Spinopelvic balance: new biomechanical insights with clinical implications for Parkinson's disease

Effects of Limbs' Spasticity on Spinopelvic Alignment in Post-Stroke Patients: A Cross-Sectional Study

Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from 18 to 70 years old who presented post-stroke hemiparesis were recruited in this cross-sectional study. The clinical assessment included the Modified Ashworth Scale (UL-MAS and LL-MAS spasticity), Upper Limb Motricity Index (UL-MI), FAST-UL, and Five Times Sit-to-Stand Test (5T-STS); the Associated Reaction Rating Scale was used to measure associated reactions in the hemiparetic UL, the plumb line distance from the spinous process of C7 on the sagittal (PL-C7s) and frontal plane (Pl-C7f), the kyphosis apex (PL-AK), and the spinous process of L3 (PL-L3). Angular measures of spinal alignment were measured by a Bunnell scoliometer™ (angle of trunk rotation-ATR) and a gravity-dependent inclinometer (inclination at C7-T1 and T12-L1). Results: In chronic post-stroke patients, there was found to be an association between the 5T-STS and PL-C7f (β = 0.41, p = 0.05) and the angle of inclination at T12-L1 (β = 0.44, p = 0.01). The FAST-UL correlated with PL-C7f (β = -0.41, p = 0.05), while the UL-MI correlated with this last parameter (β = -0.36, p = 0.04) and the ATR (β = -0.31, p = 0.05). The UL-MAS showed correlation with the ATR (β = 0.38, p = 0.01). Conclusions: The results lead to the possibility that, in chronic post-stroke patients, spinal misalignment on the frontal and sagittal plane is associated both with strength impairment and UL spasticity. The improvement or restoration of spinopelvic parameters can take advantage of therapeutic interventions targeted at motor improvement and spasticity reduction of the hemiparetic side.

Gender-Specific Differences in Spinal Alignment and Muscle Power in Patients with Parkinson's Disease

BACKGROUND

Parkinson's disease (PD) is an advancing neurodegenerative disorder characterized by spinal anomalies and muscular weakness, which may restrict daily functional capacities. A gender-focused examination of these effects could provide valuable insights into customized rehabilitation strategies for both sexes.

PURPOSE

This study investigates the influence of spinal alignment on lower-limb function during the sit-to-stand (STS) movement in patients with Parkinson's disease compared to healthy individuals.

METHODS

A cross-sectional study was conducted with 43 consecutive patients with PD (25 males and 18 females; average age 73.7 ± 7.1 years) and 42 healthy controls (22 males and 20 females; average age 69.8 ± 6.0 years). Assessments included the International Physical Activity Questionnaire (IPAQ), Hoehn and Yahr staging, and measurements of vertical deviations from several spinal landmarks. Lower-limb muscle power during the STS task was evaluated using the Muscle Quality Index (MQI).

RESULTS

Both absolute (Watts) and relative (Watts/Kg) muscle power in the lower limbs were notably decreased in the PD group compared to the control group. Within the PD cohort, muscle power showed a negative relationship with age and a positive association with the degree of lumbar lordosis (PL-L3). Importantly, gender-specific analysis revealed that male patients with PD had significantly higher lower-limb muscle power compared to female patients with PD, highlighting the need for gender-tailored therapeutic approaches.

CONCLUSIONS

The findings suggest that preserving lumbar lordosis is crucial for maintaining effective lower-limb muscle biomechanics in individuals with Parkinson's disease.

Virtual Reality-Based Assessment for Rehabilitation of the Upper Limb in Patients with Parkinson's Disease: A Pilot Cross-Sectional Study

Background and Objectives: This study aimed to examine the responsiveness and concurrent validity of a serious game and its correlation between the use of serious games and upper limbs (UL) performance in Parkinson's Disease (PD) patients. Materials and Methods: Twenty-four consecutive upper limbs (14 males, 8 females, age: 55-83 years) of PD patients were assessed. The clinical assessment included: the Box and Block test (BBT), Nine-Hole Peg test (9HPT), and sub-scores of the Unified Parkinson's Disease Rating-Scale Motor section (UPDRS-M) to assess UL disability. Performance scores obtained in two different tests (Ex. A and Ex. B, respectively, the Trolley test and Mushrooms test) based on leap motion (LM) sensors were used to study the correlations with clinical scores. Results: The subjective fatigue experienced during LM tests was measured by the Borg Rating of Perceived Exertion (RPE, 0-10); the BBT and 9HPT showed the highest correlation coefficients with UPDRS-M scores (ICCs: -0.652 and 0.712, p < 0.05). Exercise A (Trolley test) correlated with UPDRS-M (ICC: 0.31, p < 0.05), but not with the 9HPT and BBT tests (ICCs: -0.447 and 0.390, p < 0.05), while Exercise B (Mushroom test) correlated with UPDRS-M (ICC: -0.40, p < 0.05), as did these last two tests (ICCs: -0.225 and 0.272, p < 0.05). The mean RPE during LM tests was 3.4 ± 3.2. The evaluation of upper limb performance is feasible and does not induce relevant fatigue. Conclusions: The analysis of the ICC supports the use of Test B to evaluate UL disability and performance in PD patients, while Test A is mostly correlated with disability. Specifically designed serious games on LM can serve as a method of impairment in the PD population.

Relationship between Female Sexual Dysfunction and Trunk Stability Post-Stroke: A Cross-Sectional Study

Background and Objectives: Stroke can lead to a variety of consequences, the severity and nature of which are contingent upon the affected brain region or lesion type. These consequences manifest with distinct clinical presentations and recovery trajectories. This study aims to investigate the potential correlation between feminine sexual dysfunction and trunk stability among stroke survivors. Materials and Methods: Thirty-eight women (stroke group n = 19 and control group n = 19) were recruited. A cross-sectional observational study was designed. Outcome measures were recorded using the Feminine Sexual Function Index, the National Institute of Health Stroke Score, the Newcastle Stroke-specific Quality of Life Measure Beck Depression Index, the Barthel Index, the Urge-urinary Distress Inventory, and the Trunk Impairment Scale. Spearman's correlation was tested between different factors influencing feminine sexual dysfunction and trunk stability. Results: Statistically significant differences were found in sexual function between the stroke group versus the control group (Z = 88; p = 0.007; rb = 0.51). The correlation showed a relationship between feminine sexual dysfunction and trunk stability (p < 0.05). A relationship between quality of life and sexual dysfunction was also found (p < 0.05). There were no statistically significant results for the association between dependency, severity of stroke, time after stroke type of stroke, and sexual dysfunction (p = 0.378). Conclusions: The results of this study support the existence of a correlation between feminine sexual dysfunction and trunk stability, probably due to trunk and pelvic floor muscle synergy. Multidisciplinary teams assessing sexual dysfunction after stroke should include a physical therapist to assess the physical components that may interfere with feminine sexual health post-stroke.

Wearable Motion Analysis System for Thoracic Spine Mobility With Inertial Sensors

This study presents a wireless wearable portable system designed for the automatic quantitative spatio-temporal analysis of continuous thoracic spine motion across various planes and degrees of freedom (DOF). This includes automatic motion segmentation, computation of the range of motion (ROM) for six distinct thoracic spine movements across three planes, tracking of motion completion cycles, and visualization of both primary and coupled thoracic spine motions. To validate the system, this study employed an Inter-days experimental setting to conduct experiments involving a total of 957 thoracic spine movements, with participation from two representatives of varying age and gender. The reliability of the proposed system was assessed using the Intraclass Correlation Coefficient (ICC) and Standard Error of Measurement (SEM). The experimental results demonstrated strong ICC values for various thoracic spine movements across different planes, ranging from 0.774 to 0.918, with an average of 0.85. The SEM values ranged from 0.64° to 4.03°, with an average of 1.93°. Additionally, we successfully conducted an assessment of thoracic spine mobility in a stroke rehabilitation patient using the system. This illustrates the feasibility of the system for actively analyzing thoracic spine mobility, offering an effective technological means for non-invasive research on thoracic spine activity during continuous movement states.

Impact of deep brain stimulation therapy on the vertebral sagittal balance in Parkinson's disease patients

Parkinson's disease (PD) is characterized by cardinal motor signs: 4-6 Hz resting tremor, rigidity, and bradykinesia. In addition, 3-18% of PD patients have camptocormia, an abnormal forward flexion of the thoracolumbar spine, which may have a negative impact on patients' quality of life. Different possible treatments have been suggested for such a condition, but no one is resolutive. This study aims to define the possible impact of DBS, with selective targeting on the dorsal-lateral region of the STN, on the sagittal balance of patients affected by PD. Among all patients that have undergone DBS procedures in our institution, we selected eight subjects, four females and four males, with selective targeting on the dorsal-lateral region of the subthalamic nucleus (STN) because of camptocormia and other severe postural changes. Radiological assessments of spinal balance parameters before surgery and at 6 and 12 months postoperatively were carried out. Comparison of preoperative and postoperative spine X-ray data showed a statistically significant improvement in dorsal kyphosis angle (D-Cobb) 12 months after the operation. Deep brain stimulation with selective targeting of the dorsal lateral part of the STN may induce changes of the posture in patients with Parkinson's disease 12 months after the operation, which appears to improve in this small sample size, but larger observational and controlled trials would be required to confirm this observation.

Minimally Invasive Spine Surgery for Kyphoscoliosis in a Patient With Parkinson's Disease: A Case Report

The surgical treatment for severe deformity correction in patients with Parkinson's disease (PD) is usually challenging, requiring lengthy fusions, and with a high risk of postoperative complications. We present a patient with severe kyphoscoliosis and medical history of PD undergoing minimally invasive surgical deformity correction. A 75-year-old female with a 10-year history of medically controlled PD presented at our hospital's outpatient reporting progressive postural changes during the last two years and a half. On clinical examination, we recognized severe kyphoscoliosis associated with Pisa deformity, in the absence of any neurological manifestations. On the initial x-rays, the coronal angulation was 56° in the lumbar area with a significant lateral shift of the trunk, while the right ribs were close to the iliac crest. The patient underwent deformity correction with percutaneous pedicle screws from T5 to S1, a percutaneous transverse process hooks at T5, and transforaminal lumbar interbody fusion at L5-S1. The total duration of the operation was seven hours, and the estimated blood loss was approximately 300 mL. Clinically, the patient's posture improved significantly, alleviating any preoperative compensatory mechanisms such as knee flexion. The postoperative x-rays revealed a very satisfying correction in both the coronal and sagittal planes (20.1 degrees and 26.6 degrees, respectively). Our current case report showed that MIS constitutes a viable alternative for deformity correction in selected patients with PD as part of a multidisciplinary approach. Proper patient selection requires a detailed medical history and a complete neurological and musculoskeletal examination by a dedicated healthcare provider.

Relationship between Lower Limbs Performance and Spinal Alignment in Parkinson’s Disease Patients: An Observational Study with Cross Sectional Design

Parkinson’s disease (PD) is a progressive neurodegenerative disease determining spinal deformities and muscle rigidity, weakness and dystonia that can be related to a change in muscular output during sit-to-stand tasks (STS). Purpose: The aim of this study was to determine the impacts of spinal alignment on lower limbs performance during STS tasks in Parkinson’s disease (PD) patients and healthy controls. Methods: In total, 43 consecutive PD patients (“PD” Group, 25 males and 18 females; age 73.7 ± 7.1) and 42 people not affected by any type of neurological disease (“CON” Group, 22 males, 20 females; age 69.8 ± 6.0) participated in the observational study. The clinical assessment included: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb-line distance from the spinous process of C7, kyphosis apex and the spinous process of L3 and S1. We used the Muscle Quality Index test (MQI) to assess muscle power output during STS in both groups. Results: The MQI test measurements of absolute and relative lower limb power was significantly lower in the PD group, in addition to a negative correlation with age and a positive correlation with PL-L3 in that group of patients. Conclusions: A final consideration regarding our results leads to the possibility that the preservation of lumbar lordosis may be one of the factors for maintaining efficient biomechanics of the lower limb muscles, with the preservation of the physiological contractile characteristics of these muscles being the objective for a multidisciplinary rehabilitation based on postural exercises of the spine and a program of training exercises for the lower limb muscles.

Analysis of the Active Measurement Systems of the Thoracic Range of Movements of the Spine: A Systematic Review and a Meta-Analysis

(1) Objective: to analyze current active noninvasive measurement systems of the thoracic range of movements of the spine. (2) Methods: A systematic review and meta-analysis were performed that included observational or clinical trial studies published in English or Spanish, whose subjects were healthy human males or females ≥18 years of age with reported measurements of thoracic range of motion measured with an active system in either flexion, extension, lateral bending, or axial rotation. All studies that passed the screening had a low risk of bias and good methodological results, according to the PEDro and MINORS scales. The mean values and 95% confidence interval of the reported measures were calculated for different types of device groups. To calculate the differences between the type of device measures, studies were pooled for different types of device groups using Review Manager software. (3) Results: 48 studies were included in the review; all had scores higher than 7.5 over 10 on the PEDro and MINORs methodological rating scales, collecting a total of 2365 healthy subjects, 1053 males and 1312 females; they were 39.24 ± 20.64 years old and had 24.44 ± 3.81 kg/m² body mass indexes on average. We summarized and analyzed a total of 11,892 measurements: 1298 of flexoextension, 1394 of flexion, 1021 of extension, 491 of side-to-side lateral flexion, 637 of right lateral flexion, 607 of left lateral flexion, 2170 of side-to-side rotation, 2152 of right rotation and 2122 of left rotation. (4) Conclusions: All collected and analyzed measurements of physiological movements of the dorsal spine had very disparate results from each other, the cause of the reason for such analysis is that the measurement protocols of the different types of measurement tools used in these measurements are different and cause measurement biases. To solve this, it is proposed to establish a standardized measurement protocol for all tools.

Muscle echo intensity of abdominal wall in Parkinson's disease and healthy controls: a cross sectional study

PURPOSE

The aim of this study was to describe the differences between abdominal wall muscles echo intensity (EI) in PD patients and healthy controls.

METHODS

Forty-three consecutive PD patients (25 males and 18 females, age 73.7 ± 7.1, and 42 controls without neurological diseases (22 males, 20 females, age 69.8 ± 6.0) participated in this cross-sectional study. The clinical assessment included the following: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb line distance from the spinous process of C7, kyphosis apex, and spinous process of L3 and S1. A real-time ultrasound B-scanner (system MyLab40 by Esaote, Genoa, Italy) was used to obtain muscle images of the right and left biceps brachii (BB), external (EO), and internal oblique (IO) and rectus abdomen (RA). Heckmatt scale and measure of EI through ImageJ software were used to assess muscle quality.

RESULTS

When considering the Heckmatt score, the RA and BB did not significantly differ between PD and control patients, while there was a significant difference for right (p < 0.01) and left (p = 0.02) IO muscles. There was no difference among EI values of the RA, IO, and BB between PD and control patients.

CONCLUSIONS

Echo intensity of abdominal wall muscles (rectus abdominis, internal oblique) and biceps brachii did not differ between Parkinsonian patients and healthy subjects. We did not found ultrasound useful in disease evolution assessment or in early diagnosis of postural disorders.

The fate of thoracolumbar surgeries in patients with Parkinson's disease, and analysis of risk factors for revision surgeries

Background

Compared to patients without Parkinson’s disease (PD), patients with PD who underwent spinal surgeries were reported to have a relatively high complication rate. However, studies that analyze surgical risk factors for these patients are limited.

Methods

From October 2004 to April 2015, patients with PD who underwent spinal surgeries at our department were reviewed. Patients who underwent lumbar or thoracolumbar instrumented surgeries due to degeneration or deformity disease were included. Any reason for revision surgery was recorded. Risk factors including patients’ factors, surgical factors, and lumbo-pelvic radiographic parameters were analyzed. Patients’ factors included patients’ underlying diseases, body mass index (BMI), osteoporotic status, and PD’s severity using the modified Hoehn and Yahr staging scale. Surgical factors included surgical levels, extending to thoracic spine or not, corrective osteotomy, with anterior approach or not, and interbody device. Radiographic parameters included lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), coronal Cobb’s angles, and score for spino-pelvic realignment achievement.

Results

A total of 66 patients were enrolled. The mean age at surgery was 69.0 years old. The mean follow-up time was 51.2 months. Twenty-six revision surgeries were required in 19 patients (29%). Risk factors for revision surgery included modified Hoehn and Yahr stage ≥3 (p <  0.001), cancer history (p = 0.024), osteoporosis (P = 0.012) and underwent corrective osteotomy (p = 0.035). According to binary logistic regression analysis, the modified Hoehn and Yahr stage ≥3 (p <  0.001) was the only independent risk factor. The Kaplan-Meier analysis revealed patients with long instrumentation (surgical levels > 3), T-spine instrumentation, and lower score of spino-pelvic realignment achievement tended to have earlier revision.

Conclusion

For PD patients planning for elective thoracolumbar surgery, aggressive control status of PD before or after surgery is necessary to prevent surgical complications. Longer surgical levels and corrective osteotomy also tended to have earlier revision. A better score in spino-pelvic realignment achievement after surgery could reduce occurrence of revision.

Relationships between muscular impairments, pain, and disability in patients with chronic nonspecific low back pain: a cross sectional study

To clarify the significance of mechanical impairments, pain, and functional limitations as predictors of chronic low back pain (LBP). Ninety patients with chronic nonspecific low back pain (CNSLBP) were prospectively studied with clinical tests and questionnaires. Changes in muscle extensibility and endurance tests were evaluated and changes assessed in LBP intensity on numeric rating scale 0-10 and severity with Oswestry Disability Index (ODI) 0-100. In the present study we found significant associations between the 4 muscle extensibility and 2 endurance tests and pain at nonspecific patients with chronic LBP (P<0.005). The 2 muscle extensibility and 1 endurance tests were in complete equilibrium with ODI disability and hence showed similar results (P<0.005). The associations between the muscle extensibility and endurance tests and pain were significantly elevated in patients with nonspecific chronic LBP.

Surgical treatment of spinal disorders in Parkinson's disease

PURPOSE

Most patients suffering from Parkinson's disease (PD) exhibit alterations in the posture, which can in several cases give rise to spine deformities, both in the sagittal and the coronal plane. In addition, degenerative disorders of the spine frequently associated to PD, such as spinal stenosis and sagittal instability, can further impact the quality of life of the patient. In recent years, spine surgery has been increasingly performed, with mixed results. The aim of this narrative review is to analyze the spinal disorders associated to PD, and the current evidence about their surgical treatment.

METHODS

Narrative review.

RESULTS

Camptocormia, i.e., a pronounced flexible forward bending of the trunk with 7% prevalence, is the most reported sagittal disorder of the spine. Pisa syndrome and scoliosis are both common and frequently associated. Disorders to the spinopelvic alignment were not widely investigated, but a tendency toward a lower ability of PD patients to compensate the sagittal malalignment with respect to non-PD elderly subjects with imbalance seems to emerge. Spine surgery in PD patients showed high rates of complications and re-operations.

CONCLUSIONS

Disorders of the posture and spinal alignment, both in the sagittal and in the coronal planes, are common in PD patients, and have a major impact on the quality of life. Outcomes of spine surgery are generally not satisfactory, likely mostly due to muscle dystonia and poor bone quality. Knowledge in this field needs to be consolidated by further clinical and basic science studies. These slides can be retrieved under Electronic Supplementary Material.

Thoracic hyperkyphosis non invasively measured by general practitioners is associated with chronic low back pain: A cross-sectional study of 1364 subjects

OBJECTIVE

The aim of this study was to examine the association between trunk sagittal posture and nonspecific chronic low back pain (CLBP) by evaluating plumb-line distances in subjects recruited in an everyday clinical setting.

METHODS

Of the 1364 subjects recruited, 63.1% were female (mean age ± SD: 56.2 ± 16.8 years). Subjects were categorized into CLBP and control groups and were prospectively assessed over a 3-month period. They provided information about their daily activities and their history of CLBP. Prognostic factors were analysed using univariate and multivariate logistic regression analyses. A physical examination was performed to record demographic (i.e. age, height and weight) and pain characteristics, and the intensity of pain was assessed using a numerical visual analogue scale. Disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). A simple measure generally used for sagittal plane screening purposes during growth was also utilized.

RESULTS

Multivariate logistic regression analysis revealed that gender (OR = 1.70), RMDQ score (OR = 0.51) and thoracic hyperkyphosis (C7 + L3 at the plumb-line distance) (OR = 1.57) were associated with CLBP. The final regression model explained 85.6% (R² = 0.56; P < 0.001) of the variability.

CONCLUSIONS

General practitioners can clinically and easily assess trunk posture in subjects with low back pain to identify subjects at higher risk of CLBP.

Trunk and craniofacial asymmetry are not associated in the general population: a cross-sectional study of 1029 adolescents

Background

The literature did not show clearly if a correlation between trunk and facial asymmetry exists. The aim of this study was to verify the association between trunk and facial asymmetries, and trunk and facial sagittal configuration in adolescents.

Methods

This is a cross-sectional screening study. It was carried out in a small town in Northern Italy, from February to April 2014. Healthy children met the inclusion criteria. Exclusion criteria were subjects with physical and cognitive disability, genetic disease, and polymorphism. All subjects underwent a three phases for postural screening program.

Results

1029 healthy children were 491 females and 538 males with mean age: 12 (range 11–16) years. The association of facial and trunk asymmetry had a point prevalence rate around 1% for the various regions of the spine, the association on the sagittal plane of almost 1.3% for hyperkyphosis and hyperlordosis. Overall, results showed a very low sensitivity, specificity, and predictive values of facial anomalies for trunk asymmetry and sagittal spinal posture.

Conclusion

While correlations between jaw position and body posture for cervical spine can exist, our study denied association with trunk and back in a general population: postural compensatory mechanism may have minimized the effects of one area on the other, if any existed.

Management of Spinal Conditions in Patients With Parkinson Disease

Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.

Sagittal balance is correlated with Parkinson's Disease clinical parameters: an overview of spinopelvic alignment on 175 consecutive cases

PURPOSE

The aim of this study was to describe the disease-related sagittal balance changes in relation to the sacro-pelvic morphology of Parkinson's Disease patients with different duration of disease.

METHODS

One hundred and seventy-five consecutive Parkinson's Disease (PD) patients (102 males, 73 females; age: 55-83 years) participated in the cross-sectional study. The clinical assessment included: Hoehn Yahr (H&Y) score; Tinetti score; plumb line (PL) distance from the spinous process of C7, L3 and S1 and kyphosis apex. Lumbar lordosis (LL), thoracic kyphosis (TK), spinosacral (SSA) and spinopelvic (SPA) angles, spinal tilt, pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT) were radiographically assessed.

RESULTS

Spinosacral and spinopelvic were correlated with the duration of disease and Tinetti score, but not with age. We found a positive correlation between LL and both SSA and SPA. TK was significantly correlated with LL but not with pelvic parameters, while PI with SS and LL.

CONCLUSIONS

Female gender, high PI and high LL together with a low PL-C7 distance can be considered as protective factors for spinal imbalance and fall risk; negative factors are represented by male gender, longer disease duration, higher H&Y Class, and low PL-L3 distance. Looking at the pelvis is revealing new important insights in spinal disease management, both surgical and rehabilitative.

Nintendo Wii Fit for balance rehabilitation in patients with Parkinson's disease: A comparative study

BACKGROUND

Impaired postural stability places individuals with Parkinson's disease (PD) at an increased risk for falls.

OBJECTIVE

We evaluated the effectiveness of 10 vs. 15 sessions of Nintendo Wii Fit for balance recovery for outpatients PD.

METHODS

Twenty-seven patients, 48.1% female (66 ± 8 years), with PD. Patients with PD were consecutively assigned to one of two groups receiving either 10 or 15 sessions (low dose or high dose group, respectively) with Nintendo Wii Fit in recovering balancing ability. All outcome measures were collected at baseline, immediately following the intervention period, and 1-month following the end of the intervention.

MAIN OUTCOME MEASURE

Falls risk test (FRT), Stability index (PST), Berg balance scale (BBS) and Tinetti scale.

RESULTS

The patients undergoing the 10 sessions demonstrated significantly improvement on the balance performances (Tinetti balance and gait scales, BBS and BSF) (all, P < 0.05) as those undergoing 15 treatment with Nintendo Wii Fit, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way.

CONCLUSIONS

The results suggest that functional improvement can be made in fewer visits during outpatient rehabilitation sessions with Nintendo Wii Fit improving the efficiency of intervention.

Reliability of the Handgrip Strength Test in Elderly Subjects With Parkinson Disease

BACKGROUND

The handgrip strength test is widely used by clinicians; however, little has been investigated about its reliability when used in subjects with Parkinson disease (PD). The purpose of this study was to investigate the test-retest reliability of the handgrip strength test for subjects with PD.

METHODS

The PD group consisted of 15 patients, and the control group consisted of 15 healthy subjects. Each patient performed 3 pain-free maximal isometric contractions on each hand on 2 occasions, 1 week apart. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) were calculated. The 2-way analysis of variance (ANOVA) was conducted to determine the differences between sides and groups.

RESULTS

Test-retest reliability of measurements of grip strength was excellent for dominant (ICC = 0.97; P = .001) and non-dominant (ICC = 0.98; P = .001) hand of participant with PD and (ICC = 0.99; P = .001) and (ICC = 0.99; P = .001) respectively, of healthy group.

CONCLUSIONS

The Jamar hand dynamometer had fair to excellent test-retest reliability to test grip strength in participants with PD.

Spinopelvic balance and body image perception in Parkinson's disease: analysis of correlation

PURPOSE

The purpose of this study was to describe the association between body image perception and sagittal balance (SB) parameters in Parkinson's Disease (PD) patients.

METHODS

77 consecutive PD patients were included: 44 males, 33 females; 68.9 ± 6.8 years; 5.3 ± 3.8 years from diagnosis (YFD); Hoehn Yahr (HY) 2.0 ± 0.8, Unified Parkinson's Disease rating Score-Motor section (UPDRS-M) 11.8 ± 9.3. Spinopelvic angles and SB were radiographically assessed. Body image perception was assessed through Trunk appearance scale (TAPS) and Stunkard Figure rating scale for BMI. Beck Depression Inventory (BDI) was used to evaluate depressive mood.

RESULTS

We detected 32 (41.5 % of cohort) Parkinson Disease patients with scoliosis ≥15° Cobb. The mean calculated BMI was 27.1 ± 3.9 kg/m(2). According to the Figure Rating Scale, the perceived BMI averaged 27.2 ± 4.5 kg/m(2), while the mean desired BMI was 24.4 ± 2.7 kg/m(2), TAPS scored 3.4 ± 0.9 points, while BDI 12.3 ± 7.9 points. TAPS had a weak negative correlation with the duration of disease (r = -0.25, p < 0.05) and a correlation with H&Y score (r = 0.28, p < 0.05). Sacral Slope was weakly correlated to the calculated BMI (r = -0.24, p < 0.05). SSA and SPA had a negative correlation with the TAPS mean score (respectively, r = -0.36 and -0.24, p < 0.05). BDI presented a weak correlation with TAPS (r = 0.27, p < 0.05) but not with self esteemed BMI values (p > 0.05).

CONCLUSIONS

Spinopelvic parameters and depression had a specific and concurrent influence on trunk deformity perception but not on BMI self-esteem.