Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 15;58(5):206-211.
doi: 10.2176/nmc.oa.2017-0111. Epub 2018 Mar 31.

Pilot Study of a Device to Induce the Hanger Reflex in Patients with Cervical Dystonia

Takashi Asahi  1 , Michi Sato  2 , Takuto Nakamura  2 , Yuki Kon  2 , Hiroyuki Kajimoto  2 , Genko Oyama  3 , Akito Hayashi  4 , Kazunori Tanaka  5 , Shunya Nakane  6 , Takao Takeshima  7 , Masami Fujii  8 , Satoshi Kuroda  1
Affiliations

Pilot Study of a Device to Induce the Hanger Reflex in Patients with Cervical Dystonia

Takashi Asahi et al. Neurol Med Chir (Tokyo). .

Abstract

The hanger reflex (HR) is an involuntary head rotation that occurs in response to a clothes hanger encircling the head and compressing the unilateral fronto-temporal area. Here, we developed an elliptical device to induce the HR and examined its utility for the treatment of cervical dystonia (CD). The study included 19 patients with rotational-type CD. The device was applied to each subject's head for at least 30 min/day for 3 months. Severity scores on part 1 of the Toronto Western Spasmodic Torticollis Rating Scale were evaluated at baseline and after the 3-month trial. Mean scores without and with the device were significantly different both at baseline (16.6 vs. 14.7, respectively; P < 0.05) and after the trial (14.9 vs. 13.6, respectively; P < 0.05). This preliminary trial suggests that our device can improve abnormal head rotation in patients with CD.

Keywords: cervical dystonia; hanger reflex; neurorehabilitation.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Disclosure

This study was supported by JSPS KAKENHI (23791587) and a Hokugin grant for young scientists. The JSPS KAKENHI and Hokugin grant for young scientists provided unrestricted support and had no role in the oversight or review of the research data or reporting. The authors (TA, KT, MF, and SK) have registered online self-reported COI Disclosure Statement Forms through the website for the Japan Neurosurgical Society members.

Figures

Fig. 1.
Fig. 1.
Schematic of the hanger reflex (HR). (A) Hanger used for this study. An ordinary wire clothes hanger commonly available in Japan was used for HR screening. The hanger was flexible and large enough to encircle the subject’s head. (B) Head rotation to the compressed side occurred when the head was encircled with the wire clothes hanger, compressing the fronto-temporal region.
Fig. 2.
Fig. 2.
A portable device for inducing the hanger reflex. (A) The device was elliptically shaped, lightweight, and coated with urethane to prevent skin irritation and to minimize pain and discomfort. (B) Rotation of the device caused compression of the fronto-temporal head region and induction of the hanger reflex. If the patient wears a cap, the device is not visible and is cosmetically acceptable.
Fig. 3.
Fig. 3.
Changes in the severity scores of the Toronto Western Spasmodic Torticollis Rating Scale part 1 (line chart). Line chart of baseline scores without (A) and with the device (B), and after the trial without (C) and with the device (D).
Fig. 4.
Fig. 4.
Changes in the severity scores of the Toronto Western Spasmodic Torticollis Rating Scale part 1 (boxplot). Boxplots of baseline scores without (A) and with the device (B) and after the trial without (C) and with the device (D). (A and B) show the immediate effects of the device, whereas (C and D) demonstrate the absence of a habituation effect over a 3-month period. All changes were statistically significant (P < 0.05). Compared to A and C, the scores were significantly decreased (P < 0.01), which means the effect lasted even without using the device (lasting change).
Fig. 5.
Fig. 5.
Illustrative case of cervical dystonia in a 45-year-old woman. (A) At baseline, the patient was unable to turn her head to the left. (B) Immediately after device application, she was able to turn her head to the left (immediate change). (C) After using the device for 3 months, the patient was able to turn her head to the left without use of the device (lasting change).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Steeves TD, Day L, Dykeman J, Jette N, Pringsheim T: The prevalence of primary dystonia: a systematic review and meta-analysis. Mov Disord 27: 1789–1796, 2012 - PubMed
    1. Leis AA, Dimitrijevic MR, Delapasse JS, Sharkey PC: Modification of cervical dystonia by selective sensory stimulation. J Neurol Sci 110: 79–89, 1992 - PubMed
    1. Jahanshahi M, Sartory G, Marsden CD: EMG biofeedback treatment of torticollis: a controlled outcome study. Biofeedback Self Regul 16: 413–448, 1991 - PubMed
    1. Zetterberg L, Halvorsen K, Färnstrand C, Aquilonius SM, Lindmark B: Physiotherapy in cervical dystonia: six experimental single-case studies. Physiother Theory Pract 24: 275–290, 2008 - PubMed
    1. Smania N, Corato E, Tinazzi M, Montagnana B, Fiaschi A, Aglioti SM: The effect of two different rehabilitation treatments in cervical dystonia: preliminary results in four patients. Funct Neurol 18: 219–225, 2003 - PubMed