Objective: To describe the effects of a 6-week Proprioceptive Neuromuscular Facilitation (PNF)-based exercise program in improving balance functions and balance confidence in people with Pisa syndrome related to Parkinson’s disease.

Background: Pisa syndrome in Parkinson’s disease (PD) presents substantial rehabilitation challenges [1]. Proprioceptive Neuromuscular Facilitation (PNF)-based exercise could mainly improve static and standing balance functions in PD population [2]. The effects of this approach targeting comprehensive balance functions and balance confidence in PD with Pisa syndrome is under-investigated.

Method: Adopting motor control principles in PNF, a 6-week pilot trial of a tailored physiotherapy program was conducted for individual with PD and Pisa syndrome. The weekly 60-min session consisted of manual techniques, progressive training on trunk mobility and stability, postural alignment, movement control and functional and walking tasks. Suggested home exercise dosage was 30-min for 3-5 times weekly. Balance Evaluation System Test (BESTest) total scores and subsection scores [3], and the Chinese Activities-specific Balance Confidence (C-ABC) score [4] were assessed before and after training (Post_6wk).

Results: A female, aged 63 subject (PD duration 13 years and modified Hohen and Yahr stage 2.5) with Pisa Syndrome for 2 years participated in the study. She developed progressive postural deformities and severe back pain for last 6 months, and had no history of falls but needed to walk with a pair of poles outdoors. She completed the PNF-based program with full attendance and had good compliance in the home program. No adverse effects or falls was reported during training and self-practice. At Post_6wk, there were increases from baseline of BESTest total score by +5.6% (82/108 to 88/108), Limit of Stability subsection score by +9.5% and Anticipatory Postural Adjustment subsection score by +16.7%. The C-ABC score improved by +50% (60% to 90%) and she did not require poles while walking outdoors.

Conclusion: The preliminary results suggest PNF-based physiotherapy program is feasible and could improve balance functions and balance confidence in individual with PD and Pisa syndrome. Further investigations are warranted for delaying postural deformities and disability progression in PD.

References: 1. Zak, M., Sikorski, T., Wasik, M., Krupnik, S., Andrychowski, J., & Brola, W. (2021). Pisa syndrome: Pathophysiology, physical rehabilitation and falls risk. NeuroRehabilitation, 49(3), 363-73.
2. Kumar, S., Faruqui, Z., & Muhammad, Y. A. (2024). The Role of Proprioceptive Neuromuscular Facilitation in Improving Balance in Parkinson Disease: PNF for Gait Improvement in PD Patients. Allied Medical Research Journal, 2(2), 257-65.
3. Horak, F. B., Wrisley, D. M., & Frank, J. (2009). The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Physical therapy, 89(5), 484-98.
4. Mak, M. K., Lau, A. L., Law, F. S., Cheung, C. C., & Wong, I. S. (2007). Validation of the Chinese translated Activities-Specific Balance Confidence Scale. Archives of Physical Medicine and Rehabilitation, 88(4), 496-503.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-of-proprioceptive-neuromuscular-facilitation-pnf-based-exercise-in-people-with-pisa-syndrome-from-parkinsons-disease-a-case-report/