Effects of Global Postural Reeducation on gait kinematics in parkinsonian patients: a pilot randomized three-dimensional motion analysis study

Abstract

The Global Postural Reeducation (GPR) method is a physical therapy based on the stretching of antigravity muscle chains with the parallel enhancement of the basal tone of antagonistic muscles addressed to improve static and dynamic stability. Through a three-dimensional motion analysis (3DMA) system, our study aims to investigate whether in Parkinson's disease (PD) patients a GPR program results in a more physiological gait pattern. The kinematic parameters of gait of twenty subjects with clinically diagnosed PD were calculated. The patients were randomly assigned to a study (10 or control (10) group. All subjects underwent neurological and 3DMA assessments at entry time (t 0), at 4 weeks (t 1, end of GPR program), and at 8 and 12 weeks (t 2 and t 3, follow-up evaluation). The study group underwent a four-week GPR program, three times a week, for 40 min individual sessions. Kinematic gait parameters of thigh (T), knee (K) and ankle (A) and UPDRS-III scores were evaluated. At the end of the GPR program, we observed an improvement of the kinematic gait pattern, documented by the increase in KΔc and TΔc values that respectively express the flexion amplitude of knee and thigh. The amelioration was persistent at follow-up assessments, with a parallel enhancement in clinical parameters. GPR intervention shows a long-term efficacy on gait pattern in PD patients. Furthermore, we validated 3DMA as a valuable tool to study the kinematics of gait thus refining the understanding of the effects of specific rehabilitation programs.

International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease

“…Lower quality studies, but with overall positive outcome of first intervention versus active comparator on reducing falls included a “highly challenging balance program,” balance training with dual tasking training versus arm exercises, and a “global postural education” method versus no intervention . Lower quality studies with overall positive outcomes with both interventions included PT plus mental imagery or relaxation and visual step training with cues versus leg strength exercise …”

“…48 The remaining lower quality studies compared 2 interventions (a mixture of treadmill-based exercises and aerobics and resistance/ strengthening exercises; water-based physiotherapy or usual physical activity), and both interventions were generally positive with improvements when compared with baseline in both groups but not compared to each other. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] Studies in which there was no active intervention or unclear final statistical analysis were all low quality, and therefore the interpretation of outcomes was limited. [66][67][68][69] Overall, although the 3 high-quality level I studies that compared 2 interventions had 1 positive outcome in 1 type of PT compared to another, none had a best medical therapy/control group; thus the overall conclusion is "likely efficacious."…”

“…70 Lower quality studies, but with overall positive outcome of first intervention versus active comparator on reducing falls included a "highly challenging balance program," 71 balance training with dual tasking training versus arm exercises, 72 and a "global postural education" method versus no intervention. 58 Lower quality studies with overall positive outcomes with both interventions included PT plus mental imagery or relaxation 73 and visual step training with cues versus leg strength exercise. 74 Interventions that evaluated change in spinal posture directly as a primary outcome included low-quality studies that were either positive for 1 intervention including "perceptive rehabilitation" versus conventional rehabilitation 75 76 or postural rehabilitation with/without back taping for posture.…”

Morphotypological Prevalence of Individuals Assessed by the Method of Global Postural Reeducation by Proprioceptive and Muscular Rebalancing (GPR/PMR)

“…This method has been used in the urinary incontinence treatment [29,30], as well as in the neurological field, in the cervical dystonia treatment [31], stroke [32], and Parkinson's disease [33,34], were observed in the following variables: head anteriorized (96%); flexion dorsal (78%); anterior shoulders (>80%); abducted scapula (67%); and right and left foot valgus (54%, Figure 2).…”

The Effect of L-dopa on Postural Stability in Parkinson’s Disease Patients

“…Furthermore, the so-called freezing symptom may also appear, i.e., sudden obstruction while walking. Often, the patient cannot lift his/her foot up from the floor to take another step [9,10]. Sudden immobilization can cause loss of balance [11].…”