Postural instability and falls are more frequent in Parkinson’s disease patients with worse trunk mobility

Artigas, Nathalie Ribeiro; Franco, Clarissa Ribeiro da Cunha; Leão, Paula; Rieder, Carlos Roberto de Mello

doi:10.1590/0004-282x20160074

Cited by 14 publications

(15 citation statements)

References 26 publications

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“…PNF was further developed into an alternate approach (38) mainly focusing on trunk mobility, strength, endurance, and functional connection with proximal muscles. It may be particularly appropriate for patients with PD in whom the abnormal activation of trunk rotator and extensor muscles, trunk motion, ability to roll over on the bed, and axial rigidity are all associated with a high risk of falls (39, 40). PMR proposes a trunk-specific exercise program that is preliminary and preparatory for gait exercises.…”

Section: Introductionmentioning

confidence: 99%

Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover

Serrao

Pierelli

et al. 2019

Front. Neurol.

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Introduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity. Design: Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period. Participants: Forty individuals with idiopathic PD in Hoehn and Yahr stages 1–4. Intervention: Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B). Primary outcome measures: Spatiotemporal gait parameters, joint kinematics, and trunk kinematics. Secondary outcome measures: UPDRS-III scale scores. Results: The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously. Conclusions: The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD. Clinical Trial Registration : www.ClinicalTrials.gov , identifier NCT03346265.

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Section: Introductionmentioning

confidence: 99%

Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover

Serrao

Pierelli

et al. 2019

Front. Neurol.

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“…In PD patients fall rate caused by their inability to control their center of mass [26]. They also say that the lack of trunk movement coordination may increase the risk of unbalance and falls; in these studies, patients fell because they did not take a step in the direction of pull to maintain their center of mass over their feet (indicating a deficiency in postural reflexes) [22].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with PD have great difficulty maintaining balance and frequently fall [20,21]. This difficulty is a result of the combination of several deficiencies, including loss of reflexes and postural adjustments, the rigidity of the trunk/ends and akinesia [22,23]. Some authors identified 15 PD-specific risk factors [24,25].…”

Section: Discussionmentioning

confidence: 99%

Botulinum Toxin Type A and Physiokinesiterapy in the Treatment of Pisa Syndrome

Marvulli¹,

Mastromauro²,

Ml³

et al. 2017

J Alzheimers Dis Parkinsonism

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“…Previous studies have generally focused on traditional aquatic physiotherapy programs that have a mix of aerobic, strengthening and balance exercises [12]. Trunk rigidity in PD may lead to impairment in the vestibular system and therefore postural control [13,14], and prior research has shown that land based trunk rotational exercises lead to improved balance in other neurological cohorts such as stroke [15]. Little is known about whether specific aquatic therapies such as the Halliwick concept which focuses on complex trunk rotations and core stabilisation may be beneficial for this population.…”

Section: Introductionmentioning

confidence: 99%

The safety and feasibility of a Halliwick style of aquatic physiotherapy for falls and balance dysfunction in people with Parkinson's Disease: A single blind pilot trial

2020

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Background There is growing evidence that aquatic physiotherapy may be effective for people with Parkinson's Disease (PD) but most studies have investigated land based type exercises in the aquatic environment. Few studies have examined customised aquatic therapies such as the Halliwick concept which focuses on trunk rotation and core stabilisation. Objective The primary aim was to determine the feasibility of a Halliwick style aquatic physiotherapy intervention for people with PD. The secondary aim was to compare the Halliwick intervention with traditional aquatic and land based physiotherapy in terms of disease severity, balance and fear of falling. Methods Halliwick style aquatic, traditional aquatic and land based physiotherapy were trialled in a single blind pilot study. All interventions ran for 60 minutes per week over 12 weeks. Feasibility outcomes were safety, adherence and attrition. Secondary outcomes included the Unified Parkinson's Disease Rating Scale motor subsection (UPDRS-III), Berg Balance Scale (BBS), Mini BESTest and modified Falls Efficacy Scale (mFES). Results 30 participants with moderate PD were recruited. Participant mean age was 72 years (SD 8.4; range 51-86) with moderate disease severity (median Hoehn & Yahr score 3; IQR 1). No falls occurred during intervention sessions, however ten participants reported falls during the study period. No other adverse consequences were reported. All groups had adherence over 85%. No within group significant differences were found in UPDRS-III, BBS or mFES

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Postural instability and falls are more frequent in Parkinson’s disease patients with worse trunk mobility

Abstract: PD fallers present worse scores in TMS, and there is a significant correlation between difficulty rolling over in bed and TMS score.

Cited by 14 publications

References 26 publications

Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover

Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover

Botulinum Toxin Type A and Physiokinesiterapy in the Treatment of Pisa Syndrome

The safety and feasibility of a Halliwick style of aquatic physiotherapy for falls and balance dysfunction in people with Parkinson's Disease: A single blind pilot trial

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