title: Exploring the Effects of Using an Oral Appliance to Reduce Movement Dysfunction in an Individual With Parkinson Disease: A Single-Subject Design Study.
abstract: OBJECTIVE
  Clinical reports suggest that wearing an oral appliance can improve the gait and balance of an individual with Parkinson disease (PD). Our primary purpose was to systematically explore this effect using a single-subject study design and quantitative motion analysis. Secondarily, we sought to examine the quality-of-life outcomes following 1-month of routine oral appliance wear.
  
  
  METHODS
  The participant was a 73-year-old ambulatory man with mid-stage PD. Using an A-B-A design, for which a custom-made oral appliance served as the intervention, kinematic and kinetic data were captured during performance of Four Square Step Test, serpentine walk, and tandem walk tasks. Grip strength was quantified with a dynamometer. Quality-of-life outcomes were collected after 1 month of appliance wear using the Parkinson Disease Questionnaire-39 (PDQ-39). Perceived changes in balance, mobility, and quality of life were captured from the participant using an 11-point Global Rate of Change (GRC) scale.
  
  
  RESULTS
  Changes in mobility, postural control, and grip strength during appliance wear were suggestive of reduced movement dysfunction. The PDQ-39 revealed a significant improvement in quality of life, primarily related to increased emotional well-being, decreased stigma, and increased communication. GRC scores indicated a clinically significant improvement in ease of movement in the community (+3), ease of movement during the performance of activities of daily living (+4), and in standing balance while performing activities of daily living (+4).
  
  
  CONCLUSIONS
  Study findings provided quantitative evidence supporting the effectiveness of oral appliance wear for reducing movement dysfunction in a patient with mid-stage PD.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A155).
authors.affiliation: Morrison Center, Scarborough & Wells, Maine (H.L.); Achieve Orthopedic Rehabilitation Institute, Naperville, Illinois (L.E.R.); Orthopaedic Associates, Portland, Maine (M.W.); Department of Cariology and Comprehensive Care, College of Dentistry, New York University, New York (D.A.); and Department of Physical Therapy, University of New England, Portland, Maine (M.L., J.T.C.).
authors.forename: Hillary
authors.initials: H
authors.lastname: Lane
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Rose
authors.forename: Megan
authors.initials: M
authors.lastname: Woodbrey
authors.forename: David
authors.initials: D
authors.lastname: Arghavani
authors.forename: Michael
authors.initials: M
authors.lastname: Lawrence
authors.forename: James T
authors.initials: JT
authors.lastname: Cavanaugh
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001696:Biomechanical Phenomena; D005080:Exercise Test; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D018737:Hand Strength; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000209:etiology / Q000534:rehabilitation*; D016910:Orthodontic Brackets; D009989:Orthotic Devices; D010300:Parkinson Disease / Q000150:complications / Q000534:rehabilitation*; D004856:Postural Balance; D011788:Quality of Life; D013647:Task Performance and Analysis; D000070857:Walk Test