagement. Quality of life assessment scales show significant improvements across physical and social functioning dimensions.

5. Conclusion

As an emerging rehabilitation nursing approach, neuromuscular training nursing holds significant value in the treatment of spasmodic torticollis. By improving muscle function, correcting posture, and enhancing quality of life, it offers new hope for patient recovery. As research continues to mature, this nursing model is expected to play an increasingly vital role in the comprehensive management of spasmodic torticollis.

References

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\cite{2} Clinical observation of massage techniques combined with home rehabilitation nursing for pediatric congenital muscular torticollis. Journal of Clinical Chinese Medicine, 2024, 36(8):1595-1599.
\cite{3} Application of narrative nursing in school-age children with congenital muscular torticollis. Chinese Clinical Nursing, 2022, 14(12):736-738.
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