Postural deformities in Parkinson’s disease –Mutual relationships among neck flexion, fore-bent, knee-bent and lateral-bent angles and correlations with clinical predictors

Abstract

BackgroundVarious postural deformities appear during progression of Parkinson’s disease (PD), but the underlying pathophysiology of these deformities is not well understood. The angle abnormalities seen in individual patients may not be due to distinct causes, but rather they may have occurred in an interrelated manner to maintain a balanced posture.MethodsWe measured the neck flexion (NF), fore-bent (FB), knee-bent (KB) and lateral-bent (LB) angles in 120 PD patients, and examined their mutual relationships, and correlations with clinical predictors such as sex, age, disease duration, Hoehn and Yahr (H&Y) stage, medication dose (levodopa equivalent dose, LED; total dose of dopamine agonists, DDA). The relationship between the side of the initial symptoms and the direction of LB angle was also investigated.ResultsOur main findings were: (1) Significant relationships between NF and KB, NF and LB, FB and KB, KB and LB were observed. (2) NF angle was larger in males than in females, but FB, KB and LB angles showed no significant difference between the sexes. (3) FB and KB angles became larger with advancing age. (4) NF and FB angles were associated with disease duration. (5) NF, FB, KB and LB angles all increased significantly with increase of H&Y stage. (6) FB angle was significantly associated with LED, but DDA did not show a significant relationship with any of the measured angles. (7) Direction of LB angle was not associated with the side of initial symptoms.ConclusionsPostural abnormalities are interrelated, possibly to maintain a balanced posture.

Body posture in patients with Parkinson’s disease

“…The dose of levodopa was significantly correlated with the size of the angle of forward inclination. In contrast, doses of dopamine agonists were not significantly correlated with postural changes [26]. In other studies, Parkinson's disease was associated with a higher incidence of scoliosis in women.…”

“…In the course of Parkinson's disease, due to, among others, muscle rigidity and bradykinesia, there develops an abnormal body posture and pathological walking pattern. In patient's posture the following symptoms are observed: forward leaning of the head and the neck section of the spine, increased thoracic kyphosis, flattened lumbar lordosis, extensor arm joints position and their adduction and internal rotation, bending elbow joints with pronation, bending of metacarpophalangeal joints, extension of interphalangeal joints, www.balticsportscience.com adduction of the thumb, light extension, bending, internal rotation of the hip joints, and light bending of the knee joints [3,[16][17][18][19][20][21][22][23]. In view of the above, the purpose of the study was to analyze changes in the body posture and to assess the differences in posture between women and men with PD.…”

Wearable Sensor Based Stooped Posture Estimation in Simulated Parkinson’s Disease Gaits

“…The sensor was chosen to be mounted on the upper back (T2 bone) since this position might accurately represent SP. To determine whether the upper back is the preferential position for measuring, we also quantitatively analyzed the neck sensor position at the C4 bone, as neck flexion has a high correlation with the trunk forward bending angle [4]. The estimated SP angles were defined by the inclination angles of the sensors at their positions, while the reference angles for the neck and back flexion were described by the angles formed by the transverse plane and the (trueC7C1¯) and (trueT6C7¯) lines, respectively, as can be seen in Figure 1.…”

“…This research also noted that SP led to burdens in life, since 77% of PD patients needed to use walking aids and 85% experienced specific disabilities, such as dyspnea and fall risk. As neck flexion and fore-bent angles were seen to have a high correlation and were associated with PD duration [4], SP also reduces the ability of PD patients to look forward. Furthermore, late diagnosis may lead SP to become rigid kyphosis, which is much more challenging to correct [5].…”

Investigation of the Pharmaceutical Care in One Elderly Parkinson’s Disease Patient with Psychotic Symptoms

“…Therefore, the therapeutic dosage of levodopa/carbidopa 200 mg/50 mg orally was reduced from half a pill every 6 h to quarter of a pill every 6 h. Additionally, large neutral amino acids (e.g., phenylalanine, tyrosine, and tryptophan) have been shown to compete with levodopa for absorption and brain penetration [ 17 – 20 ]. It is reported that clinically significant protein interaction with levodopa may reduce its effectiveness and therefore lead to worsened motor fluctuations of PD, taking hallucinations, gait freezing, and dyskinesias as markers of motor fluctuations [ 21 ]. This means that allowing the patient to take levodopa before or after meals, to avoid reducing levodopa effectiveness and developing motor fluctuations, could get a significantly increased benefit.…”