The Effect of Proprioceptive Neuromuscular Facilitation on Trunk Mobility, Gait, Fear of Falling, and Quality of Life in Individuals Diagnosed With Parkinson's Disease

Summary

Parkinson's disease (PD) is a neurological disease that includes four main findings: resting tremor, bradykinesia, postural instability, and rigidity, in addition to many motor and non-motor symptoms . PD, the most common form of Parkinsonism, is a chronic and progressive disease characterized by the loss of dopaminergic neurons located in the pars compacta region of the substantia nigra. Its degenerative prognosis, characterized by motor and non-motor problems such as bradykinesia, tremor, rigidity, abnormal postural control, gait disorders, depression, and cognitive impairment, makes the management of the disease difficult . The incidence of PD, which typically begins around the ages of 55-60, varies between 15-250/100,000. Studies conducted in Turkey have indicated an incidence of 202/100,000 . In PH, as the disease progresses, there is a decrease in trunk mobility, forward flexion posture, and consequently loss of postural stability, particularly due to axial rigidity. Trunk stiffness and decreased trunk muscle strength are greater in individuals with PH compared to healthy controls. It has been noted that the decrease in trunk mobility impairs both anterior-posterior and lateral balance, and that individuals with PH experiencing these symptoms have difficulty in timing and scaling effective corrective movements, resulting in an increased risk of falls.

Gait disorders are considered one of the most disabling aspects of PH and can strongly affect the patient's independence and quality of life. The underlying mechanisms of gait disorders are multifactorial and usually result from a multisystem lesion involving both dopaminergic and non-dopaminergic mechanisms . In addition to the clinical and functional effects of gait disorders, a more important issue is that this impairment in gait can result in falls and trauma. The fact that gait disorders are affected by the motor and non-motor symptoms of the disease, and that they are parallel to longevity and cognitive decline, increases the importance of treatment . Therefore, rehabilitation interventions aimed at treating or alleviating gait disorders should be one of the main focuses in individuals with PH .

Falls are one of the most important causes of morbidity for PH . Approximately 60% of PH patients fall at least once a year, and falls are recurrent in at least one-third of these patients . Falls, which occur as a result of various factors, lead to injuries, fear of falling, decreased independence, decreased quality of life, and increased healthcare costs in patients. Fear of falling leads to a decrease in the patient's self-confidence, withdrawal from social life, and the choice of an inactive lifestyle, resulting in an increased risk of falling. This situation becomes a vicious cycle over time. While 28-55% of elderly people living at home fear falling, this rate increases to 50-65% in those who have fallen before . In PH patients, this rate is much higher than in healthy controls and is important in predicting future falls . Therefore, it is stated that fear of falling should be included in the assessment and treatment programs of individuals with PH .

Quality of life is a multidimensional outcome measure consisting of three areas: physical, mental, and social, which are influenced by the individual's personal characteristics and environmental factors . Since chronic and progressive diseases affect every aspect of an individual's life, health-related quality of life is taken into consideration in the management of such diseases . PH affects the individual's ability to independently perform almost all daily living activities and causes negative consequences in quality of life. PH affects the individual not only physically, mentally, and socially, but also economically for the individual and their family due to the additional financial burden brought about by care and treatment costs . Therefore, the assessment of quality of life in individuals with PH is important and necessary .

Proprioceptive Neuromuscular Facilitation (PNF) is a method frequently used by physiotherapists to facilitate the emergence of motor responses through the stimulation of proprioceptors and to improve voluntary control in the central nervous system . The International PNF Association defines the PNF philosophy under 5 subheadings: positive approach (mental participation in therapy), functional approach (integrating real tasks from daily life), mobilizing reserves (radiation principle), holistic treatment of the individual, motor learning, and control principles using motor learning. PNF fully complies with the International Classification of Functioning, Disability and Health (ICF) because it addresses the relevant patient with their personal and environmental context components of deficiencies, activity limitations, and participation restrictions .

Conditions

• PARKINSON DISEASE (Disorder)
• Proprioceptive Neuromuscular Facilitation
• Fear of Falling
• Gait Performance
• Functional Abilities
• Trunk Mobility

Interventions

OTHER

Proprioceptive Neuromuscular Facilitation (PNF)

Group 2 Treatment Program Warm-up exercises combined with breathing Scapula and pelvis PNF patterns Application of the D2 diagonal in the upper extremity and the D1 diagonal in the lower extremity with slow, opposing technique, without physiotherapist hand contact, accompanied by a metronome Cool-down exercises combined with breathing

OTHER

Proprioceptive Neuromuscular Facilitation (PNF)

Group 1 Treatment Program Warm-up exercises combined with breathing Scapula and pelvis PNF patterns Application of the D2 diagonal in the upper extremity and the D1 diagonal in the lower extremity with slow, opposing technique, accompanied by physiotherapist's hand contact Cool-down exercises combined with breathing

OTHER

Proprioceptive Neuromuscular Facilitation (PNF)

Group 3 Treatment Program Warm-up exercises combined with breathing Scapula and pelvis PNF patterns Application of the D2 diagonal in the upper extremity and the D1 diagonal in the lower extremity with slow, opposing technique, under physiotherapist observation, without physiotherapist contact or metronome Cool-down exercises combined with breathing

Sponsors & Collaborators

• Pamukkale University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

40 Years

Max Age

90 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2023-08-04

Primary Completion

2025-07-30

Completion

2025-08-30

Countries

• Turkey (Türkiye)

Study Locations