Four‐week trunk‐specific rehabilitation treatment improves lateral trunk flexion in Parkinson's disease

People with Parkinson's disease (PD) often have a posture characterized by lateral trunk flexion poorly responsive to antiparkinsonian drugs. To examine the effects of a rehabilitation programme (daily individual 90‐minute‐sessions, 5‐days‐a‐week for 4‐consecutive weeks) on lateral trunk flexion and mobility, 22 PD patients with mild to severe lateral trunk flexion, and 22 PD patients without trunk flexion were studied. Patients were evaluated using the Unified Parkinson's Disease Rating Scale motor subscale (UPDRS‐III) score, and the kinematic behavior of the trunk was recorded by means of an optoelectronic system to determine: a) trunk flexion, inclination and rotation values in the erect standing posture; b) ranges of trunk flexion and inclination during trunk movements. After the treatment, significant decreases in trunk flexion [24°(4) vs. 14°(3), P < 0.001] and inclination in the static condition [23°(5) vs. 12°(4), P < 0.001)] were observed, both of which were maintained at the 6‐month follow up. During the trunk flexion task, a significantly increased range of trunk flexion [64°(15) vs. 83°(15), P < 0.001] was observed; similarly, during the lateral bending task, the range of trunk inclination was found to be significantly increased, both toward the side of the trunk deviation [29°(8) vs. 42°(13), P < 0.01] and toward the contralateral side [14°(6) vs 29°(11), P < 0.01]. No further significant changes were observed at the 6‐month follow‐up. Trunk flexion and inclination values in the upright standing posture correlated slightly with the UPDRS‐III score. Our findings show that significant improvements in axial posture and trunk mobility can be obtained through the 4‐week rehabilitation programme described, with a parallel improvement in clinical status. © 2010 Movement Disorder Society

[1]  C. Marsden,et al.  Note on the scoliosis of Parkinsonism. , 1975, Journal of neurology, neurosurgery, and psychiatry.

[2]  K. Gwinn‐Hardy,et al.  Pain in Parkinson's disease , 2001, Postgraduate medicine.

[3]  S. Buckley,et al.  Parkinson's disease patients who fracture their neck of femur: a review of outcome data. , 2006, Injury.

[4]  L. Piron,et al.  Effects of conventional and sensory-enhanced physiotherapy on disability of Parkinson's disease patients. , 1996, Advances in neurology.

[5]  K. Abe,et al.  Camptocormia in Parkinson's Disease , 2010, Parkinson's disease.

[6]  C. Marsden,et al.  Recent Developments in Parkinson's Disease , 1986 .

[7]  Gammon M Earhart,et al.  Tai Chi improves balance and mobility in people with Parkinson disease. , 2008, Gait & posture.

[8]  F Franchignoni,et al.  Balance and fear of falling in Parkinson's disease. , 2005, Parkinsonism & related disorders.

[9]  Ph.D. Fusako Yokochi M.D..  Lateral flexion in Parkinson’s disease and Pisa syndrome , 2006, Journal of Neurology.

[10]  A. Krygowska-Wajs,et al.  Falls in Parkinson's disease. Causes and impact on patients' quality of life. , 2005, Functional neurology.

[11]  J. Allum,et al.  Postural responses to multidirectional stance perturbations in cerebellar ataxia , 2006, Experimental Neurology.

[12]  N. Çetin,et al.  Trunk Muscle Strength in Relation to Balance and Functional Disability in Unihemispheric Stroke Patients , 2004, American journal of physical medicine & rehabilitation.

[13]  M. Sharpe,et al.  Trunk muscle training and early Parkinson's disease , 1997 .

[14]  Jason Eibling.  Physical Therapy and Parkinsonʼs Disease: A Controlled Clinical Trial , 1995 .

[15]  L. Oddsson,et al.  Control of voluntary trunk movements in man. Mechanisms for postural equilibrium during standing. , 1990, Acta physiologica Scandinavica. Supplementum.

[16]  P. Castaigne,et al.  [Medical treatment of Parkinson's disease]. , 1972, Annales de medecine interne.

[17]  M. Schenkman,et al.  Pharmacological and nonpharmacological interventions in the treatment of Parkinson's disease. , 1995, Physical therapy.

[18]  Christopher G. Goetz,et al.  Physical therapy and Parkinson's disease , 1994, Neurology.

[19]  C. Marsden,et al.  Scoliosis and Parkinson's disease. , 1980, Archives of neurology.

[20]  R. J. Sullivan,et al.  Spinal-flexibility-plus-aerobic versus aerobic-only training: effect of a randomized clinical trial on function in at-risk older adults. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[21]  A. Thorstensson,et al.  Motor control of voluntary trunk movements in standing. , 1985, Acta physiologica Scandinavica.

[22]  P. Pasquetti,et al.  Effects of physical training on straightening-up processes in patients with Parkinson's disease. , 1999, Disability and rehabilitation.

[23]  R. van Emmerik,et al.  Identification of axial rigidity during locomotion in Parkinson disease. , 1999, Archives of physical medicine and rehabilitation.

[24]  R. Cardini,et al.  Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with multiple sclerosis. , 2004, Archives of physical medicine and rehabilitation.

[25]  J. Hughes,et al.  Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[26]  Margaret Schenkman,et al.  Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease: A Randomized, Controlled Trial , 1998, Journal of the American Geriatrics Society.

[27]  I. Jonkers,et al.  Quantitative gait analysis in Parkinson's disease: comparison with a healthy control group. , 2005, Archives of physical medicine and rehabilitation.

[28]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[29]  S. Fahn.  Unified Parkinson's Disease Rating Scale , 1987 .

[30]  Adrian H. Taylor,et al.  The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta‐analysis , 2008, Movement disorders : official journal of the Movement Disorder Society.

[31]  Jeffrey M. Hausdorff,et al.  Falls and freezing of gait in Parkinson's disease: A review of two interconnected, episodic phenomena , 2004, Movement disorders : official journal of the Movement Disorder Society.

[32]  J. Davis.  Team management of Parkinson's disease. , 1977, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[33]  Robert Lalonde,et al.  Brain regions and genes affecting postural control , 2007, Progress in Neurobiology.

[34]  Bastiaan R Bloem,et al.  Falls in Parkinson's disease , 2004, Current opinion in neurology.

[35]  S. Palmer,et al.  Exercise therapy for Parkinson's disease. , 1986, Archives of physical medicine and rehabilitation.

[36]  D. Jc.  Team management of Parkinson's disease. , 1977 .

[37]  Madeleine. E. Hackney,et al.  Health-related quality of life and alternative forms of exercise in Parkinson disease. , 2009, Parkinsonism & related disorders.

[38]  L. Dibble,et al.  Predicting Falls In Individuals with Parkinson Disease: A Reconsideration of Clinical Balance Measures , 2006, Journal of neurologic physical therapy : JNPT.

[39]  K. Stecker,et al.  Therapeutic value of exercise training in Parkinson's disease. , 2000, Medicine and science in sports and exercise.

[40]  S. Studenski,et al.  Relationships between mobility of axial structures and physical performance. , 1996, Physical therapy.

[41]  Y. Agid,et al.  Parkinson’s disease with camptocormia , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[42]  Gammon M. Earhart,et al.  Rehabilitation and Parkinson's Disease , 2012, Parkinson's disease.

[43]  M. Kuchibhatla,et al.  Spinal flexibility and balance control among community-dwelling adults with and without Parkinson's disease. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[44]  D R Rajput,et al.  Accuracy of clinical diagnosis of idiopathic Parkinson's disease. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[45]  G. Abbruzzese,et al.  The role of sensory cues in the rehabilitation of parkinsonian patients: A comparison of two physical therapy protocols , 2000, Movement disorders : official journal of the Movement Disorder Society.