Effects of Cervical Stabilization Exercises and Vibration Application in Individuals With Parkinson's Disease

Summary

Parkinson's disease (PD) is the second most common neurodegenerative disease that causes a progressive decrease in motor functions, which is caused by the influence of dopaminergic pathways in the substantia nigra (SN). Motor and non-motor symptoms seen in PD seriously affect patients negatively.

Proprioception, which is one of the deep senses, is known to help maintain body verticalization in the sense of posture and movement and has a primary importance in the regulation of motor activities. Depending on the progression of the disease, flexion of the body is triggered as a result of the deterioration of proprioception over time. It is suggested that the losses in proprioception may result from the inability to properly regulate motor control and body reflexes. Therefore, the assessment of proprioception plays an important role in assessing changes in postural instability, gait and fall risk.

It is said that while peripheral muscle feedback is preserved in Parkinson's patients, there is deterioration in integration in the central. Changes in the supraspinal processing of proprioceptive input in PD have been demonstrated by analyzing the effect of mechanical vibration applied to the tendon of a stretched muscle during voluntary movements. Vibrator stimulation activates muscle spindle afferents, particularly primary endings. It is also stated that muscle feedback is not only related to the movement performed, but also to the response induced by vibration.

In line with this information, vibration applications have been added to the treatment of PD in recent years with the aim of stimulating postural adjustments through the application of an external proprioceptive input.

It is selectively used in neurological rehabilitation because of the effect of local vibration training on spinal excitability. When the literature is examined, it has been determined that the studies on the effects of local vibration applied to the neck region on posture, balance, proprioception and other sensory profiles are insufficient, especially in individuals with Parkinson's disease.

In this project, it is aimed to guide professionals working with Parkinson's disease in the management of this disease by determining the effects of cervical stabilization and local vibration application to the cervical region on motor symptoms and sensory profile in individuals with Parkinson's disease.

Conditions

• Parkinson Disease

Interventions

DEVICE

Chattanooga Stabilizer pressure biofeedback

Stabilization exercises, which form the basis of spinal stabilization training, increase the strength and endurance of the postural and stabilizer muscles by using the basic principles of motor learning, and improve balance control in stable and unstable positions. In addition, stabilization exercises include kinesthetic training and functional training. Spinal stabilization training is very important for proper control of extremity movements. It is also an important factor in the formation of proper spinal posture and the neutral position required for the spine. In cervical region problems, cervical stabilization exercises that activate the deep neck flexors (longus colli and longus capitis) can be applied. Cervical stabilization training improves the cervical proprioception sense as well as strength and endurance, thereby reducing joint position sense error.

DEVICE

VibraSens - Focal Vibration Therapy (TechnoConcept - France)

Vibration applications have also started to be used for treatment purposes. Therapeutic vibration produces minor changes in skeletal muscle length. Vibrations elicit a response called the "tonic vibration reflex", which includes activation of muscle spindles, neural signals by Ia afferents, and activation of muscle fibers via large α-motor neurons. The tonic vibration reflex can also cause an increase in activation of motor units through activation of muscle spindles and polysynaptic pathways. It is well known that the input of the proprioceptive pathways (Ia, IIa and possibly IIb) plays an important role in the production of isometric contractions. The increase in isometric strength after application of vibration with extensive sensory stimulation may be the result of more efficient use of the positive proprioceptive feedback loop. It can be predicted that the increased muscle strength after vibration application is due to neural adaptation.

OTHER

Telerehabilitation

Telerehabilitation is a method that aims to provide rehabilitation to patients/clinicians by reducing obstacles such as distance, time and cost by using information and communication technologies. Telerehabilitation enables patients who cannot access rehabilitation due to geographic, economic or physical disabilities to benefit from rehabilitation services. The COVID-19 pandemic has highlighted the importance of telerehabilitation practices. In order to minimize the risk of transmission in the COVID-19 pandemic, the physical activity levels of individuals have decreased and their access to rehabilitation services has been restricted by the restriction of social life.

Sponsors & Collaborators

• Hacettepe University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

40 Years

Max Age

80 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2023-08-30

Primary Completion

2023-12-30

Completion

2024-01-15