Effects of postural exercises in patients with Parkinson's disease and Pisa syndrome: A pilot study

BACKGROUND: Pisa syndrome (PS) or lateral axial dystonia is often seen in patients with Parkinson's disease (PD). It is characterized by a marked and reversible lateral flexion of the trunk (LFT) more than 10°. OBJECTIVE: To assess the effectiveness of a program of postural exercises and assess the effectiveness in term of pattern of muscular hyperactivity. METHODS: A total of 6 patients with PD and PS enrolled in the program of 10 sessions of postural exercise (90min/session). EMG of thoraco-lumbar paraspinal muscles was performed to detect the pattern of muscular hyperactivity. Outcomes were examined using the Unified Parkinson's Disease Rating Scale part II and part III, degree of LFT and Visual Analogues Scale for back pain. RESULTS: EMG showed two patterns of muscular hyperactivity; ipsilateral to the bending side and contralateral to the bending side. The exercise improved the outcomes in both groups. Patients with muscular hyperactivity ipsilateral to the bending side gained more improvements. CONCLUSION: Our results show that the exercise may be considered as a possible treatment for patients with PD and PS irrespective of the pattern of muscular activation. The effectiveness of exercise differed according to the pattern of muscular activation.