Poster 143: Relative efficacy of daily versus weekly lower-extremity mechanical ranging combined with exercise in promoting improvement of motor function in persons with Parkinson’s disease.

Abstract

Objective: To examine the therapeutic effect of a treatment package on the motor function of persons with Parkinson’s disease (PD). Design: Randomized crossover study. Setting: Urban medical center. Participants: 50 persons with PD. Interventions: Reciprocal mechanical ranging and therapeutic exercise during weekly visits for 6 weeks (group 1), or 6 weeks of daily reciprocal mechanical ranging supplemented by therapeutic exercise once weekly (group 2). The groups were crossed over after 6 weeks. Main Outcome Measures: United Parkinson’s Disease Rating Scale (UPDRS), Functional Ambulation Profile, balance, and motor planning. Results: Weekly ranging proved as effective as daily ranging. Compared with baseline performance, both groups improved on all 8 computerized motor tests. Center of pressure tracking tests (performed while standing) yielded lower error scores (better performance) than head tracking (performed while seated). Poorest tracking performance occurred when stimulus-response relations were incompatible. When head tracking was performed under compatible conditions, difficulty was encountered only when continuous video feedback was withheld. These results reflect difficulties with motor planning that some of the sitting tasks require. Both groups yeilded statistically significant improvement relative to baseline performance. Steadiness, whether head or standing, statistically improved over baseline. There was a 4° increase in the active range of knee extension. Of a possible 100, functional ambulation performance increased from a mean of 79.5 at baseline to 85.5, 85.7, and 86.3 at the first, final, and follow-up evaluations, respectively. Statistically significant improvements from baseline were yielded by section III items (motor evaluation subscale) of the UPDRS, indicating test sensitivity and selectivity. Conclusions: The study confirmed that persons with PD recover functionality from mechanical ranging and exercise. Whether mechanical ranging was done daily or weekly, subjects showed statistically significant improvement compared with baseline performance on all computerized motor tests.