Table 5.

Occupational therapy approaches in functional dystonia.

OT Intervention	Examples	Rationale
Distraction strategies	- Promote normal movement through use of physical (i.e., manipulate item in hand) and cognitive (i.e., counting backwards from 100 by 3) strategies	Distraction reduces the focus on the altered posture/movement
Change posture/position	- Use gravity eliminated positions to achieve improved performance with functional tasks and posture at rest - Avoid prolonged postures at end ranges of motion	Changing the body or limb posture relative to gravity alters sensory input and can minimize abnormal posturing allowing for active movement
Graded task performance	- Focus on reintegration of affected limb with activity-based functional tasks	Begin slowly with goals for performance set in conjunction with the patient to promote intrinsic motivation. Gradually incorporate segmental limb movements then full body using functional tasks
Elicit automatic movement	- Ball toss, weight bearing in quadruped, sit on therapy ball	Reflexive and automatic movements are often retained and can be used to demonstrate to the individual that typical movement is available. Increasing speed of movement might reduce posturing
Motor retraining	- Mirror therapy - Visualization - Mental Imagery	Actual vs. perceived body/limb/joint posture might be disparate. Visualization helps reduce the disparity
Sensory retraining	With eyes closed: - Palpate and identify raised letters of alphabet - Use limb to search for coins in rice - Put shapes into matched holes	Actual vs. perceived body/limb/joint posture might be disparate. Visualization helps reduce the disparity
Coping strategies	- Guided meditation - Progressive muscle relaxation - Diaphragmatic breathing	Patient's ability to handle stress and anxiety and providing technique to allow relaxation of muscles
Sensory modulation training	- Explore and use different sensory tools based on preference (i.e., eating strong tasting mint/candy, weighted blanket, etc.) - Develop and use a Sensory Diet (planned use) to facilitate self-awareness of positive change	To assist with process of regulating specific behavioral responses to sensory stimuli
Interventions to avoid/limit use of	- Splinting to prevent non-use of limb - Adaptive aids - May consider use at rest (i.e., positional splint while sleeping)	Attempting to alter the posturing passively may result in increased muscle contraction of already overactive musclesThe goal is to reduce attention to the altered posture or movement and not provide reliance on aids
Additional considerations	- Develop functional goals vs. symptom-based goals - Encourage normal movements through participation in functional activities	Altered postures and difficulty moving can result in reduced activity levels and to promote normal activity where possible