Effects of Physical Training on Straightening-Up Processes in Patients With Parkinson's Disease.

Effects of Physical Training on Straightening-Up Processes in Patients With Parkinson's Disease 

Viliani T, Pasquetti P, Magnolfi S, et al (Rehabilitation Department, Prato Hospital, Prato, Italy), Disabil Rehabil. 1999;21:68-73.

The study's purpose was to judge whether a group exercise program produced more rapid performance of straightening-up tasks among patients with Parkinson disease. The authors believed that improvement in these tasks could lead to improvements in the patients' ability to change body position. The authors enrolled 20 outpatients with idiopathic Parkinson disease (12 men, 8 women; average age = 72.9 years) in exercise groups of 6 or 7 people. Each group met for 1 hour, twice a week, for 5 consecutive weeks.

The authors described the groups' activities as "active mobilization" exercises--performed while sitting or standing--for the upper and lower extremities, the cervical spine, and the trunk. Patients also performed active movements that required alternation between limbs and "pendular oscillations of the limbs." Patients received cues to correct their postures during the exercises and also performed gait exercises that involved, among other unspecified activities, stepping in place to an audible cue.

Motor performance was assessed by measuring the time required to perform activities that required a straighten-up motor sequence. The straighten-up tasks that the authors measured included transitions between supine and sitting positions, rolling while supine to the right or left, and standing up from a chair. A Wilcoxon test was used to analyze differences in the mean time required to perform a given motor task before versus after training.

When patients were analyzed as a group, the mean time required to perform each task decreased significantly after completing the training program. Examination of individual patients, however, revealed that the time required for most tasks increased in 2 patients and remained virtually unchanged for 2 patients. The other 16 patients showed distinct improvements in all motor performance times, and they also reported subjective improvements in the ability to perform everyday tasks outside of the laboratory/clinical setting.

The authors described some limitations of their study. They did not measure the performance of a control or comparison group whose members received other treatments. Also, the patients' functional abilities or disease severity were not described. Nevertheless, the authors argued that the study illustrates how a group of patients with Parkinson disease improved their function following a simple outpatient intervention. They reserved judgment on the reasons why most patients could move more quickly after the treatment period. They pointed out that the exercises involved a set of skills that differed from the ones that they timed. Accordingly, the authors were inclined to rule out both a "conditioning effect" and "relearning of deficient motor performance." They believed that the exercises' association with more rapid functioning may stem instead from increases in patients' joint mobility in the spine and extremities.

David M Thompson, PT University of Oklahoma Health Sciences Center Oklahoma City, Okla