The Hanger Reflex: An Inexpensive and Non-invasive Therapeutic Modality for Dystonia and Neurological Disorders

A Case of Bilateral Auricular Dystonia With Both Sensory Trick and Reverse Sensory Trick Successfully Treated With Botulinum Toxin Therapy

The patient was a 39-year-old male who presented to our hospital with a 15-year history of sustained involuntary movements of both auricles. A phenomenon suspected to be a sensory trick was observed, in which pressing on the frontal region above the eyebrows ceased the involuntary movements and was accompanied by compensatory contraction of the frontalis muscle. It was considered that this sensory trick, induced by pressure stimulation, led to the simultaneous occurrence of two distinct behaviors: the improvement of auricular dystonia and the emergence of involuntary contraction of the frontalis muscle. Botulinum toxin A was administered to both the auricular muscles and the frontalis muscle, resulting in favorable control of the symptoms. Reports of bilateral auricular dystonia are exceedingly rare. Moreover, the concurrent appearance of two types of sensory tricks - one alleviating dystonia and the other exacerbating it - is also uncommon. When administering botulinum toxin A injection in such cases, it may be beneficial to consider not only for the primary dystonia but also for the sites where reverse sensory tricks manifest, potentially achieving better outcomes.

Immediate changes in standing and walking when placing a hanger around the head of a patient with body lateropulsion: a case report

INTRODUCTION

Body lateropulsion is a postural disorder characterized by involuntary leaning to one side and is a major symptom in individuals with Wallenberg syndrome. Although the hanger reflex has potential applications as a simple stimulus to control posture, there are no reports of its use in body lateropulsion cases. The case report aims to document the immediate effects of a wire hanger worn around the head on the center of foot pressure and gait pattern parameters.

CASE DESCRIPTION

The patient, a man in his 50s, exhibited no motor paralysis of the upper and lower extremities following the onset of stroke but demonstrated left lateropulsion. Assessments of center of pressure (COP) during standing, as well as evaluating spatiotemporal and kinematic factors through three-dimensional gait analysis, both with and without a hanger worn around the head.

OUTCOMES

The application of the hanger to the patient's head resulted in immediate improvements in postural control and walking ability. When the hanger was placed around the head, compared with the non-hanger condition, the deviation of the COP toward the lateropulsion side during the standing trial improved immediately. Additionally, placement of a hanger around the head increased hip adduction range of motion during the stance phase, decreased step width, and increased gait speed.

DISCUSSION

This case report suggests the need for further research regarding the effect and efficacy of a hanger worn around the head as a tool for understanding the pathophysiology of body lateropulsion and for providing enhancements in both standing posture and walking ability.

Sustainable Improvement of Anterocollis-type Cervical Dystonia with a Hanger Reflex Device: A Case Report

The hanger reflex is an automatic head rotation movement. When individuals wear a wire clothes hanger on the head to compress the frontotemporal region, the head spontaneously rotates toward the compressed side. The device to induce the hanger reflex was first developed for treating rotation-type cervical dystonia, followed by the development of a device for anterocollis-type cervical dystonia. However, there is a lack of comprehensive clinical reports on hanger reflex treatments, especially for anterocollis-type dystonia. We present the case of anterocollis that completely resolved after hanger reflex treatment without any other invasive treatment. In the treatment, patients wear the device on their heads for 30 min once per day. Hanger reflex treatment is an easy, simple, noninvasive, and inexpensiveness approach that may be considered the first choice for cervical dystonia.

Dystonia-like Movement Disorders Ameliorated by Shear Force and Pressure Stimulation after Small Infarction in the Left Posterolateral Thalamus

Focal dystonia (FD) can develop after thalamic lesions. Abnormal somatic sensations were argued to be responsible for FD. Our patient experienced FD-like movement disorders, agraphesthesia, and a reduced sense of shear force on the skin and pressure to deep tissues of the right upper limb following a small infarction in the left posterolateral thalamus. FD-like symptoms improved while the skin was being pulled or the deep tissue was being pushed in a manner proportional to the strength of muscle contractions. Therefore, the lack of these sensations was suggested to be related to FD-like symptoms.

Electrically Induced Sensory Trick in a Patient with Musician's Dystonia: A Case Report

A sensory trick is a specific maneuver that temporarily improves focal dystonia. We describe a case of musician's dystonia in the right-hand fingers of a patient, who showed good and immediate improvement after using an electrical stimulation-mimicking sensory trick. A 49-year-old professional guitarist presented with chronic involuntary flexion of the right-hand third and fourth fingers that occurred during guitar performances. Electrical stimulation with a frequency of 40 Hz and an intensity of 1.5 times the sensory threshold was administered on the third and fourth fingernails of the right hand, which facilitated fluent guitar playing. While he played guitar with and without electrical stimulation, we measured the surface electromyograms (sEMG) of the right extensor digitorum and flexor digitorum superficialis muscles to evaluate the sensory-trick-like effects of electrical stimulation. This phenomenon can offer clues for developing electrical stimulation-based treatment devices for focal dystonia. Electrical stimulation has the advantage that it can be turned off to avoid habituation. Moreover, the device is easy to use and portable. These findings warrant further investigation into the use of sensory stimulation for treating focal dystonia.

Effects of hanger reflex on the cervical muscular activation and function: A surface electromyography assessment

Introduction: Cervical muscular dysfunction is closely associated with disorders and neuromuscular diseases of the cervical spine, and the hanger reflex (HR) has the potential to become a rehabilitation method. The muscular electrophysiology mechanism of HR is unclear. This study aims to identify the impacts of HR on cervical rotators’ myoelectrical activity and function.

Methods: We designed a self-control clinical trial, and asymptomatic volunteers were continuously included from 1 September 2021 to 30 April 2022 in our department. Rotation tasks were performed on both sides under each of the situations: no HR, unilateral HR, and bilateral HR. Surface electromyography (SEMG) was used to detect the myoelectrical activity of agonistic splenius capitis (SPL), upper trapezius (UTr), and sternocleidomastoid (SCM). The co-contraction ratio (CCR) during rotation tasks was calculated. Correlation analyses and multiple linear regression were performed.

Results: Finally, 90 subjects were enrolled (power >90%). The adjusted EMG value (aEMG) of SPL UTr, SCM, and rotating CCR under the unilateral HR and bilateral HR were higher than no HR; the aEMG of SPL and rotating CCR under the bilateral HR were higher than the unilateral HR. Multiple linear regression showed that HR pattern and age were the independent affecting factors for the aEMG of SPL (p < 0.001, p < 0.001), UTr (p < 0.001, p < 0.001), and SCM (p < 0.001, p < 0.001); BMI was an independent affecting factor for the aEMG of SPL (p < 0.001) and SCM (p < 0.001); HR pattern was the only affecting factor for CCR (p < 0.001).

Conclusion: HR can increase the cervical rotators’ myoelectrical activities and rotating CCR, and the effects of bilateral HR are greater than unilateral HR, suggesting that bilateral HR has a greater clinical potential to become a rehabilitation method for treating cervical neuromuscular disorders.