The Acute Effect of Lumbosacral Mobilization in Parkinson's Disease
Condition: Idiopathic Parkinson's Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      Parkinson's disease is a neurodegenerative disease including resting tremor, bradykinesia,
      rigidity and postural instability. In addition, postural disorders, motor freezing, gait
      disturbances, decreased arm swing and axial rotation loss accompany the disease. There is an
      important relationship between axial rotation and turning, which is one of many activities in
      daily life. Parkinson's patients with loss of axial rotation have a difficulty gait, daily
      living activities and is associated with falls.

      Classical physiotherapy methods for Parkinson's patients such as stretching, strengthening
      and posture exercises, balance, coordination and gait training, and different methods such as
      motor imagery, sensory stimuli and neurophysiological approaches can be used in the treatment
      of Parkinson's patients. Although there are applications that can increase axial rotation in
      physiotherapy programs, all programs may be able to focus adequately on the treatment of this
      symptom. In addition, according to the literature, the effects of all physiotherapy
      approaches emerge as a result of long-term training.

      Mobilization techniques are applications that are included in physiotherapy programs and have
      a wide area of use. It is divided into three subtitles according to its severity and degree:
      Grade A (mobilization), grade B (mobilization) and grade C (manipulation).

      Considering the effects of mobilization on muscle activation and balance, grade A and grade B
      mobilization applications are likely to increase the mobility of this area when applied on
      the lumbosacral region. Therefore, these practices can affect balance, gait and functional
      activities by regulating muscle tone (rigidity) and muscle activation and reducing axial
      symptoms in Parkinson's patients. Based on this information, the aim of our study is to
      investigate the acute effect of lumbosacral mobilization on balance, gait and functional
      activities in patients with Parkinson's disease.
    

Detailed description: 
      Parkinson's disease is a neurodegenerative disease defined by James Parkinson in 1817,
      resulting from the progressive loss of dopaminergic neurons in the basal ganglion and
      substantia nigra. The four main motor signs of the disease are resting tremor, bradykinesia,
      rigidity and postural instability. In addition, postural disorders, motor freezing, gait
      disturbances, decreased arm swing and axial rotation loss accompany the disease. There is an
      important relationship between axial rotation and turning, which is one of many activities in
      daily life. Turning is a complex action that involves head and trunk rotation in the
      transverse plane. En bloc turning occurs with the decrease of inter-segment coordination in
      Parkinson's patients with loss of axial rotation, which refers to the almost simultaneous
      rotation of the head, trunk and pelvis. This problem affects a large percentage of people
      with Parkinson's disease, hinders daily living activities, is associated with falls, and has
      a significant impact on quality of life. Losses in axial rotation also can affect properties
      of gait such as speed and stride length.

      Physiotherapy is effective in improving gait, balance and functional activities in
      Parkinson's patients. Classical physiotherapy methods such as stretching, strengthening and
      posture exercises, balance, coordination and gait training, and different methods such as
      motor imagery, sensory stimuli and neurophysiological approaches can be used in the treatment
      of Parkinson's patients. Although there are applications that can increase axial rotation in
      physiotherapy programs, all programs may be able to focus adequately on the treatment of this
      symptom. In addition, according to the literature, the effects of all physiotherapy
      approaches emerge as a result of long-term training.

      Mobilization techniques are applications that are included in physiotherapy programs and have
      a wide area of use. It is divided into three subtitles according to its severity and degree:
      Grade A (mobilization), grade B (mobilization) and grade C (manipulation). Grade A
      (mobilization) is active, active-assisted or passive mobilization in the spinal joints within
      the painless range of motion. It is generally applied in the middle range in spinal joints.
      It is especially preferred in the treatment of acute, irritable spinal lesions. Grade B
      (mobilization) refers to mobilization in the form of continuous stretching at the end of the
      range of motion in the spinal joints. Grade C (manipulation) is a minimal amplitude high
      velocity passive pushing motion performed at the end of the joint range of motion.

      Considering the effects of mobilization on muscle activation and balance, grade A and grade B
      mobilization applications are likely to increase the mobility of this area when applied on
      the lumbosacral region. Therefore, these practices can affect balance, gait and functional
      activities by regulating muscle tone (rigidity) and muscle activation and reducing axial
      symptoms in Parkinson's patients. Based on this information, the aim of our study is to
      investigate the acute effect of lumbosacral mobilization on balance, gait and functional
      activities in patients with Parkinson's disease.
    

Intervention name(s): control group; mobilization group
Intervention type(s): Other; Other
Intervention description(s): There was no intervention in the control group during study.
At the end of study all patients were received home-based exercise tailored to each individual's needs which include stretching, strengthening, balance and gait exercise and posture exercise; Lumbosacral mobilization for 10 minutes in the study group (pelvis forward and backward distraction, passive rotation of the lower body, short lever rotation, long lever rotation, lumbar central posterior-anterior, lumbar unilateral posterior-anterior, anterior rotation-posterior superior iliac spine- down, posterior rotation-posterior superior iliac spine-up were applied.
At the end of study all patients were received home-based exercise tailored to each individual's needs which include stretching, strengthening, balance and gait exercise and posture exercise
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized controlled
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Parkinson's disease; Lumbosacral Region; Postural Balance; Gait; Manual Therapies; Activities of Daily Living