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Working on asymmetry in Parkinson’s disease: randomized, controlled pilot study

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Abstract

Posture, gait and balance problems are very disabling symptoms in Parkinson’s disease (PD). An increased stride-to-stri de variability, reduction of automaticity and asymmetry of lower limbs function characterize parkinsonian gait. These features predispose to freezing of gait (FOG), which often leads to falls. The aim of this study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and reduce FOG, thus preventing falls. Twenty-eight PD patients entered a double-blind pilot feasibility controlled study and were evaluated at baseline and after 3 months of a rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire, Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire. Patients were randomly assigned to three treatment arms: (1) worst side improvement; (2) best side improvement; (3) standard therapy. All study arms showed a significant improvement of the Tinetti and SPPB scores. BSI led to a greater improvement than ST in terms of UPDRS-III (p = 0.01); Tinetti total score (p = 0.05) and Tinetti gait subscore (p = 0.01). Our study confirms the efficacy of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g., asymmetry of motor condition) might be even more effective than standard rehabilitative programs.

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Abbreviations

BSI:

Best side improvement

FAB:

Frontal Assessment Battery

FOG:

Freezing of gait

GFQ:

Gait and Falls Questionnaire

HARS:

Hamilton Anxiety Rating Scale

HDRS:

Hamilton Depression Rating Scale

LEDD:

Levodopa daily dose equivalent

MMSE:

Mini Mental State Examination

PAS:

Paired associative stimulation

PD:

Parkinson’s disease

SPPB:

Short Physical Performance Battery

ST:

Standard treatment

UPDRS-III:

Unified Parkinson Disease Rating Scale-motor score

VAS:

Visual analogic scale

WSI:

Worst side improvement

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Conflict of interest

Authors declare no conflict of interest in regard to the manuscript.

Author information

Authors and Affiliations

  1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK

    Lucia Ricciardi

  2. Dipartimento di gerontologia e geriatria, Università Cattolica del Sacro Cuore, Rome, Italy

    Diego Ricciardi & Roberto Bernabei

  3. Neuromed Institute, Pozzilli, IS, Italy

    Francesco Lena, Simona Barricella & Nicola Modugno

  4. Center for Advanced Technologies in Rehabilitation, Rehabilitaion Hospital, Sheba Medical Center, Tel Hashomer, Israel

    Meir Plotnik

  5. Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Meir Plotnik

  6. Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel

    Meir Plotnik

  7. Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy

    Martina Petracca & Anna Rita Bentivoglio

  8. Movement Disorders Centre, Toronto Western Hospital, 399 Bathurst St, 7 Mc412, Toronto, ON, M5T 2S8, Canada

    Alfonso Fasano

Authors
  1. Lucia Ricciardi
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  2. Diego Ricciardi
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  3. Francesco Lena
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  4. Meir Plotnik
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  9. Roberto Bernabei
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  10. Alfonso Fasano
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Corresponding author

Correspondence to Alfonso Fasano.

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Ricciardi, L., Ricciardi, D., Lena, F. et al. Working on asymmetry in Parkinson’s disease: randomized, controlled pilot study. Neurol Sci 36, 1337–1343 (2015). https://doi.org/10.1007/s10072-015-2082-8

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  • DOI: https://doi.org/10.1007/s10072-015-2082-8

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