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

An Erratum to this article was published on 04 February 2016


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.

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  1. QTM—Qualysis AB, Packhusgatan 6, 411 13 Gothenburg, Sweden.

  2. Visual 3D—C-Motion Inc. 20030 Century Blvd, Suite 104A Germantown, MD 20874.

  3. SPSS—IBM Corporation 1 New Orchard Road Armonk, New York 10504-1722 USA.


  1. Morris ME, Iansek R, Matyas TA, Summers JJ (1994) The pathogenesis of gait hypokinesia in Parkinson’s disease. Brain 117:1169–1181

    Article  PubMed  Google Scholar 

  2. Grimbergen YA, Schrag A, Mazibrada G, Borm GF, Bloem BR (2013) Impact of falls and fear of falling on health-related quality of life in patients with Parkinson’s disease. J Parkinson’s dis 3:409–413

    Google Scholar 

  3. Aita JF (1982) Why patients with Parkinson’s disease fall. JAMA 247:515–516

    CAS  Article  PubMed  Google Scholar 

  4. Tomlinson CL, Patel S, Meek C, Clarke CE, Stowe R, Shah L et al. (2013) Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev 9:CD002817.

  5. Van der Kolk NM, King LA (2013) Effects of exercise on mobility in people with Parkinson’s disease. Mov Disord 28:1587–1596

    Article  PubMed  Google Scholar 

  6. Gobbi LT, Oliveira-Ferreira MD, Caetano MJ et al (2009) Exercise programs improve mobility and balance in people with Parkinson’s disease. Parkinsonism Relat Disord 15:S49–S52

    Article  PubMed  Google Scholar 

  7. Reuter I, Engelhardt KS, Baas H (1999) Therapeutic value of exercise training in Parkinson’s disease. Med Sci Sports Exerc 31:1544–1549

    CAS  Article  PubMed  Google Scholar 

  8. Miyai I, Fujimoto Y, Ueda Y et al (2000) Treadmill training with body weight support: its effect on Parkinson’s disease. Arch Phys Med Rehabil 81:849–852

    CAS  Article  PubMed  Google Scholar 

  9. Scandalis TA, Bosak A, Berliner JC et al (2001) Resistance training and gait function in patients with Parkinson’s disease. Am J Phys Med Rehabil 80:38–43

    CAS  Article  PubMed  Google Scholar 

  10. Dibble LE, Hale TF, Marcus RL et al (2009) High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson’s disease: a preliminary study. Parkinsonism Relat Disord 15:752–757

    Article  PubMed  Google Scholar 

  11. Bergen JL, Toole T, Elliott RG III et al (2002) Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson’s disease patients. NeuroRehabilitation 17:161–168

    PubMed  Google Scholar 

  12. Hackney ME, Earhart GM (2009) Health-related quality of life and alternative forms of exercise in Parkinson disease. Parkinsonism Relat Disord 15:644–648

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nocera J, Horvat M, Ray CT (2009) Effects of home-based exercise on postural control and sensory organization in individuals with Parkinson disease. Parkinsonism Relat Disord 15:742–745

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hirayama MS, Gobbi S, Gobbi LTB, Stella F (2008) Quality of life (QoL) in relation to disease severity in Brazilian Parkinson’s patients as measured using the WHOQOL-BREF. Arch Gerontol Geriatr 46:147–160

    Article  PubMed  Google Scholar 

  15. Morris ME, Iansek R, Kirkwood B (2009) A randomized control trial of movement strategies compared with exercise for people with Parkinson’s disease. Mov Disord 24:64–71

    Article  PubMed  Google Scholar 

  16. Li F, Harmer P, Fitzgerald K et al (2012) Tai Chi and postural stability in patients with parkinson’s disease. N Engl J Med 366:511–519

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Souchard PE (2003) Principes et originalité de la reéducation posturale globale. Le Pousoë, Paris

    Google Scholar 

  18. Oliveri M, Caltagirone C, Loriga R, Pompa MN, Versace V, Souchard P (2012) Fast increase of motor cortical inhibition following postural changes in healthy subjects. Neurosci Lett 530:7–11

    CAS  Article  PubMed  Google Scholar 

  19. Vitale C, Agosti V, Avella D et al (2012) Effect of Global Postural Rehabilitation program on spatiotemporal gait parameters of parkinsonian patients: a three-dimensional motion analysis study. Neurol Sci 33:1337–1343

    Article  PubMed  Google Scholar 

  20. Lord S, Galna B, Rochester L (2013) Moving forward on gait measurement: toward a more refined approach. Mov Disord 28:1534–1543

    Article  PubMed  Google Scholar 

  21. Gibb WR, Lees AJ (1998) The relevance of the Lewy body in the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51:745–752

    Article  Google Scholar 

  22. Measso G, Cavarzeran F, Zappalà G et al (1993) The mini-mental state examination: normative study of an Italian random sample. Developmental neuropsychology 9:77–85

    Article  Google Scholar 

  23. Davis RB III, Ounpuu S, Tyburski D, Gage JR (1991) A gait analysis data collection and reduction technique. Hum Mov Sci 10:575–587

    Article  Google Scholar 

  24. Levangi PK, Norkin CC (2011) Joint structure and function: a comprehensive analysis, 5th edn. F. A. Davis Company, Philadelphia

    Google Scholar 

  25. Perry J, Burnfield J (2010) Gait analysis: normal and pathological function, 2nd edn. Slacks Incorporated, Thorofare

    Google Scholar 

  26. Grosset K, Needleman F, Macphee G, Grosset D (2004) Switching from ergot to nonergot dopamine agonists in Parkinson’s disease: a clinical series and five-drug dose conversion table. Mov Disord 19:1370–1374

    Article  PubMed  Google Scholar 

  27. Knutsson E (1972) An analysis of parkinsonian gait. Brain 95:475–486

    CAS  Article  PubMed  Google Scholar 

  28. Murray MP, Sepic SB, Gardner GM, Downs WJ (1978) Walking patterns of men with parkinsonism. Am J Phys Med 57:278–294

    CAS  PubMed  Google Scholar 

  29. Morris ME, McGinley J, Huxham F, Collier J, Iansek R (1999) Constraints on the kinetic, kinematic and spatiotemporal parameters of gait in Parkinson’s disease. Hum Mov Sci 18:461–483

    Article  Google Scholar 

  30. Knutsson E, Mårtensson A (1971) Quantitative effects of L-dopa on different types of movements and muscle tone in Parkinsonian patients. Scand J Rehabil Med 3:121–130

    CAS  PubMed  Google Scholar 

  31. Morris M, Iansek R, McGinley J, Matyas T, Huxham F (2005) Three-dimensional gait biomechanics in parkinson’s disease: evidence for a centrally mediated amplitude regulation disorder. Mov Disord 20:40–50

    Article  PubMed  Google Scholar 

  32. Bonetti F, Curti S, Mattioli S et al (2010) Effectiveness of a global postural reeducation program for persistent low back pain: a non-randomized controlled trial. BMC Musculoskelet Disord 11:285

    Article  PubMed  PubMed Central  Google Scholar 

  33. Guissard N, Duchateau J, Hainaut K (2001) Mechanisms of decreased motoneuron excitation during passive muscle stretching. Exp Brain Res 137:163–169

    CAS  Article  PubMed  Google Scholar 

  34. Casey Kerrigan D, Todd Mary K, Croce Ugo Della et al (1998) Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments. Arch Phys Med Rehabil 79:317–322

    Article  Google Scholar 

  35. Casey Kerrigan D, Xenopoulos-Oddsson Annette, Sullivan Meaghan J et al (2003) Effect of a hip flexor-stretching program on gait in the elderly D. Arch Phys Med Rehabil 84:1–6

    Article  PubMed  Google Scholar 

  36. Rodacki ALF, Souza RM, Ugrinowitsch C et al (2009) Transient effects of stretching exercises on gait parameters of elderly women. Man Ther 14:167–172

    Article  PubMed  Google Scholar 

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The work was supported by a grant from MIUR (FIRB—MERIT RBNE08LN4P:006).

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Correspondence to Giuseppe Sorrentino.

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All authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

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V. Agosti and C. Vitale contributed equally to this paper.

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Agosti, V., Vitale, C., Avella, D. et al. Effects of Global Postural Reeducation on gait kinematics in parkinsonian patients: a pilot randomized three-dimensional motion analysis study. Neurol Sci 37, 515–522 (2016).

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  • 3D motion analysis
  • Global postural reeducation
  • Gait
  • Kinematics
  • Parkinson disease
  • Range of motion