The effect of the rehabilitation program on balance, gait, physical performance and trunk rotation in Parkinson’s disease

Aging Clin Exp Res The effect of the rehabilitation program on balance, gait, physical performance and trunk rotation in Parkinson's disease Joanna Stoz_ ek 0 1 2 3 Monika Rudzin´ ska 0 1 2 3 Urszula Pustułka-Piwnik 0 1 2 3 Andrzej Szczudlik 0 1 2 3 0 Department of Neurology, Jagiellonian University Medical College , Cracow , Poland 1 & Joanna Stoz_ek 2 Department of Neurology, Medical University of Silesia , Katowice , Poland 3 Department of Clinical Rehabilitation, University School of Physical Education , Cracow , Poland Background Parkinson's disease (PD) is a progressive, neurodegenerative disease which leads to postural and gait disorders, limitation in mobility, activities of daily living and disability. Aims The aim of the study is to assess the effects of the rehabilitation program on balance, gait, motor performance and trunk rotations in PD patients. Methods Sixty-four patients with 1.5-3.0 stage PD in the Hoehn and Yahr scale were randomly allocated to rehabilitation and control groups. Sixty-one patients completed the study. Patients were assessed three times, at month intervals. Between the first and second assessments, the rehabilitation group participated in a rehabilitation training program focused on mobility, balance and gait exercises, consisting of 28 sessions. Balance was assessed with tandem stance and the Pastor test (shoulder tug). Gait was assessed with a 10 m walk at preferred speed and 360 turn. Motor performance was evaluated by means of the Physical Performance Test (PPT) and timed motor activities. The trunk rotations were measured in the lumbar and thoraco-lumbar spine with a tape measure. Results The rehabilitation group significantly improved (p \ 0.05) in balance and gait outcomes, PPT score, timed activities and trunk rotations both in comparison to the control group and baseline results. The positive effects of the exercise program maintained for at least 1 month. Conclusion The 4-week rehabilitation training program focused on mobility, balance and gait exercises improved balance, gait, physical performance and trunk rotations in patients with PD. Parkinson's disease; Rehabilitation functions; Physical performance Introduction Parkinson’s disease (PD) is a progressive, neurodegenerative disease which leads to limitation in mobility and activities of daily living (ADL), and in consequence to disability, dependency and decreased quality of life [ 1–4 ]. Poor functioning in daily life is associated with higher risk of falls in PD [5]. Many mobility problems in PD are associated with postural deficits and conversely: postural disturbances have their reflection in physical performance and activities of daily life [ 6 ]. Postural disturbances in PD have a wide range and can be considered in terms of postural instability, falls, difficulties in changing position of the body (e.g., sit to stand, bed mobility) [ 7 ] as well as in terms of restricted spinal, axial mobility [ 6, 8 ] and various postural deformities [9]. Schenkman et al. [ 6, 10 ] found the connection between restricted mobility of axial structures of the spine and the ability to perform activities. Balance and gait disorders as well as bradykinesia are strongly correlated with disability in PD [ 1 ]. Furthermore, postural and gait disturbances are levodopa unresponsive symptoms [ 11 ]. According to Shulman [ 1 ], delaying and prevention of disability should be the priority of clinical management in PD. Despite optimal pharmacological treatment, disability increases in PD patients as the disease progresses [ 1 ]. Therefore, it is relevant to use rehabilitation in the treatment of PD. Although most studies indicate a beneficial influence of physiotherapy on at least some aspects of balance, gait, mobility and spinal flexibility, there are also some deficiencies in studies to date and there is a need for further, high-quality research [ 12 ]. The aim of the study is to assess the effects of the rehabilitation program on balance, gait, motor performance and trunk rotation in PD patients. Methods Participants Participation in the study was offered to 100 consecutive PD patients attending the Movement Disorders Clinic, Department of Neurology, University Hospital in Cracow. Inclusion criteria were: diagnosis of PD according to UK PD Society Brain Bank criteria [ 13 ] established at least 6 months prior to the study, 1.5–3.0 Hoehn and Yahr stage and unchanged pharmacological treatment for at least 3 months preceding the study. The subjects’ informed written consent for participation was obtained. The study was conducted in accordance with the Declaration of Helsinki. Exclusion criteria were: severe gait disability with inability to walk unassisted, neurological, vascular or systemic disorders that may have caused permanent or intermittent weakness or instability, severe hepatic or renal insufficiency, cancer, a history of orthopedic hip or knee surgery which led to gait difficulties, other (...truncated)