An exploratory study of the consistency of balance control and the mobility of people with Parkinson's disease (PD) between medication doses

Pisa Syndrome Secondary to Drugs: A Scope Review

BACKGROUND

Pisa syndrome, also known as pleurothotonus, is a neurological condition characterized by more than ten degrees of constant lateral curvature of the spine when upright. In this way, the present manuscript aims to systematically review Pisa syndrome secondary to drugs.

METHODS

Two reviewers identified and assessed relevant reports in six databases without language restriction between January 1990 and June 2024.

RESULTS

The prevalence of Pisa syndrome varied from 0.037 to 9.3%. We found 109 articles containing 191 cases of drug-induced Pisa syndrome reported in the literature. The mean and median ages were 59.70 (SD = 19.02) and 67 (range = 12-98 years). The most prevalent sex was female, 56.91% (107/188). The most frequent medications associated with Pisa syndrome were acetylcholinesterase inhibitors in 87 individuals. Of 112 individuals in which the onset time from the medication to the movement disorder occurrence was reported, 59 took place within a month. In this way, a return to baseline was observed in 45.50% of the cases, and partial recovery was observed in 14.28%.

CONCLUSION

We proposed new diagnostic criteria for Pisa syndrome based on previous findings in the literature. Moreover, multiple mechanisms are probably involved in balance control and the development of lateral trunk flexions.

Translating digital healthcare to enhance clinical management: a protocol for an observational study using a digital health technology system to monitor medication adherence and its effect on mobility in people with Parkinson's

INTRODUCTION

In people with Parkinson's (PwP) impaired mobility is associated with an increased falls risk. To improve mobility, dopaminergic medication is typically prescribed, but complex medication regimens result in suboptimal adherence. Exploring medication adherence and its impact on mobility in PwP will provide essential insights to optimise medication regimens and improve mobility. However, this is typically assessed in controlled environments, during one-off clinical assessments. Digital health technology (DHT) presents a means to overcome this, by continuously and remotely monitoring mobility and medication adherence. This study aims to use a novel DHT system (DHTS) (comprising of a smartphone, smartwatch and inertial measurement unit (IMU)) to assess self-reported medication adherence, and its impact on digital mobility outcomes (DMOs) in PwP.

METHODS AND ANALYSIS

This single-centre, UK-based study, will recruit 55 participants with Parkinson's. Participants will complete a range of clinical, and physical assessments. Participants will interact with a DHTS over 7 days, to assess self-reported medication adherence, and monitor mobility and contextual factors in the real world. Participants will complete a motor complications diary (ON-OFF-Dyskinesia) throughout the monitoring period and, at the end, a questionnaire and series of open-text questions to evaluate DHTS usability. Feasibility of the DHTS and the motor complications diary will be assessed. Validated algorithms will quantify DMOs from IMU walking activity. Time series modelling and deep learning techniques will model and predict DMO response to medication and effects of contextual factors. This study will provide essential insights into medication adherence and its effect on real-world mobility in PwP, providing insights to optimise medication regimens.

ETHICS AND DISSEMINATION

Ethical approval was granted by London-142 Westminster Research Ethics Committee (REC: 21/PR/0469), protocol V.2.4. Results will be published in peer-reviewed journals. All participants will provide written, informed consent.

TRIAL REGISTRATION NUMBER

ISRCTN13156149.

[Possibilities of non-drug treatment for Parkinson's disease]

In this article, non-drug methods of treatment of Parkinson's disease are reviewed. Particular attention is given to the motor symptoms of disease, specifically to gait disorders. Information about objective methods of gait impairment is presented. Own results that confirm the effect of a method of tempo-rhythmical correction of walk in patients with Parkinson's disease (PD) and vascular parkinsonism as well as a device for assessment of gait parameters developed by the authors are analyzed. The efficacy of other methods of gait correction using external cues, study design and level of evidence are analyzed as well. Information about possibilities of physical therapy and ergotherapy for correction of different symptoms of Parkinson's disease is presented. Positive and negative results of transcranial magnetic stimulation, light therapy and transcranial micropolarization in PD are analyzed. Basis non-drug methods of PD treatment, which currently have insufficient level of evidence (methods of mental relaxation and auditory training, methods of whole body vibration (vibromassage), laser therapy (photoacoustic therapy), acupuncture), are described in brief. Perspectives of the method of gait recovery in PD using tempo-rhythmic correction are emphasized.

Postural disorders in Parkinson's disease

Posture is often affected in Parkinson's disease. Postural abnormalities belong to the motor axial involvement. Generally, postural dysfunction induces clinical impairment at the latest stages of the disease, except in late-onset idiopathic Parkinson's disease and in atypical parkinsonian syndromes. Posture may be affected in its orientation component (stooped posture, camptocormia, Pisa syndrome) or in its balance component (loss of postural reflexes). Overall, postural impairment is poorly improved by levodopa, which implies that it is unlikely due to the nigrostriatal dopaminergic denervation. Several methods of investigation have been proposed but are generally not available in clinical practice. Medical treatment and deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus pars interna are less efficient on axial than on distal motor signs. The pedonculopontine nucleus seems promising as a new target for DBS in combination with the subthalamic nucleus. Physical therapy is, in most cases, the best way to improve postural dysfunction.

Falls in Parkinson's disease

PURPOSE OF REVIEW

To summarize the latest insights into the clinical significance, assessment, pathophysiology and treatment of falls in Parkinson's disease.

RECENT FINDINGS

Recent studies have shown that falls are common in Parkinson's disease, even when compared with other fall-prone populations. The clinical impact of falls is considerable, often leading to an incapacitating fear of renewed falls. The associated costs for society are substantial. Clinical assessment often includes the retropulsion test, and recent studies have offered practical recommendations regarding the execution and scoring of this test. Insights into the pathophysiology underlying falls are growing and point to an important role for the loss of inter-segmental flexibility ('stiffness'), which predisposes patients to falls in a backward or medial-lateral direction. New evidence has clarified why Parkinson's disease patients commonly fall during transfers and under 'dual tasking' circumstances. The absence of adequately directed arm movements may explain the relatively high proportion of hip fractures in Parkinson's disease. The importance of freezing of gait as a cause of falls is recognized, and we are beginning to understand the different manifestations of gait freezing. Recent work has defined the contributions of pharmacotherapy, stereotactic neurosurgery, physiotherapy and multidisciplinary interventions in the treatment of postural instability to prevent falls in Parkinson's disease.

SUMMARY

No dramatic breakthroughs have occurred during the review period, but new information in various areas may be useful for practising clinicians. Interesting new questions have been raised that should fuel studies of pathophysiological mechanisms, which could help in the development of improved treatment strategies to reduce falls in Parkinson's disease.

Improved ambulation and speech production in an adolescent post-traumatic brain injury through a therapeutic intervention to increase postural control

PURPOSE

This case study examined the effectiveness of a programme designed to improve anticipatory postural control in an adolescent over years 2 and 3 post-traumatic brain injury (TBI). It was hypothesized that her difficulty in walking and talking simultaneously was caused by excessive co-activation of extremity, trunk, and oral musculature during upright activities.

METHODS

The participant was treated weekly by physical and speech therapy. Treatment focussed on improving anticipatory postural control during gross motor activities in conjunction with oral-motor function.

RESULTS

Initially, the participant walked using a walker at a speed of 23 cm s(-1). Two years later, she could walk without a device at 53 cm s(-1). Initial laryngoscopic examination showed minimal movement of the velum or pharyngeal walls; full movement was present after treatment. The measure of intelligibility improved from no single word intelligible utterances to 85% intelligible utterances after 2 years.

DISCUSSION

The results suggest that less compensatory rigidification of oral musculature was needed to maintain an upright position against gravity as postural control improved.

CONCLUSION

An adolescent 1-year post-TBI was followed as she underwent additional rehabilitation focussed on improving anticipatory postural control. The functional goal of simultaneously talking while walking was achieved through this intervention.