Staying UpRight in Parkinson's disease: A pilot study of a novel wearable postural intervention

OBJECTIVES

This interventional pilot study aimed to 1) examine whether a novel wearable vibro-tactile feedback device ('UpRight Go') is effective and feasible to improve postural alignment in Parkinson's disease (PD); 2) explore relationships between postural alignment and attention in PD; 3) explore effect of vibro-tactile device on balance and gait; and 4) gain initial feedback on the use of the vibro-tactile device in the laboratory and at home.

METHODS

25 people with PD sat, stood and walked for two-minutes without and with the UpRight device attached to their upper backs to provide feedback on postural alignment in the laboratory. A sub-group (n = 12) wore the UpRight device at home for 60 min. per day for 7-days of postural feedback. Subjective feedback on use of the device was obtained in the laboratory and at the end of the 7-day period. The primary outcome for this study was posture measured by verticality of inertial measurement units (IMUs) at the neck, trunk and low back, which was done with and without the UpRight device. Secondary outcomes included clinical measures of posture, subjective feedback on the device, computerized attention measures, gait and balance.

RESULTS

Neck postural alignment in PD was significantly improved (reduced neck flexion) with the UpRight during sitting and standing in both clinical measures (p = 0.005) and IMU outcomes (p = 0.046), but trunk and low back posture did not change. There was no change in postural alignment during walking with the UpRight. Postural alignment response was related to attentional capabilities. Many subjects (68 %) reported that they felt a benefit from the UpRight and most participants reported that the device was acceptable (Lab use; 72 %, Home use; 75 %).

CONCLUSION

The UpRight Go feedback device may improve neck/upper-back posture in PD during sitting and standing, but not during walking. Postural alignment response to the device may depend on attentional mechanisms.

The effect of comprehensive physiotherapy-based rehabilitation on stooped posture in Parkinson's disease

[Purpose] The effect of physiotherapy on stooped posture in Parkinson's disease patients remains to be clarified. Therefore, the purpose of this study was to investigate whether comprehensive physiotherapy-based rehabilitation can improve stooped posture in Parkinson's disease patients. [Participants and Methods] The participants were Parkinson's disease patients with stooped posture. Outpatients were assigned to the control group and inpatients to the postural rehabilitation group. The outcomes measured were trunk bending angle, lumbar lordosis, and thoracic kyphosis. Each group was assessed at baseline and 1 month later. [Results] Of 22 participants identified, 20 were included, with 10 participants in the postural rehabilitation group and 10 in the control group. The age in the postural rehabilitation group was significantly greater than that in the control group, while other parameters were comparable in both groups. After the month-long intervention, the trunk bending angle and lumbar lordosis were significantly improved in the postural rehabilitation group compared to the control group. [Conclusion] The results showed improvement in stooped posture in the postural rehabilitation group as compared to the control group. Furthermore, improvement of lumbar lordosis accompanied improvement of stooped posture. These findings suggest that comprehensive physiotherapy-based rehabilitation may improve stooped posture in Parkinson's disease patients.

Reliability and Validity of Nonradiologic Measures of Forward Flexed Posture in Parkinson Disease

OBJECTIVE

To examine the intertester reliability and validity of 5 nonradiologic measures of forward flexed posture in individuals with Parkinson disease (PD).

DESIGN

Cross-sectional observational study.

SETTING

University outpatient facility and community centers.

PARTICIPANTS

Individuals (N=28) with PD with Hoehn and Yahr scores of 1 through 4.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Occiput to wall status, tragus to wall distance, C7 to wall distance, photographically derived trunk flexion angle, and inclinometric kyphosis measure.

RESULTS

Participants were older adults (mean, 69.7±10.6y) with a 14-month to 15-year (mean, 5.9±3.5y) history of PD. Intertester reliability was excellent for all measures (κ=.89 [cued condition] and 1.0 [relaxed condition] for occiput to wall status; intraclass correlation coefficients, .779-.897 for tragus to wall distance, C7 to wall distance, flexion angle, and inclinometric kyphosis measure). Convergent validity was supported for all measures by significant correlations between the same measures obtained during relaxed and cued conditions (eg, occiput to wall relaxed and cued) and for most measures by significant correlations between measures obtained under the same condition (eg, occiput to wall cued and tragus to wall cued). Significant correlations between tragus to wall distance, C7 to wall distance, flexion angle, and inclinometric kyphosis measure and the Unified Parkinson Disease Rating Scale item 28 (posture) also supported convergent validity. Significant differences between tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure values under relaxed and cued conditions supported known condition validity. Known group validity was demonstrated by significant differences in tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure obtained from individuals able and individuals unable to touch their occiput to wall when cued to stand tall.

CONCLUSIONS

Tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure are reliable and valid nonradiologic measures of forward flexed posture in PD.