Objective: A prospective cohort study of the effectiveness of osteopathic manipulative medicine (OMM) and physical therapy in improving postural control and dysautonomia in Parkinson’s disease (PD) with camptocormia.

Background: Camptocormia is a truncal dystonia associated with PD, having significantly more dysautonomia and perceptual problems than PD alone. The effect of dysautonomia on heart rate in PD with camptocormia is not clear. Current literature supports the use of exercise therapy in these patients, although minimal improvement is typically achieved.

Methods: Subjects with camptocormia and PD underwent a health history, review of systems, and physical exams at the initial and final visits. Postural changes in the distance between external auditory meatus and a vertical plumb line were measured. Beat-to-beat variation in heart rate (HRV) was measured supine and after a tilt test. Between the initial and final visits, subjects were treated weekly with OMM and twice weekly with physical therapy for 6 weeks. HRV was computed using spectral analysis by AcqKnowledge 4.1 (BIOPAC, Goleta, CA) in a manner previously described. Low frequency (LF) power was normalized (LFnu) with very low frequency and high frequency (HF) powers prior to comparison.

Results: Subjects were 83 and 70 years old with 1.5 and 18 years of Parkinson’s disease, respectively. Both subjects had frontal bone extension dysfunction with strain of the anterior dural girdle, vertical strains and torsions at the sphenobasilar synchondrosis, occipitomastoid suture compression, hypertonic sternocleidomastoid muscles, C2 flexion dysfunction, elevated 1st ribs, myofascial strain of the abdominal wall, and posterior sacral bases. These somatic dysfunctions improved in severity from severe to moderate. Pain on a ten-point scale, height, Berg Balance Scale scores, shoulder, hip, and range of motion, and forward bending posture improved with treatment. Analysis of HRV revealed a differential change in LF and HF.

Conclusions: This study suggests that a combination of OMM to specified anatomy and physical therapy over a 6 week period may improve posture and symptoms in people with PD and camptocormia. Additional subjects are necessary to differentiate the effects of individual differences.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-in-posture-pain-and-cardiac-autonomic-function-in-a-prospective-study-of-osteopathic-manipulative-medicine-and-physical-therapy-for-camptocormia-in-parkinsons-disease/