Objective: To investigate the effectiveness of exercise focused on ankle joint movement for postural instability in patients with Parkinson’s disease (PD).

Background: Postural instability is a common and serious problem in PD, but the effects of dopaminergic medications are negligible. Clinically, heel landing at retropulsion is a specific feature of PD. Recent studies have found that repetitive training of compensatory steps can positively influence postural instability in patients with PD [1]. However, ankle joint movement during the backward response has not been examined.

Method: Nine inpatients with PD (mean age=70.7 years; mean disease duration=7.0 years; Modified Hoehn and Yahr 2.5-4) underwent 10 exercise sessions, including standardized physiotherapy. They exercised 5 times per week for 40 minutes in an ON medication state. This exercise consisted of repetitive pulls on the shoulders backward, and the patients were instructed on how to land on their toes as a backward response. Outcome measures included backward response (pull test), performance in activities of daily living (Barthel Index (BI)) and effects of medication (L-dopa dose), and were taken at baseline and post-intervention. Statistical analyses were performed using the Wilcoxon signed-rank test.

Results: No adverse effects or falls were reported during the study period. There was significantly improvement in the pull test from 2.6 to 0.4 (P < 0.01) and BI from 65.6 to 87.8 (P < 0.01). The L-dopa dose did not differ significantly.

Conclusion: Our intervention is a safe, feasible and potentially effective exercise for inpatients with moderate to severe PD in the short-term. Instruction on toe landing may be one of the most important components to treat postural instability in PD.

References: [1] Jöbges M, Heuschkel G, Pretzel C, Illhardt C, Renner C, Hummelsheim H, Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2004; 75(12): 1682-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effects-of-exercise-focused-on-ankle-joint-movement-for-postural-instability-in-patients-with-parkinsons-disease-a-pilot-study/