Utilization of Visual Imagery and an External Focus of Attention (EFA) for Head Drop Syndrome (HDS)

Research Objectives: The objective of this case study is to examine the effectiveness of conservative management for an individual with HDS while implementing visual imagery and an EFA as clinical strategies.

Design: Case study

Setting: Outpatient hospital-based

Participants: The patient was a 75-year-old male, who was diagnosed with DHS, presented with complaints of insidious neck pain that started approximately 2 months ago. Patient demonstrated exaggerated cervical and thoracic kyphosis. He reported familiar symptoms with prolonged sitting, standing and walking during the day. He reported 7/10 on the Numerical Pain Rating Scale (NPRS) and a 20 on the Neck Disability Index (NDI). Patient was severely limited in all planes of cervical range of motion (ROM). He also exhibited moderate limitations in thoracic ROM. Manual muscle tested yield grossly 4-/5 throughout right shoulder. Ligamentous testing was unremarkable.

Interventions: The plan of care included therapeutic exercises addressing postural reeducation to focus on strength and range of motion impairments. Visual imagery and an EFA was utilized during exercises as strategies to enhance neuromuscular motor control. A self-management program was provided emphasizing strategies learned during respective episode of care.

Main Outcome Measures: Numerical Pain Rating Score (NPRS)

Neck Disability Index (NDI)

Results: The patient was seen for 12 visits over the course of 6 weeks. Upon initial evaluation, his NPRS improved from 7/10 to 0/10 and is NDI score of 20 improved to 0, upon discharge respectively. Interventions associated with the positive outcome including on postural reeducation, visual cueing during therapeutic exercise, and implementation of an EFA.

Conclusions: Conservative management for DHS aims to decrease progression of the condition and promote improved overall function.7 This case study demonstrates the effectiveness of utilizing visual imagery and an EFA as prudent strategies for the conventional management. The use of an EFA and imagery of an object yields similar outcomes.4 Goal oriented attention can result in improve cognitive, motor, somatosensory, and visual processing leading to improved functional outcomes.3 An EFA may contribute to promoting self-motivation as well as improving self-efficacy.6 Further research is warranted to investigate visual imagery and an EFA as clinical utilities for individuals with DHS.

Author(s) Disclosures: There are no conflicts to declare or disclose.