Parkinson Disease and Pisa Syndrome Clinical Trial
Official title:
Efficacy of Osteopathic Manipulative Treatment on Postural Control in Parkinsonian Patients With Pisa Syndrome: a Pilot Randomized Placebo-controlled Trial
The aim of the study is to evaluate the efficacy of osteopathic manipulations added to an intensive, multidisciplinary rehabilitative (MIRT) program on postural control of PD-PS patients.
Pisa Syndrome is frequently associated with Parkinson Disease and it is characterized by a
trunk lateral flexion higher than 10 degrees that is reversible with the lying position. Its
pathophysiology is multifactorial, and it is probably different depending on disease onset
duration. However, a relevant association between subjective visual vertical misperception
and the PS involved side was recently described. Moreover, an impairment in postural control
in PD-PS patients has been recognized. Nowadays, physical therapy is the standard treatment
and it is proposed to ameliorate paraspinal muscle hyperactivity and balance, as showed by
previews descriptive and clinical studies. Despite being physical therapy a cornerstone in
PD-PS axial symptoms treatment, the therapeutic protocol for postural control in PD-PS
patients is under active study.
In recent years, preliminary studies described the effects of osteopathic manipulative
treatment on motor functionality and balance in PD patients in a multidisciplinary setting,
which is in line with the evidence of the need of a multidisciplinary and intensive approach
to achieve better outcomes. However, the effect of OMT has never been investigated in PD-PS
patients. The aim of the study is to evaluate the effects of OMT on postural control of PD-PS
patients undergoing the MIRT program. Literature reported the possible benefit of OMT on the
balance of healthy subjects, possibly interacting with the multisensorial integration of
balance. 24 PD-PS patients are enrolled and randomized in two groups. Posturography is
performed to assess Eye-closed Sway Area (ECSA) at baseline and 30 days after enrolment. The
investigator who perform posturography and trunk inclination assessment is kept blinded.
Trunk inclination is measured with "DIERS Formetric 4D". Other variables considered in the
investigation are Eye-opened sway area (EOSA), Trunk Lateral Flexion (TLF), Kyphothic Angle
(KA), Unified Parkinson Disease Rating Scale (UPDRS), Six-minute Walking Test (6MWT).
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