Does the Pisa syndrome affect postural control, balance, and gait in patients with Parkinson's disease? An observational cross-sectional study.
BACKGROUND
An altered sense of verticality, associated with impaired proprioception and somatosensory integration deficits, has been reported in patients with Parkinson's disease (PD) but it has not been characterized in patients with Pisa syndrome (PS). Therefore, we investigated postural control, balance, and gait disturbances in patients with PD and PS, patients with PD but without PS, and aged-matched normal controls.


METHODS
This observational cross-sectional study involved patients with PD and PS (n = 10, Hoehn & Yahr score <4), patients with PD but without PS (n = 10), and age-matched healthy controls (n = 10). The primary outcome measure was the velocity of CoP displacement (VEL_MED_AP/ML) assessed by static stabilometry in eyes open (EO) and eyes closed (EC) conditions. The secondary outcomes were other stabilometric parameters, the Sensory Organization Balance Test (SOT), and gait analysis (GA).


RESULTS
There were no significant differences in demographic and clinical data and Berg Balance Scale scores between the groups. There was a significant main effect in the VEL_MED_AP/ML between the groups and eye conditions (p = .016). A significant main effect was found in the EO (p = .01) and EC (p = .04) conditions. Post-hoc comparisons showed a significant increase in VEL_CoP in both the EO and EC conditions only in the patients with PD and PS. No significant main effects on SOT and GA were found.


CONCLUSIONS
Patients with PD and PS had more difficulty achieving good postural alignment with gravity and greater velocity of body sway than the other groups. Rehabilitation programs for patients with PD and PS should include spine alignment and dynamic postural training.
Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy. Electronic address: christian.geroin@univr.it.
Christian
C
Geroin
Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, P.le Scuro 10, 37134 Verona, Italy. Electronic address: nicola.smania@univr.it.
Nicola
N
Smania
School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy. Electronic address: federico.schena@univr.it.
Federico
F
Schena
Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy. Electronic address: eleonora.dimitrova11@gmail.com.
Eleonora
E
Dimitrova
School of Specialization in Physical Medicine and Rehabilitation, Department of Neurological and Movement Sciences, University of Verona, Italy. Electronic address: elisabetta.verzini@gmail.com.
Elisabetta
E
Verzini
School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy. Electronic address: federica.bombieri@univr.it.
Federica
F
Bombieri
School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy. Electronic address: francesca.nardello@univr.it.
Francesca
F
Nardello
Neurology Unit, Movement Disorders Division, Department of Neurological and Movement Sciences, University of Verona, P.le Scuro 10, 37134 Verona, Italy. Electronic address: michele.tinazzi@univr.it.
Michele
M
Tinazzi
Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy. Electronic address: marialuisa.gandolfi@univr.it.
Marialuisa
M
Gandolfi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology; D020886:Somatosensory Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D013577:Syndrome
Equilibrium; Falls; Postural orientation; Proprioception