Dry Immersion as a Novel Physical Therapeutic Intervention for Rehabilitation of Parkinson’s Disease Patients: A Feasibility Study

Abstract

Background The study was aimed at evaluating therapeutic effect of analogue microgravity in a form of “dry immersion” (DI) on motor and non-motor symptoms in patients with Parkinson’s disease (PD). Methods A group of 12 PD patients aged 67 (63–68) years, Hoenh and Yahr staged 1–3, participated in this study. During DI a subject wrapped in a thin waterproof material was immersed in a bathtub at 31°C. The rehabilitation program included 7 DI sessions (45 min each, 2 times per week, on-medication). The Unified Parkinson’s Disease Rating Scale parts I, II and III (UPDRS-I/II/III) and the Hamilton’s Depression Rate Scale (HDRS) were applied before the 1st, after 4th and 7th DI session, and 2 weeks and 2 months after the whole DI program. Results The UPDRS-III score, HDRS, and rigidity signs score have significantly decreased by 16–35% two weeks after the DI program. Two months after completion of the DI program all studied parameters regained their pre-treatment values. The UPDRS-I, II, tremor and akinesia signs score did not respond to the DI program. Conclusion The DI program promises rehabilitation potential for patients with parkinsonism.

Parameters of Surface Electromyogram Suggest That Dry Immersion Relieves Motor Symptoms in Patients With Parkinsonism

“…Second, as muscle tone appears as muscle state of readiness to contraction (Davis et al, 2011 ) triggered by brainstem, basal ganglia, cerebellum, and cortical circuits in stressful conditions, we assume that central neural mechanisms might also have been involved in sEMG amplitude decreasing in PD patients during DI session. That is in good line with our earlier finding that after a program of DI the score of depression has significantly decreased (Meigal et al, 2018 ). As such, the DI condition has probably exerted its action on muscle hypertonicity (rigidity) via lowering the level of anxiety and thus relieving disinhibition of the stretch reflex.…”

“…Therefore, shift of determinism and recurrence rate of sEMG after a single one DI session in the direction of lower values may be indicative of diminished synchronization of motor units firing and, hence, temporary inhibition of parkinsonian tremor. In our recent study we observed decrease of tremor score in some PD patients (Meigal et al, 2018 ). Still, direct accelerometric measurements are needed to validate that effect in a single DI session.…”

“…Similarly, in healthy subjects under a program of DI the reflex component of muscle tone has been diminished due to deprivation of excitatory tonic stimuli from the pacinian corpuscles of sole (Kozlovskaya et al, 1988 ; Navasiolava et al, 2011 ). In our recent study we have found that the rigidity subscore has indeed decreased under the program of short-term DI sessions (Meigal et al, 2018 ). However, the non-reflexive (mechano-elastic) component of muscle tone may also have contributed to the decrease of rigidity score.…”

“…These data promise that even a short-term DI session, which would be more suitable for older people and PD patients, could exert rehabilitation effect on the motor system. Indeed, the program of several DI sessions with the same patient group as here has been recently reported to exert positive effect on some clinical metrics of PD patients, including scores of depressive mood, UPDRS-III (Unified Parkinson's disease rating scale, motor part), and the rigidity subtotal of the UPDRS-III (Meigal et al, 2018 ). Tremor subtotal of the UPDRS-III has also decreased, though insignificantly.…”

“…In that study we omitted measuring UPDRS scores right after the DI session due to highly probable inference of cardiovascular factors, such as DI-induced decrease of blood pressure and orthostatic reactions, on motor signs (gait, postural reactions, muscle tone) in PD patients. From our earlier study we know that muscle rigidity subtotal of UPDRS-III score and, to lesser degree, tremor subtotal, decrease across the program of DI (Meigal et al, 2018 ). In further studies, it would be wise to correlate sEMG parameters with clinical symptoms and scales that characterize parkinsonian patients for better understanding of the association between sEMG and motor symptoms.…”