Exercises for Trunk Rigidity Seen to Help Patients Safely Make Turns

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by Steve Bryson, PhD |

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A four-week, task-specific exercise program done at home can improve turning ability and balance, and ease disease severity for people with early- to mid-stage Parkinson’s, a small study suggested.

This Parkinson’s exercise program focuses explicitly on rotating those parts of the body most involved in turning. It may be a promising alternative rehabilitation program for patients with trunk rigidity that makes turning difficult and risks falls, the researchers said.

The study, “Benefits of task-specific movement program on en bloc turning in Parkinson’s disease: A randomized controlled trial,” was published in the journal Physiotherapy Research International.

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Trunk rigidity is a common symptom of Parkinson’s disease. Instead of turning the body in a top-down approach — with the head moving first, then the shoulders and the hips — patients tend to move all these body parts together, or “en bloc.”

Such rigidity in movement can affect turning and balance to increase the risk of falling, the researchers noted. While Parkinson’s treatments like levodopa therapy and deep brain stimulation aim to address such difficulties, they best do so when paired with exercise training, the team added.

How task-specific movement exercises might improve “en bloc” turning in Parkinson’s, however, has not been reported.

Researchers based at the Mahidol University in Thailand evaluated a monthlong and task-specific movement exercise program on turning motion and clinical disease outcomes in a small patient group.

They enrolled 22 early- to mid-stage Parkinson’s patients matched by age and disease severity. Half were randomly assigned to an exercise group, and the other half continued with routine medication as a control group. Turning movements and clinical outcomes, determined by measures that included the Unified Parkinson’s Disease Rating Scale or UPDRS, were assessed before and after the exercise program.

Task-specific exercises were given in three weekly, physiotherapist-supervised sessions at a clinic for two weeks, then as two supervised and two at-home exercise sessions in the third week, followed by five at-home exercises for the fourth and final week.

The primary exercise program included 45 minutes of rotating, 10 times each, different parts of the body — the head, shoulders, hips, etc. — while in positions like sitting, standing, and lying down. Its goal is to increase the flexibility and mobility of each body part.

Patients then engaged for five minutes in a throwing task to improve balance, and for 10 minute in making turns in each direction while walking to increase their range of body rotation. A 15-minute warm-up and cool-down period of deep breathing and stretching was held before and after the exercises.

To measure turning movements (kinematics) and stepping motion, special sensors were attached to the center of the head, middle chest, and the feet. Participants performed a half-circle turn, and the team recorded the delays, or latencies, in the movement of each body segment as they turned, and their speed and their stepping motions.

According to the analysis, those who engaged in the exercises had reduced latencies, or faster movement, for all body parts, including the head, chest, leading foot, and trailing foot, compared with the control group. Overall, the mean onset latency significantly decreased — indicating faster onset of movement — in the exercise group only.

While turning the half-circle, the step size, total step, step duration, and turning speed all significantly improved in exercise group patients relative to the control group.

“This result could be explained by the fact that the repetition of the desired movement [180-degree turns] and task-specific training should enhance motor learning by reducing the complexity of motor planning and decreasing the reliance on sensory feedback,” the researchers wrote.

UPDRS scores showed that those in the exercise group had significantly lower (improved) UPDRS total, motor, and rigidity scores compared to their pre-program scores, indicating a lessening in Parkinson’s severity among these people.

The exercise program also significantly improved balance, as measured by the functional reach test, and eased the fear of falling, assessed with the fall efficacy scale, a self‐report questionnaire used to evaluate a fear of falling in an elderly population.

“The main finding of this study was that a [four]‐week specific home‐based exercise program, which focused on TSM [task-specific movement], could improve en bloc turning and clinical outcomes in people with early‐to‐mid stage [Parkinson’s disease],” the researchers wrote.

One study limitation was that the control group was not provided a similar amount of attention as the exercise group; thus, it “cannot be ruled out as a factor contributing to group differences,” they said.

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