Cervical dystonia:Disability and the value of physical therapy

Cervical dystonia (CD) is a neurological movement disorder characterized by involuntary muscle contractions causing abnormal postures and/or twisting movements of the head and neck. Patients may also experience non-motor symptoms including pain, anxiety and depression. The main treatment option is botulinum toxin (BoNT) injections in affected muscles to improve head postures and reduce pain. In addition to BoNT treatment, patients are often referred for physical therapy (PT), but there is little evidence regarding the long-term effectiveness. Despite remarkable improvements during the last decades, there are still many unmet needs that remain open in the treatment of cervical dystonia (CD). The first goal of this thesis was to assess clinical issues in BoNT treatment that need further improvement and to define clinical recommendations for clinicians. The second goal was to explore which determinants play an important role in disability of CD patients and the third goal was to develop a specialized PT program and to evaluate its effects on disability. Results showed that BoNT treatment can be further improved despite all the evidence for its effectiveness. Further research is needed towards optimal treatment intervals, dose equivalence between different BoNT formulations, the use of supportive techniques like electromyography or ultrasound and managing side effects. Secondly, we found that psychological factors are important determinants of disability. Finally, we found that PT is a valuable addition to BoNT treatment to improve disability and pain. Based on these findings, a multidisciplinary treatment approach to further improve the treatment and quality of life for CD patients is recommended

Never again:Legal change after public health crises in China

This thesis examines legal change after public health crises in China. The research aim is threefold. First of all, it aims to contribute to our understanding of how crises can lead to legal change in China. Secondly, the thesis aims to contribute to our understanding of post-crisis lawmaking. Thirdly, the thesis aims to develop tools for measuring and assessing the nature of legal change and of post-crisis legal change in particular. These three aims have been captured in one overarching research question: To what extent and under which conditions do public health crises lead to legal change in China