Previous studies of posture in Parkinson’s disease (PD) patients focused on the pathophysiology of severe deformities, using mainly subjective estimations or goniometric measures. The aim of this study was to investigate risk factors associated with flexed posture in PD and their effects on the course of posture variations. One hundred-ninety patients with definite PD were prospectively evaluated for angles of spinal inclination in upright position, extension, and flexion using a mechanical computer-assisted, hand-held device (SpinalMouse). Patients underwent clinical examination, including background data and bone mineral density. Motor function was evaluated with the UPDRS, and back pain with the RMDQ. Physical activity data were collected by self-report. Postural measurements were repeated after 10–17 months. Angle of upright inclination correlated with age (p = 0.0004), older age at disease onset (p = 0.0085), longer disease duration (p = 0.003), higher UPDRS motor and posture score (p = 0.0005 and 0.0001), the presence of back-pain (p = 0.0097), and osteoporosis (p = 0.027). There was no correlation between upright angle of inclination and gender, disease type, or side of disease onset. Re-evaluation of posture in 124 patients at 13.77 ± 4.4 months after the initial evaluation showed significant deterioration in forward bending (p < 0.0001) and was significantly associated with disease duration (p = 0.029), worsening of the UPDRS score (p = 0.016), right-side disease onset (p = 0.032), presence of vertebral fractures (p = 0.049), and the lack of physical activity (p = 0.0327). Older age, disease severity and duration, presence of back-pain and osteoporosis are associated with postural abnormalities in PD. Physical activity might slow the worsening of postural abnormalities in PD.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
The study was approved by the ethics committee of Rabin Medical Center.
All patients signed an informed consent form.
Doherty KM, van de Warrenburg BP, Peralta MC, Silveira-Moriyama L, Azulay JP, Gershanik OS, Bloem BR (2011) Postural deformities in Parkinson’s disease. Lancet Neurol 10:538–549CrossRefPubMedGoogle Scholar
Djaldetti R, Mosberg Galili R, Sroka H, Merims D, Melamed E (1999) Camptocormia (bent spine) in patients with Parkinson’s disease—characterization and possible pathogenesis of an unusual phenomenon. Mov Disord 14:443–447CrossRefPubMedGoogle Scholar
Margraf NG, Wrede A, Rohr A, Schulz-Schaeffer WJ, Raethien J, Eymees A, Volkmann J, Mehdorn MH, Jansen O, Deuschl G (2010) Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord 25:542–551CrossRefPubMedGoogle Scholar
van den Bos F, Speelman AD, Samson M, Munneke M, Bloem BR, Verhaar HR (2013) Parkinson’s disease and osteoporosis. Age Ageing 42:156–162CrossRefPubMedGoogle Scholar
Chen H, Zhang SM, Schwarzschild MA, Hernán MA, Ascherio A (2005) Physical activity and the risk of Parkinson disease. Neurology 64:664–669CrossRefPubMedGoogle Scholar
Mannion AF, Knecht K, Balaban G, Dvorak J, Grob D (2004) A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature. Eur Spine J 13:122–136CrossRefPubMedGoogle Scholar
Post RB, Leferink VJM (2004) Spinal mobility: sagittal range of motion measured with the SpinalMouse, a new non-invasive device. Arch Orthop Trauma Surg 124:187–192CrossRefPubMedGoogle Scholar
Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y (2013) Spinal sagittal contour affecting falls: cut-off value of the lumbar spine for falls. Gait Posture 38:260–263CrossRefPubMedGoogle Scholar
Lepoutre A-C, Devos D, Blanchard-Dauphin A, Pardessus V, Maurage CA, Ferriby D, Hurtevent JF, Cotten A, Destée A, Defebvre L (2006) A specific clinical pattern of camptocormia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:1229–1234CrossRefPubMedPubMedCentralGoogle Scholar
Ashburn A, Roberts L, Pickering R, Roberts HC, Wiles R, Kunkel D, Hulbert S, Robison J, Fitton C (2014) A design to investigate the feasibility and effects of partnered ballroom dancing on people with Parkinson disease: randomized controlled trial protocol. JMIR Res Protoc 3:e34CrossRefPubMedPubMedCentralGoogle Scholar
Benninger F, Khlebtovsky A, Roditi Y, Keret O, Steiner I, Melamed E, Djaldetti R (2015) Beneficial effect of levodopa therapy on stooped posture in Parkinson’s disease. Gait Posture 42:263–268CrossRefPubMedGoogle Scholar
Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184CrossRefPubMedPubMedCentralGoogle Scholar
Jankovic J, McDermott M, Carter J et al (1990) Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology 40:1529–1534CrossRefPubMedGoogle Scholar
Prevention and management of osteoporosis (2003) World Health Organ Tech Rep Ser 921:1–164 (back cover)Google Scholar
Damiano J, Kolta S, Porcher R, Tournoux C, Dougados M, Roux C (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9:66–71CrossRefPubMedGoogle Scholar
Roland M, Fairbank J (2000) The Roland–Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 25:3115–3124CrossRefPubMedGoogle Scholar
Michałowska M, Fiszer U, Krygowska-Wajs A, Owczarek K (2005) Falls in Parkinson’s disease. Causes and impact on patients” quality of life. Funct Neurol 20:163–168PubMedGoogle Scholar
Cholewicki J, Panjabi MM, Khachatryan A (1997) Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine (Phila Pa 1976) 22:2207–2212CrossRefGoogle Scholar
Jacobs JV, Dimitrova DM, Nutt JG, Horak FB (2005) Can stooped posture explain multidirectional postural instability in patients with Parkinson’s disease? Exp Brain Res 166:78–88CrossRefPubMedPubMedCentralGoogle Scholar
Djaldetti R, Ziv I, Melamed E (2006) The mystery of motor asymmetry in Parkinson’s disease. Lancet Neurol 5:796–802CrossRefPubMedGoogle Scholar
Haaxma CA, Helmich RCG, Borm GF, Kappelle AC, Horstink MW, Bloem BR (2010) Side of symptom onset affects motor dysfunction in Parkinson’s disease. Neuroscience 170:1282–1285CrossRefPubMedGoogle Scholar
Bezza A, Ouzzif Z, Naji H, Achemlal L, Mounach A, Nouijai M, Bourazza A, Mossadeq R, El Maghraoui A (2008) Prevalence and risk factors of osteoporosis in patients with Parkinson’s disease. Rheumatol Int 28:1205–1209CrossRefPubMedGoogle Scholar
Lorefält B, Toss G, Granérus A-K (2007) Bone mass in elderly patients with Parkinson’s disease. Acta Neurol Scand 116:248–254CrossRefPubMedGoogle Scholar
Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Yl Shimada (2009) Spinal curvature and postural balance in patients with osteoporosis. Osteoporos Int 20:2049–2053CrossRefPubMedGoogle Scholar
Lau Y-S, Patki G, Das-Panja K, Le WD, Ahmad SO (2011) Neuroprotective effects and mechanisms of exercise in a chronic mouse model of Parkinson’s disease with moderate neurodegeneration. Eur J Neurosci 33:1264–1274CrossRefPubMedPubMedCentralGoogle Scholar
Petzinger GM, Fisher BE, Van Leeuwen JE, Vukovic M, Akopian G, Meshul CK, Holschneider DP, Nacca A, Walsh JP, Jakowec MW (2010) Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson’s disease. Mov Disord 25(Suppl 1):S141–S145CrossRefPubMedPubMedCentralGoogle Scholar
Ridgel AL, Vitek JL, Alberts JL (2009) Forced, not voluntary, exercise improves motor function in Parkinson’s disease patients. Neurorehabil Neural Repair 23:600–608CrossRefPubMedGoogle Scholar