Abstract
BackgroundThere is growing evidence for proprioceptive dysfunction in patients with Parkinson’s disease (PD). The Lee Silvermann Voice Treatment-BIG therapy (LSVT-BIG), a special training program aiming at an increase of movement amplitudes in persons with PD (PwPD), has shown to be effective on motor symptoms. LSVT-BIG is conceptionally based on improving bradykinesia, in particular the decrement of repetitive movements, by proprioceptive recalibration.ObjectiveTo assess proprioceptive impairment in PwPD as compared to matched controls and to probe potential recalibration effects of the LSVT-BIG therapy on proprioception.MethodsProprioceptive performance and fine motor skills were assessed in 30 PwPD and 15 matched controls. Measurements with significant impairment in PwPD were chosen as outcome parameters for a standardized 4 weeks amplitude-based training intervention (LSVT-BIG) in 11 PwPD. Proprioceptive performance served as primary outcome measure. Secondary outcome measures included the motor part of the MDS-UPDRS, the nine-hole-peg test, and a questionnaire on quality of life. Post-interventional assessments were conducted at weeks 4 and 8.ResultsCompared to the control group, PwPD showed significantly larger pointing errors. After 4 weeks of LSVT-BIG therapy and even more so after an additional 4 weeks of continued training, proprioceptive performance improved significantly. In addition, quality of life improved as indicated by a questionnaire.ConclusionLSVT-BIG training may achieve a recalibration of proprioceptive processing in PwPD. Our data indicates a probable physiological mechanism of a symptom-specific, amplitude-based behavioral intervention in PwPD.
Highlights
There is growing evidence for proprioceptive dysfunction in patients with Parkinson’s disease (PD)
There was no significant difference between persons with PD (PwPD) and controls in the SPIRAL-test [Time], the SPIRAL test [FOS], the ELEL test [speed], the ELEL-test [width], and the ELEL test [amplitude]
Lee Silvermann Voice treatment (LSVT)-LSVT-BIG therapy group (BIG): impact on proprioceptive performance According to their training diaries, all patients kept up a LSVT-BIG training routine during the follow-up period, with approximately 30 min daily practice on at least 5 days a week
Summary
There is growing evidence for proprioceptive dysfunction in patients with Parkinson’s disease (PD). LSVT-BIG is conceptionally based on improving bradykinesia, in particular the decrement of repetitive movements, by proprioceptive recalibration. Bradykinesia, defined as a slowness of movement and a progressive reduction of frequency or amplitude of repetitive movements, is the key symptom of PD [2]. Clinical manifestations of this “poverty of movement” [3] are gait impairment with reduced arm swing and smaller steps, difficulties to rise. Proprioceptive input is needed for the accuracy of amplitude and speed of executed movements and has been shown to be altered in PD [10,11,12]. Pathological processing of Peterka et al BMC Neurology (2020) 20:276 proprioceptive information may be a key pathological mechanism of bradykinesia [13,14,15]
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