<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03247868</url>
  </required_header>
  <id_info>
    <org_study_id>SPRIntFdG</org_study_id>
    <nct_id>NCT03247868</nct_id>
  </id_info>
  <brief_title>A Multimodal Approach to Cervical Dystonia Treatment With Association of Botulinum Toxin and Motor Learning Techniques</brief_title>
  <acronym>SPRInt</acronym>
  <official_title>Multimodal Treatment of Cervical Dystonia With Botulinum Toxin Injections Associated With a Sensory-motor Perceptive Rehabilitation Integrated Approach (SPRInt) Based on Motor Learning Techniques</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Fondazione Don Carlo Gnocchi Onlus</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Fondazione Don Carlo Gnocchi Onlus</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      the aim of this study protocol is to describe, using a longitudinal study, a multimodal&#xD;
      approach of treatment of cervical dystonia with botulinum toxin (BoNTA) and a new&#xD;
      rehabilitation protocol named SPRInt (Sensory-motor perceptive rehabilitation integrated)&#xD;
      approach based on motor learning techniques and spatial rehabilitation.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Longitudinal study utilizing a multimodal treatment protocol developing in six months time:&#xD;
&#xD;
      Phase 1 : BoNTA injections localized in dystonic cervical muscles with EMG/US guides&#xD;
      performed after polygraphy and kinematic analysis of cervical region Times: T0: pre&#xD;
      treatment; T1: 6 weeks after T0 considered BoNTA pharmacological peak effect; T2: 12 weeks&#xD;
      after T0 considered from guidelines and pharmaceutical data sheet the lowest BoNTA effect.&#xD;
&#xD;
      Phase 2: BoNTA performed in the same way of Phase 1 associated to SPRInt protocol Times: T2:&#xD;
      before combination of BoNTA and rehabilitation treatment (18 sessions of 45 minutes three&#xD;
      times a week); T3: 6 weeks after T2 considered BoNTA pharmacological peak effect and the end&#xD;
      of SPRInt protocol; T4: 12 weeks after T2 considered from guidelines and pharmaceutical data&#xD;
      sheet the lowest BoNTA effect and follow up of SPRInt-consolidation.&#xD;
&#xD;
      The SPRInt approach aims are to improve body perception, posture and movement quality and to&#xD;
      restore body axis by using specific sensory feedbacks, both intrinsic (IFB) and extrinsic&#xD;
      (EFB), and motor exercises (ME) with specific rhythmic temporal structure.The ME can be&#xD;
      focused on different body parts (eyes, head, neck, trunk, arm) and involve different spatial&#xD;
      planes (frontal, sagittal, horizontal, multiplanar).&#xD;
&#xD;
      The exercises can be performed with eyes closed and with an external passive motor leading in&#xD;
      order to improve proprioception and facilitate sensory integration by excluding visual or&#xD;
      verbal information that can be misleading for the patient. The ability to perceive and&#xD;
      integrate intrinsic feedback is the fundamental element to create mental image that define&#xD;
      body scheme and motor behaviour.&#xD;
&#xD;
      The extrinsic feedback can be continuous or discontinuous (on-off timing) and gives the&#xD;
      patient information about the performance or result by positive or negative reinforcement;&#xD;
      this process can be important to motivate and empower the patient in reaching new skills.&#xD;
&#xD;
      The final goal for the patient is to reinforce and retain the informations collected with&#xD;
      working memory and then stored with the consolidation process which ends in learning new&#xD;
      skills (ie rescue postural axis) and improving motor tasks (ie move the head in the opposite&#xD;
      position).&#xD;
&#xD;
      At each time point these test are performed:&#xD;
&#xD;
        -  CLINICAL SCALES i. Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)&#xD;
&#xD;
             1. Severity&#xD;
&#xD;
             2. Disability&#xD;
&#xD;
             3. Pain ii. Quality of life iii. Depression Beck Scale iv. Zung Self Rating Anxiety&#xD;
                Scale v. Rey Test to test visuo spatial abilities&#xD;
&#xD;
        -  MOVEMENT ANALYSIS and KINEMATIC AND EMG MAPPING of cervical region ( head and neck)&#xD;
&#xD;
        -  FUNCTIONAL MAGNETIC RESONANCE BRAIN STUDY to perform brain measurements of functional&#xD;
           connectivity (resting state-Default Mode Network), morphometry (volume, area, cortical&#xD;
           thickness, cortical curvature, node degree) and tractography.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Recruiting</last_known_status>
  <start_date>March 16, 2016</start_date>
  <completion_date type="Anticipated">June 30, 2018</completion_date>
  <primary_completion_date type="Anticipated">March 28, 2018</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <intervention_model>Sequential Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Dystonia phenomenology improvement</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>a clinical assessment of dystonia will be conducted at each study visit using TWSTRS</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>quality of life</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>a clinical assessment of dystonia severity will be conducted at each study visit using quality of life scale (EQ5D5L)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>brain plasticity</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>study of functional connectivity using functional magnetic resonance</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>depression</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>depression scale (BECK)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>anxiety</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>anxiety scale (ZUNG)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>structural grey matter plasticity</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>brain study of morphometry using functional magnetic resonance</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>structural white matter plasticity</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>tractography of brain areas using functional magnetic resonance</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>kinematic assessment of dystonia severity</measure>
    <time_frame>every six weeks during six months time</time_frame>
    <description>visit with optoelectronic system</description>
  </secondary_outcome>
  <number_of_arms>1</number_of_arms>
  <enrollment type="Anticipated">20</enrollment>
  <condition>Cervical Dystonia,Primary</condition>
  <arm_group>
    <arm_group_label>Botulinum toxin+SPRInt protocol</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>patients affected by cervical dystonia receive botulinum toxin treatment (EMG-US guided injections in dystonic muscles) for two times at T0 and T2; after T2 patients are treated also with SPRInt rehabilitation protocol based on motor learning techniques.</description>
  </arm_group>
  <intervention>
    <intervention_type>Combination Product</intervention_type>
    <intervention_name>Botulinum Toxin+SPRInt</intervention_name>
    <description>Botulinum toxin injections in association with rehabilitative approach to cervical dystonia (SPRInt)</description>
    <arm_group_label>Botulinum toxin+SPRInt protocol</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  more than 18 yo&#xD;
&#xD;
          -  diagnosis of idiopathic cervical dystonia&#xD;
&#xD;
          -  disease duration more than 6 months&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  diagnosis of secondary dystonia on previously performed neuroimaging data (ie&#xD;
             structural lesion of cervical spine, vascular or traumatic brain injuries)&#xD;
&#xD;
          -  history of neuroleptic drug treatment (antidopaminergic drugs)&#xD;
&#xD;
          -  associated neurological illness&#xD;
&#xD;
          -  botulinum toxin treatment in the 3 previous months before recruitment&#xD;
&#xD;
          -  head tremor without dystonic posturing&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>80 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Anna Castagna, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>IRCCS Fondazione Don Gnocchi</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Anna Castagna, MD</last_name>
    <phone>+39 02 40308075</phone>
    <email>acastagna@dongnocchi.it</email>
  </overall_contact>
  <location>
    <facility>
      <name>IRCCS Fondazione Don Gnocchi</name>
      <address>
        <city>Milano</city>
        <state>MI</state>
        <zip>20148</zip>
        <country>Italy</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Anna Castagna, MD</last_name>
      <phone>+3902 40308075</phone>
      <email>acastagna@dongnocchi.it</email>
    </contact>
  </location>
  <location_countries>
    <country>Italy</country>
  </location_countries>
  <reference>
    <citation>Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013 Jun 15;28(7):863-73. doi: 10.1002/mds.25475. Epub 2013 May 6.</citation>
    <PMID>23649720</PMID>
  </reference>
  <reference>
    <citation>Boccagni C, Carpaneto J, Micera S, Bagnato S, Galardi G. Motion analysis in cervical dystonia. Neurol Sci. 2008 Dec;29(6):375-81. doi: 10.1007/s10072-008-1033-z. Epub 2008 Nov 29.</citation>
    <PMID>19043661</PMID>
  </reference>
  <reference>
    <citation>Walter U, Dressler D. Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Rev Neurother. 2014 Aug;14(8):923-36. doi: 10.1586/14737175.2014.936387. Epub 2014 Jul 21.</citation>
    <PMID>25046267</PMID>
  </reference>
  <reference>
    <citation>Prudente CN, Hess EJ, Jinnah HA. Dystonia as a network disorder: what is the role of the cerebellum? Neuroscience. 2014 Feb 28;260:23-35. doi: 10.1016/j.neuroscience.2013.11.062. Epub 2013 Dec 11.</citation>
    <PMID>24333801</PMID>
  </reference>
  <reference>
    <citation>Delnooz CC, Pasman JW, van de Warrenburg BP. Dynamic cortical gray matter volume changes after botulinum toxin in cervical dystonia. Neurobiol Dis. 2015 Jan;73:327-33. doi: 10.1016/j.nbd.2014.10.013. Epub 2014 Oct 28.</citation>
    <PMID>25447226</PMID>
  </reference>
  <reference>
    <citation>Delnooz CC, Pasman JW, Beckmann CF, van de Warrenburg BP. Task-free functional MRI in cervical dystonia reveals multi-network changes that partially normalize with botulinum toxin. PLoS One. 2013 May 1;8(5):e62877. doi: 10.1371/journal.pone.0062877. Print 2013.</citation>
    <PMID>23650536</PMID>
  </reference>
  <reference>
    <citation>De Pauw J, Van der Velden K, Meirte J, Van Daele U, Truijen S, Cras P, Mercelis R, De Hertogh W. The effectiveness of physiotherapy for cervical dystonia: a systematic literature review. J Neurol. 2014 Oct;261(10):1857-65. doi: 10.1007/s00415-013-7220-8. Epub 2014 Jan 12.</citation>
    <PMID>24413637</PMID>
  </reference>
  <reference>
    <citation>van den Dool J, Visser B, Koelman JH, Engelbert RH, Tijssen MA. Cervical dystonia: effectiveness of a standardized physical therapy program; study design and protocol of a single blind randomized controlled trial. BMC Neurol. 2013 Jul 15;13:85. doi: 10.1186/1471-2377-13-85.</citation>
    <PMID>23855591</PMID>
  </reference>
  <reference>
    <citation>Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, Armstrong MJ, Gloss D, Potrebic S, Jankovic J, Karp BP, Naumann M, So YT, Yablon SA. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016 May 10;86(19):1818-26. doi: 10.1212/WNL.0000000000002560. Epub 2016 Apr 18.</citation>
    <PMID>27164716</PMID>
  </reference>
  <reference>
    <citation>Curra A, Trompetto C, Abbruzzese G, Berardelli A. Central effects of botulinum toxin type A: evidence and supposition. Mov Disord. 2004 Mar;19 Suppl 8:S60-4. doi: 10.1002/mds.20011.</citation>
    <PMID>15027056</PMID>
  </reference>
  <reference>
    <citation>Kitago T, Krakauer JW. Motor learning principles for neurorehabilitation. Handb Clin Neurol. 2013;110:93-103. doi: 10.1016/B978-0-444-52901-5.00008-3.</citation>
    <PMID>23312633</PMID>
  </reference>
  <verification_date>July 2017</verification_date>
  <study_first_submitted>July 27, 2017</study_first_submitted>
  <study_first_submitted_qc>August 11, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 14, 2017</study_first_posted>
  <last_update_submitted>August 11, 2017</last_update_submitted>
  <last_update_submitted_qc>August 11, 2017</last_update_submitted_qc>
  <last_update_posted type="Actual">August 14, 2017</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Dystonia</mesh_term>
    <mesh_term>Dystonic Disorders</mesh_term>
    <mesh_term>Torticollis</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Botulinum Toxins</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03247868
org study id: SPRIntFdG
nct id: NCT03247868
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
is us export: No
the aim of this study protocol is to describe, using a longitudinal study, a multimodal
      approach of treatment of cervical dystonia with botulinum toxin (BoNTA) and a new
      rehabilitation protocol named SPRInt (Sensory-motor perceptive rehabilitation integrated)
      approach based on motor learning techniques and spatial rehabilitation.
Longitudinal study utilizing a multimodal treatment protocol developing in six months time:

      Phase 1 : BoNTA injections localized in dystonic cervical muscles with EMG/US guides
      performed after polygraphy and kinematic analysis of cervical region Times: T0: pre
      treatment; T1: 6 weeks after T0 considered BoNTA pharmacological peak effect; T2: 12 weeks
      after T0 considered from guidelines and pharmaceutical data sheet the lowest BoNTA effect.

      Phase 2: BoNTA performed in the same way of Phase 1 associated to SPRInt protocol Times: T2:
      before combination of BoNTA and rehabilitation treatment (18 sessions of 45 minutes three
      times a week); T3: 6 weeks after T2 considered BoNTA pharmacological peak effect and the end
      of SPRInt protocol; T4: 12 weeks after T2 considered from guidelines and pharmaceutical data
      sheet the lowest BoNTA effect and follow up of SPRInt-consolidation.

      The SPRInt approach aims are to improve body perception, posture and movement quality and to
      restore body axis by using specific sensory feedbacks, both intrinsic (IFB) and extrinsic
      (EFB), and motor exercises (ME) with specific rhythmic temporal structure.The ME can be
      focused on different body parts (eyes, head, neck, trunk, arm) and involve different spatial
      planes (frontal, sagittal, horizontal, multiplanar).

      The exercises can be performed with eyes closed and with an external passive motor leading in
      order to improve proprioception and facilitate sensory integration by excluding visual or
      verbal information that can be misleading for the patient. The ability to perceive and
      integrate intrinsic feedback is the fundamental element to create mental image that define
      body scheme and motor behaviour.

      The extrinsic feedback can be continuous or discontinuous (on-off timing) and gives the
      patient information about the performance or result by positive or negative reinforcement;
      this process can be important to motivate and empower the patient in reaching new skills.

      The final goal for the patient is to reinforce and retain the informations collected with
      working memory and then stored with the consolidation process which ends in learning new
      skills (ie rescue postural axis) and improving motor tasks (ie move the head in the opposite
      position).

      At each time point these test are performed:

        -  CLINICAL SCALES i. Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)

             1. Severity

             2. Disability

             3. Pain ii. Quality of life iii. Depression Beck Scale iv. Zung Self Rating Anxiety
                Scale v. Rey Test to test visuo spatial abilities

        -  MOVEMENT ANALYSIS and KINEMATIC AND EMG MAPPING of cervical region ( head and neck)

        -  FUNCTIONAL MAGNETIC RESONANCE BRAIN STUDY to perform brain measurements of functional
           connectivity (resting state-Default Mode Network), morphometry (volume, area, cortical
           thickness, cortical curvature, node degree) and tractography.
intervention model: Sequential Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: Dystonia phenomenology improvement
time frame: every six weeks during six months time
description: a clinical assessment of dystonia will be conducted at each study visit using TWSTRS
measure: quality of life
time frame: every six weeks during six months time
description: a clinical assessment of dystonia severity will be conducted at each study visit using quality of life scale (EQ5D5L)
measure: brain plasticity
time frame: every six weeks during six months time
description: study of functional connectivity using functional magnetic resonance
measure: depression
time frame: every six weeks during six months time
description: depression scale (BECK)
measure: anxiety
time frame: every six weeks during six months time
description: anxiety scale (ZUNG)
measure: structural grey matter plasticity
time frame: every six weeks during six months time
description: brain study of morphometry using functional magnetic resonance
measure: structural white matter plasticity
time frame: every six weeks during six months time
description: tractography of brain areas using functional magnetic resonance
measure: kinematic assessment of dystonia severity
time frame: every six weeks during six months time
description: visit with optoelectronic system
arm group label: Botulinum toxin+SPRInt protocol
arm group type: Experimental
description: patients affected by cervical dystonia receive botulinum toxin treatment (EMG-US guided injections in dystonic muscles) for two times at T0 and T2; after T2 patients are treated also with SPRInt rehabilitation protocol based on motor learning techniques.
intervention type: Combination Product
intervention name: Botulinum Toxin+SPRInt
description: Botulinum toxin injections in association with rehabilitative approach to cervical dystonia (SPRInt)
arm group label: Botulinum toxin+SPRInt protocol
criteria: 
gender: All
minimum age: 18 Years
maximum age: 80 Years
healthy volunteers: No
last name: Anna Castagna, MD
role: Principal Investigator
affiliation: IRCCS Fondazione Don Gnocchi
last name: Anna Castagna, MD
phone: +39 02 40308075
email: acastagna@dongnocchi.it
facility: 
status: Recruiting
contact: 
country: Italy
citation: Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013 Jun 15;28(7):863-73. doi: 10.1002/mds.25475. Epub 2013 May 6.
PMID: 23649720
citation: Boccagni C, Carpaneto J, Micera S, Bagnato S, Galardi G. Motion analysis in cervical dystonia. Neurol Sci. 2008 Dec;29(6):375-81. doi: 10.1007/s10072-008-1033-z. Epub 2008 Nov 29.
PMID: 19043661
citation: Walter U, Dressler D. Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Rev Neurother. 2014 Aug;14(8):923-36. doi: 10.1586/14737175.2014.936387. Epub 2014 Jul 21.
PMID: 25046267
citation: Prudente CN, Hess EJ, Jinnah HA. Dystonia as a network disorder: what is the role of the cerebellum? Neuroscience. 2014 Feb 28;260:23-35. doi: 10.1016/j.neuroscience.2013.11.062. Epub 2013 Dec 11.
PMID: 24333801
citation: Delnooz CC, Pasman JW, van de Warrenburg BP. Dynamic cortical gray matter volume changes after botulinum toxin in cervical dystonia. Neurobiol Dis. 2015 Jan;73:327-33. doi: 10.1016/j.nbd.2014.10.013. Epub 2014 Oct 28.
PMID: 25447226
citation: Delnooz CC, Pasman JW, Beckmann CF, van de Warrenburg BP. Task-free functional MRI in cervical dystonia reveals multi-network changes that partially normalize with botulinum toxin. PLoS One. 2013 May 1;8(5):e62877. doi: 10.1371/journal.pone.0062877. Print 2013.
PMID: 23650536
citation: De Pauw J, Van der Velden K, Meirte J, Van Daele U, Truijen S, Cras P, Mercelis R, De Hertogh W. The effectiveness of physiotherapy for cervical dystonia: a systematic literature review. J Neurol. 2014 Oct;261(10):1857-65. doi: 10.1007/s00415-013-7220-8. Epub 2014 Jan 12.
PMID: 24413637
citation: van den Dool J, Visser B, Koelman JH, Engelbert RH, Tijssen MA. Cervical dystonia: effectiveness of a standardized physical therapy program; study design and protocol of a single blind randomized controlled trial. BMC Neurol. 2013 Jul 15;13:85. doi: 10.1186/1471-2377-13-85.
PMID: 23855591
citation: Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, Armstrong MJ, Gloss D, Potrebic S, Jankovic J, Karp BP, Naumann M, So YT, Yablon SA. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016 May 10;86(19):1818-26. doi: 10.1212/WNL.0000000000002560. Epub 2016 Apr 18.
PMID: 27164716
citation: Curra A, Trompetto C, Abbruzzese G, Berardelli A. Central effects of botulinum toxin type A: evidence and supposition. Mov Disord. 2004 Mar;19 Suppl 8:S60-4. doi: 10.1002/mds.20011.
PMID: 15027056
citation: Kitago T, Krakauer JW. Motor learning principles for neurorehabilitation. Handb Clin Neurol. 2013;110:93-103. doi: 10.1016/B978-0-444-52901-5.00008-3.
PMID: 23312633
responsible party type: Sponsor
mesh term: Dystonia
mesh term: Dystonic Disorders
mesh term: Torticollis
mesh term: Botulinum Toxins
sharing ipd: No