The Acute Effect of Cervical Mobilization in Parkinson's Disease

Not Applicable

Completed

Brief Summary: Patients with Idiopathic Parkinson's disease have balance and gait problems due to sensory and motor impairments. In the literature, there are lots of studies including various approaches for rehabilitation of these parameters such as sensory interventions, conservative treatments, neurophysiological approaches and motor imagery. However, taking into account of literature, there is no study investigating the effects on balance and gait of cervical mobilization by stimulating proprioceptors and vestibular receptors. Therefore, the aim of this study is to investigate the acute effect of cervical mobilization on balance and gait in patients with idiopathic Parkinson's disease.

Detailed Description: Patients with Idiopathic Parkinson's disease have balance and gait problems due to sensory and motor impairments. In the literature, there are lots of studies including various approaches for rehabilitation of these parameters such as sensory interventions, conservative treatments, neurophysiological approaches and motor imagery. The posture of the cervical region is impaired by the findings of the disease such as rigidity, flexor posture and loss of axial rotation. Considering that the cervical region is rich in proprioceptors and one of the key points for the vestibular system, interventions to this area can be thought to contribute to postural control and gait. However, taking into account of literature, there is no study investigating the effects on balance and gait of cervical mobilization by stimulating proprioceptors and vestibular receptors. Therefore, the aim of this study is to investigate the acute effect of cervical mobilization on balance and gait in patients with idiopathic Parkinson's disease.

Recruitment & Eligibility

Inclusion Criteria

Having been diagnosed with Idiopathic Parkinson's disease
Being between the ages of 50-80
Patients scoring >24 on Standardized Mini Mental State Examination
Modified Hoehn and Yahr stage 2-3
No medication or dose changes during treatment
Not participating in the physiotherapy and rehabilitation program in the last 6 months
Volunteering to participate in the study

Exclusion Criteria

Vertebrobasilar insufficiency
Other neurological diseases
Postural hypotension, visual problems (which can not be compensated with the correct lens) or vestibular disorders that may affect balance
Cardiopulmonary diseases that may affect gait
Orthopedic problems (such as fracture, osteomyelitis, severe osteoporosis), advanced inflammatory arthritis, knee prothesis
Uncontrolled dyskinesia or motor fluctuation
Excessive use of alcohol or substance abuse
Anticoagulant therapy, blood clotting diseases
Long-term use of corticosteroids

Arm && Interventions

Group	Intervention	Description
mobilization group	cervical mobilization	Cervical mobilization was applied to the mobilization group. Cervical mobilization techniques were applied for 10 minutes in the supine position. (At the end of study all patients were received home- based exercise)
mobilization group	control	Cervical mobilization was applied to the mobilization group. Cervical mobilization techniques were applied for 10 minutes in the supine position. (At the end of study all patients were received home- based exercise)
control group	control	There was no intervention in the control group during the study (At the end of study all patients were received home-based exercise)

Primary Outcome Measures

Name	Time	Method
Dynamic Gait Index	Baseline and immediately after cervical mobilization	It is a measurement tool that can be used to assess dynamic balance, gait, and risk for falls. Balance and walking pattern changes are scored during tasks such as changing gait speed, gait with vertical and horizontal head turns, pivot turn, step over obstacle, step around obstacles and climbing stairs. A four-point ordinal scale, ranging from 0-3. "0" indicates the lowest level of function and "3" the highest level of function.Total score is 24 for this scale.
Static Posturography Assesment (NeuroCom® Balance Master® Systems)	Baseline and immediately after cervical mobilization	Posturography measures postural stability statically and dynamically. Device has lots of test parameters such as Modified Clinical Test of Sensory Integration on Balance Test, limits of stability, rhythmic weight shift, weight bearing squat, unilateral stance, sit to stand, walk across, tandem walk, step/quick turn, step up/over and forward lunge. In addition to assesment, exercise training can also be given by posturography.

Secondary Outcome Measures

Name	Time	Method
Tandem Stance Balance Test	Baseline and immediately after cervical mobilization	In the tandem position, a person places one foot in front of the other and tries to maintain its balance in this position. The stance time is recorded.
Clinical Test of Sensory Integration on Balance	Baseline and immediately after cervical mobilization	In this clinical test, which evaluates the static balance in the standing posture, there are 6 different parameters that are formed by a combination of three visual (eyes open, eyes closed and DOME) and two support surfaces (firm and foam floor). Oscillations are observed during the evaluation and it is expected to maintain each test position for 30 seconds
Functional Reach Test	Baseline and immediately after cervical mobilization	It is used to evaluate dynamic equilibrium and anteroposterior stability. Test is performed with the participant in standing. It is the measure of the difference between arm's length with arms at 90° flexion and maximal forward reach. A score between 6-10 inches indicates a moderate risk for falls.