Significant improvement after sensory tricks and trunk strength training for Parkinson’s disease with Antecollis and Camptocormia: a case report and literature review

doi:10.21203/rs.3.rs-3199690/v1

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Significant improvement after sensory tricks and trunk strength training for Parkinson’s disease with Antecollis and Camptocormia: a case report and literature review

https://doi.org/10.21203/rs.3.rs-3199690/v1

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Objective: To investigate whether central and peripheral interventions can alleviate symptoms in a patient with Parkinson's disease (PD) with Antecollis (AC) and Camptocormia (CC) as the primary manifestations. To the best of our knowledge, this case is the first reported case of rehabilitation method for AC.

Methods: We present the case of a 65-year-old female PD patient with AC and CC. The course of the disease was 5 years. She was treated with rehabilitation strategies such as sensory tricks and trunk strength training. In the inpatient period, we compared and analyzed this patient's gait analysis, rehabilitation assessment scale, and angles of her trunk abnormal posture in the first, third, and fifth weeks.

Results: The patient's stride length increased, indicating that the patient's walking ability was improved. The patient could simulate shopping on the street under supervision and needed minimal assistance to go up and down stairs. The Unified Parkinson's Disease ScalePart Three score and Camptocormia severity score decreased. Furthermore, the Modified Barthel Index score, Lawton's Scale of Instrumental Activities of Daily Living score, and Berg Balance Scale score increased. In addition, the patient showed significant improvements in the angles of AC, Upper CC, and Lower CC.

Conclusion: The present case suggests that sensory tricks and trunk strength training are beneficial and safe for patients with AC and CC. Further studies are required to confirm the effectiveness of therapeutic interventions.

Antecollis

Camptocormia

Parkinson's Disease

sensory tricks

trunk strength training

Patients with Parkinson's Disease (PD) may have advanced postural abnormalities that can severely affect their daily living abilities [1, 2].PD sagittal posture abnormalities include Antecollis (AC) and Camptocormia (CC). PD coronal posture abnormalities include Pisa syndrome and scoliosis[3]. In 1989, Quinn first noted Camptocormia in the Lancet[4], defined as 45° anterior flexion above C7[5]. The incidence occurs in 5 to 7 percent of patients with PD[6, 7]. In 1999, Dr. Djaldetti referred to the phenomenon of the changing position of the spine. He described PD patients with forward flexion of the thoracolumbar segment while the disappearance of forward flexion in the supine position as CC[8]. The current diagnostic criteria for Upper CC is an upper anterior flexion angle of C7 to T12-L1 over 45°. Additionally, the criteria for Lower CC is a flexion angle of L1 – sacrum, hip flexion over 30°[9]. The incidence occurs in 7 to 16 percent of PD patients[10]. Currently, the pathogenesis of AC and CC is unclear, and the mainstream view is that a combination of the central and peripheral mechanisms causes it.

This case reported a PD patient with predominantly AC and CC symptoms. This report focuses on the intervention to treat proprioceptive dysfunction caused by AC and CC and concomitant loss of peripheral trunk muscles. Currently, the treatment of AC is mainly based on the adjustment of drug therapy[11, 12]. For patients with CC, transcranial magnetic stimulation, postural training, botulinum toxin injection, and spinal cord electrical stimulation were used. The expert suggested that nonsurgical intervention be used as first-line therapy[13]. Therefore, this case tried to use sensory tricks and trunk strength training. We aim to observe whether the patient's sagittal postural abnormalities were alleviated. Thus, we analyze the patient's gait analysis, Modified Barthel Index (MBI), Lawton's scale of Instrumental Activities of Daily Living (Lawton IADLs), Berg Balance Scale (BBS), the Unified Parkinson's Disease Scale Part Three (UPDRS III), CC severity[14] and angles of her trunk abnormal posture in the first week, the third week, and the fifth week.

2.1 GENERAL INFORMATION

The 65- year-old female patient consulted our neurologist and complained of slow movement for more than four years and bent while walking for over one year. The disease began in 2017. The initial manifestation of the disease was slow mobility, resting tremors of the right lower extremity, stereotyped face, and shouting during sleep. Additionally, there is no noticeable loss of smell and no apparent constipation. She went to the local hospital for treatment. The physical examination showed "face stereotyped, joint action reduction disappeared, forward gait, right lower extremity resting tremor, muscle tone is lead-pipe rigidity." The electromyography results showed that “the 4Hz group discharge position can be seen when the right tibial anterior muscle is resting”. Cranial magnetic resonance showed paraventricular white matter ischemia on both sides, which diagnosed the patient with “Parkinson's disease”. The physician gave her Madopar 375mg orally each day. The patient then reported that the effect began 30 minutes after taking it, lasting 3 hours each time. Two years before, the consultation showed that the right finger flapping test and bilateral leg flexibility test scored low, and the muscle tone of the right limb increased. Furthermore, the posterior pull test was three steps back, and the Hoehn-Yahr (HY) stage (off-stage) was 2.5. Pramipexole was added to control the symptoms of PD. After six months of regular administration, the above symptoms were not significantly relieved. Selegiline and Amantadine were added for a second visit. No obvious side effects were observed during drug administration. The patient had the phenomena of dropping head and bending waist while walking or standing disappeared when lying down one year ago. During the course of the disease, the onset of effective time of taking the drug is gradually extended to about 1 hour. At present, the patient can still walk. However, when she walks, she will bend over and drop her head more significantly than before. Before she was admitted to our hospital, she was treated with Madopar (500 mg/day), Pramipexole (1.5mg/day), Amantadine (0.2g/day), and Selegiline (10mg/day). Since the onset of the disease, the patient has been in normal mental status and sleeps routinely. She has no significant change in weight. Furthermore, she urinates and usually bowels. She denied a history of a similar disease. She described lumbar interbody fusion and posterior pedicle screw internal fixation for lumbar spondylolisthesis in 2016 and provided us with a full spine x-ray. See Fig. 1.

In the neurological examination, the patient had clear speech and few facial expressions. Executive neurological function tests were good. We used the Graded Manual Muscle Test (GMMT) to examine the patient’s trunk strength. Upper and lower extremity muscle strength was graded 5, cervical extensors 1+, rectus abdominis 2, abdominal internal and external oblique muscle 3, lumbar back muscle strength 1+, bilateral gluteus muscle strength 1+. Muscle tone increased in the right extremity, and resting tremor is seen in the right lower extremity. There were no abnormalities in the depth and superficial sensation of both limbs. The bilateral finger-nose test and heel-knee-tibia test were stable. The bilateral Babinski sign showed negative. The sitting balance was graded level 3, and the standing balance was graded level 2. The trunk is bent forward while walking in postural gait examination. The swing action of both upper limbs was reduced.

2.2 REHABILITATION ASSESSMENT

HY stage: grade 3 (off-stage). CC Severity Score assessment score: 14/32 points. BBS: 21/56 points. MBI: 89/100 points. The patient presents with moderate assistance in walking up and down stairs. Lawton IADLs: 16/27 points. The rehabilitation physician and physiotherapist evaluated gait analysis and recorded three periods of step frequency, step length, step width, and stride length. We analyzed their improvement through the process and horizontal comparison with standard values. We used Neuro Posture App to measure the forward flexion angle of the patient's spine, referring to the measurement method of the literature[15].The AC angle was 98.2°, Upper CC was 71°, and Lower CC was 62°. Chasing and scanning in vision function is normal. There is a compensatory saccade in the head-shaking experiment showing abnormal vestibular function.

2.3 DIAGNOSIS

Clinical diagnosis: PD (HY staging off-stage 3).

2.4 INTERVENTION METHODS

Sensory tricks training: It is defined as the phenomenon of improving dystonia through specific event orientation[16]. CC symptoms of forward flexion of the spine disappear while they lie down and sit against the wall, referring to sensory tricks[17]. During the treatment, the author considered whether it was possible to make assistive devices to achieve the effect. By searching the literature, it was found that two sensory tricks methods can be given to patients with CC. One is adding weight to a backpack. In patients with CC, the original muscle position is altered due to forward flexion of the spine, resulting in impaired proprioceptive and sensory integration [18]. We put clay, air-plastic bags, and daily necessities in the backpack to make the overall weight greater than 6kg. The backpack's weight gives weight perception to the spine, increasing proprioception. In addition, patients can carry a backpack before discharge and only need minimal assistance to go up and down two-floor stairs. Another sensory trick is a high-frame walker (HFW), which significantly relieves the forward bending of the trunk when used. This small cart increases the patient's walking safety and allows for items to shop. The patient would at least walk for over 20 minutes during the treatment each time.

Lumbar muscle strength training: Due to the GMMT of the back muscle graded 1+, this represents lumbar muscle strength weakness and may affect the patient's standing posture. Under the rhythmic auditory stimulation method, the patient can stretch the lumbar and paraspinal muscles rhythmically. The patient did the exercises 5 minutes during every day’s program, lasting for six days per week.

Abdominal muscle strength training: The patient complains of difficulty turning over and getting up. The strength of the rectus abdominis muscle and the internal and external oblique muscles of the abdomen is weak. The abdominal muscles are essential in the patient's recumbent position[19]. As a result, we added abdominal muscle training such as gluteal bridge support with both legs, the gluteal bridge with one leg, and plank training in the last 1/3 of treatment. Abdominal training increases the patient's core strength and helps her maintain the correct posture. The patient spent 10 minutes at the end of the treatment session every day.

Neck strength training: The patient's cervical extensor strength is weak, unable to control active neck movement. When the patient sits in a wheelchair or standing, the head drops significantly. This phenomenon adversely affects the patient of being aware of things around her and increases the risk of falling. Therefore, the patient was given neck muscle training to help maintain the correct neck posture in a sitting position. In addition, we use posture correction mirrors to train her self-stretch to achieve postural reeducation of patients. The patient did the exercises for 10 minutes during every day’s program, lasting for six days per week.

The results of the gait analysis of patients at different periods in the first week, the third week, and the fifth week can be seen in Table 1. The comparison before and after different scales of patients is shown in Table 2. The changes in the angles of AC, Upper CC, and Lower CC in different periods are shown in Fig. 2.

Table 1

Results of gait analysis and evaluation of patients at different time
Time	Step Frequency (Steps/min)			Step Length (m)			Step Width (m)			Stride Length (m)
Time	Left	Right	Normal Value	Left	Right	Normal Value	Left	Right	Normal Value	Left	Right	Normal Value
First week	93.8	90.9	98.8 ± 11.6	0.28	0.36	0.59 ± 0.08	0.21	0.23	0.15 ± 0.04	0.66	0.66	1.15 ± 0.04
Third week	88.2	95.2		0.32	0.35		0.28	0.27		0.67	0.68
Fifth week	90.2	93		0.33	0.44		0.24	0.23		0.76	0.77

Video 1. The patient’s poor posture control while walking on the trajectory in the first week.

Video 2. The patient ambulated on the trajectory more stably in the third week.

Video 3. The patient accomplished the gait analysis test with confidence and in a relatively good posture in the fifth week.

Table 2

The evaluation results of patients after one week, three weeks, and five weeks of treatment on different scales were compared Note: UPDRS-III: Unified Parkinson’s Disease Rating Scale Part Three; CC: Camptocormia; MBI: Modified Barthel Index; BBS: Berg balance scale; AC: Antecollis.
	First week	Third week	Fifth week
UPDRS-III score	60	33	19
CC severity score	14	/	8
MBI score	89	/	95
Lawton, IADL score	16	/	22
BBS score	21	27	35
Angles of AC	98.2	49	22
Angles of Upper CC	71	53	46
Angles of Lower CC	62	52	46

Here, we report a case of a PD patient with AC and CC as the primary symptoms, who showed significant relief in abnormal posture and a great improvement in quality of life after sensory tricks and trunk strength training. To the best of our knowledge, this case is the first reported case of rehabilitation method for AC. In addition, gait analysis was used to assess the improvement of balance and walking ability objectively. The gait speed and other gait data measured in gait analysis can be used as a sign of disease severity in PD patients[20]. Although there are challenges in measuring the anterior flexion of the cervical, thoracic, and lumbar spine. The author still found a Neuro Posture App method to compare the changes of the corresponding angle before and after treatment.

There are many causative factors in AC and CC, and the mainstream view is that pathogenesis can be divided into central and peripheral mechanisms. The central mechanism is exercise-induced dystonia, a disease of the striatum and its projection to the reticular spinal tract or thalamus in PD patients, clearly represented by abnormal trunk posture[21]. In addition, the spinal cord's multisynaptic reflex arch integrates sensory information into the motor output. Sensory input comes from Golgi tendon organs, muscle spindles, and articular receptors. Their information is integrated into the motor output and raises awareness so that it can voluntarily influence the motor output. The sense of joint position, movement, and muscle strength are part of our self-consciousness or proprioception. Central and peripheral mechanisms produce proprioceptive disorders. The central mechanism is associated with the progression of PD. Peripheral muscle stiffness due to aging leads to the degeneration of paraspinal muscle groups. Both conditions result in characteristic pathological changes in the axial musculature that maintains upright body posture and result in abnormal axial trunk posture[22]. In addition, Tiple et al. found that a history of spinal surgery induces CC[10]. Srivanitchapoom et al. found that drug factors are causative factors in AC and CC[23].

In terms of central mechanism, we used two sensory tricks methods due to the patient's dystonia while standing or walking. One is the a weighted backpack. The backpack generates proprioception and light touch input to the patient, increasing the integration of sensorimotor function[24]. Studies have shown that higher beta waves increase the severity of PD. Thus, effective treatment is needed to reduce beta waves generated by central vibrations[25]. Peripheral sensory input given by inexpensive backpacks may impact the central network, reducing abnormal movements due to dystonia[26]. Second, a HFW is recommended, which can be used as a motor trick to provide continuous proprioception to PD patients while walking. As a behavioral strategy, it can be taught to both the patient and the caregiver[27]. In addition, this HFW, which is a light portable walker, can be used for activities at home and work[28].

Peripherally, trunk muscle training reduces the risk of falling[29]. Trunk strength can be improved because it plays a role in stabilizing the head in dynamic tasks. In back muscle training, we targeted paraspinal muscles and other back extensors, such as latissimus dorsi. These exercises increase the patient's strength to maintain an upright posture. In abdominal muscle training, training targets the patient's internal and external oblique muscles and can improve forward flexion of the upper trunk. Second, the rectus abdominis and iliopsoas muscles are trained to improve forward flexion of the lower trunk[23]. Training these core muscles simultaneously can improve transferring from supine to sitting. During the training, the author asked patients to use rhythmic auditory stimulation software (metronome) with visual conduction to enhance visual and proprioceptive input and strengthen the cervical muscle. Adjustment of trunk posture is performed by positive feedback[30]. Trunk stretching is a static stretch that increases tendon length immediately, improving the relationship between muscle tone and tendon length. It alters the viscoelastic function of muscles. Therefore, it can reduce muscle motor neuron hyperexcitability by modulating spinal cord suppressor neurons[31, 32]. As a result, stretching helps the patient improve her stiffness in the trunk muscles.

Marialuisa et al. used proprioceptive and visual feedback as the primary spinal posture correction training to improve the postural control and trunk forward flexion of patients with PD posture abnormalities. They found that patients decreased 8.84° in trunk forward flexion angle and a 4.94 point reduction on the UPDRS-III [33]. They used peripheral mechanism methods to improve the patient’s posture and motor abilities. Meanwhile, the central mechanism seems to have an effect on treating PD patients with posture abnormalities. The study applied an HFW as a central mechanism method. Frauke et al. recruited 20 CC patients using an HFW to accomplish upright standing and walking. The author claimed therapeutic effects according to the report. However, the treatment was not controlled to other treatments and the duration was 3–7 days[34]. The study had sufficient patients to facilitate but was poor in the short duration of the treatment. We learned from these two studies and thought that the combination of central and peripheral mechanism methods would help the patient improve her function better. As a result, our study showed the patient’s angles of AC, Upper CC, and Lower CC decreased by 76.2°, 25°, and 16°.

Similarly, Byung Kook Ye et al. reported one CC case. The patient wears a heavily loaded backpack, cruciform anterior spinal hyperextension brace, and back extensor strengthening exercises[35]. Kun Hee Lee et al., in the same hospital, recruited 9 CC patients to investigate conservative treatment effects. They added core muscle training and a low-slung backpack to the patients. The author reported an overall improvement in activities of daily living and motor movement[36]. In the case we report, we provided comprehensive assessment tool results and detailed gait analysis data and images to record the improvement of the patient’s function.

Notably, we found that the angle of AC improved even more than the angle of CC. In searched articles, treatments for AC have mostly been found by reducing drugs such as donepezil and dopaminergic agonists such as pramipexole[11, 37, 38]. Though decreasing pramipexole for patients in the literature is also used and thought to relieve symptoms, this drug is crucial for symptom control in PD patients, and therefore reduction is not considered. Besides, there is no such typical literature on AC rehabilitation, our study methods may have positive effects on PD patients with AC.

The present study has several limitations. First, Parkinson's medication switch on/off was not set in the treatment. Thus, the patient was evaluated under the condition of medication. Second, a single case is not universal. We should increase the number of cases. Further studies are required to confirm the effectiveness of therapeutic interventions.

In summary, through sensory tricks and trunk strength training, PD sagittal posture is improved. In addition, the patient's stride length correspondingly improved, indicating that the patient's walking ability was improved. She has improved her ability in activities of daily living. She can simulate shopping on the street under supervision and go up and down stairs with minimal assistance, indicating improved quality of life. The patient still maintained good posture in the follow-up study after 6 months. The patient was satisfied with the therapy and participated positively in the treatment session and follow-up visit. In the future, we should recruit more patients to conduct the experiment.

Acknowledgements

We would like to extend our heartfelt thanks for the patient’s participation and assistance. We are also grateful for the contribution of team members.

Declarations:

i. Funding

Not applicable.

ii. Conflicts of Interests

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interests.

iii. Ethics approval

The studies involving human participants were reviewed and approved by Medical Ethics Committee of Shanghai Yangzhi, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center). Written informed consent to participate in this study was provided by the participant's legal guardian/next of kin.

iv. Consent to participate

The participant in the research is completely VOLUNTARY. She was willing to participate and gave a signature to our profile of Consent to participate.

v. Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal

vi. Availability of data and material

The original contributions presented in the study are included in the article/Supplementary MATERIAL further inquiries can be directed to the corresponding author/s.

vii. Code availability

Not applicable.

viii. Author’s contributions

WJR and HY collected data from medical records, contributed to the design of the study, and wrote the first draft of the manuscript. HY contributed to the conception and design of the study. WJR provided clinical evaluation and treatment for the patient. All authors contributed to manuscript revision, and read and approved the submitted version.

Castrioto A, Piscicelli C, Pérennou D, Krack P, Debû B. The pathogenesis of Pisa syndrome in Parkinson's disease. Mov Disord. 2014;29(9):1100–7. 10.1002/mds.25925.
Mikami K, Shiraishi M, Kamo T. Effect of abnormal posture on quality of life in patients with Parkinson’s disease. Adv Parkinson's Disease. 2016;5(2):7–14.
Doherty KM, van de Warrenburg BP, Peralta MC, Silveira-Moriyama L, Azulay JP, Gershanik OS, et al. Postural deformities in Parkinson's disease. Lancet Neurol. 2011;10(6):538–49. 10.1016/s1474-4422(11)70067-9.
Quinn N. Disproportionate antecollis in multiple system atrophy. Lancet. 1989;1(8642):844. 10.1016/s0140-6736(89)92300-3.
Woo KA, Joo JY, Shin JH, Lee CY, Jeon SH, Lee JY, et al. Measurement Issue in Antecollis. Tremor Other Hyperkinet Mov (N Y). 2022;12:31. 10.5334/tohm.723.
Kashihara K, Ohno M, Tomita S. Dropped head syndrome in Parkinson's disease. Mov Disord. 2006;21(8):1213–6. 10.1002/mds.20948.
Fujimoto K. Dropped head in Parkinson's disease. J Neurol. 2006;253 Suppl 7:Vii21-6. doi: 10.1007/s00415-006-7006-3.
Djaldetti R, Mosberg-Galili R, Sroka H, Merims D, Melamed E. Camptocormia (bent spine) in patients with Parkinson's disease–characterization and possible pathogenesis of an unusual phenomenon. Mov Disord. 1999;14(3):443–7. 10.1002/1531-8257(199905)14:3<443::aid-mds1009>3.0.co;2-g.
Fasano A, Geroin C, Berardelli A, Bloem BR, Espay AJ, Hallett M, et al. Diagnostic criteria for camptocormia in Parkinson's disease: A consensus-based proposal. Parkinsonism Relat Disord. 2018;53:53–7. 10.1016/j.parkreldis.2018.04.033.
Tiple D, Fabbrini G, Colosimo C, Ottaviani D, Camerota F, Defazio G, et al. Camptocormia in Parkinson disease: an epidemiological and clinical study. J Neurol Neurosurg Psychiatry. 2009;80(2):145–8. 10.1136/jnnp.2008.150011.
Uzawa A, Mori M, Kojima S, Mitsuma S, Sekiguchi Y, Kanesaka T, et al. Dopamine agonist-induced antecollis in Parkinson's disease. Mov Disord. 2009;24(16):2408–11. 10.1002/mds.22779.
Iijima M, Osawa M, Uchiyama S, Kitagawa K. Pramipexole-induced antecollis in patients with Parkinson's disease: Two cases and literature review. eNeurologicalSci. 2015;1:21–3. 10.1016/j.ensci.2015.09.001.
Doherty KM, Davagnanam I, Molloy S, Silveira-Moriyama L, Lees AJ. Pisa syndrome in Parkinson's disease: a mobile or fixed deformity? J Neurol Neurosurg Psychiatry. 2013;84(12):1400–3. 10.1136/jnnp-2012-304700.
Margraf NG, Wrede A, Rohr A, Schulz-Schaeffer WJ, Raethjen J, Eymess A, et al. Camptocormia in idiopathic Parkinson's disease: a focal myopathy of the paravertebral muscles. Mov Disord. 2010;25(5):542–51. 10.1002/mds.22780.
Schlenstedt C, Boße K, Gavriliuc O, Wolke R, Granert O, Deuschl G, et al. Quantitative assessment of posture in healthy controls and patients with Parkinson's disease. Parkinsonism Relat Disord. 2020;76:85–90. 10.1016/j.parkreldis.2020.01.012.
Ramos VF, Karp BI, Hallett M. Tricks in dystonia: ordering the complexity. J Neurol Neurosurg Psychiatry. 2014;85(9):987–93. 10.1136/jnnp-2013-306971.
Zhao J, Wang Q, Sun H, Liu X, Leng B, Wang T. Quetiapine Relieved Pisa Syndrome in Patient With Parkinson Disease. Clin Neuropharmacol. 2020;43(6):171–4. 10.1097/wnf.0000000000000416.
Wolke R, Kuhtz-Buschbeck JP, Deuschl G, Margraf NG. Insufficiency of trunk extension and impaired control of muscle force in Parkinson's disease with camptocormia. Clin Neurophysiol. 2020;131(11):2621–9. 10.1016/j.clinph.2020.07.019.
Fujita T, Sato A, Togashi Y, Kasahara R, Ohashi T, Yamamoto Y. Contribution of abdominal muscle strength to various activities of daily living of stroke patients with mild paralysis. J Phys Ther Sci. 2015;27(3):815–8. 10.1589/jpts.27.815.
Matsumoto H, Shiraishi M, Higashi A, Hino S, Kaburagi M, Mizukami H, et al. The Forward and Lateral Tilt Angle of the Neck and Trunk Measured by Three-Dimensional Gait and Motion Analysis as a Candidate for a Severity Index in Patients with Parkinson's Disease. Neurol Int. 2022;14(3):727–37. 10.3390/neurolint14030061.
Djaldetti R, Melamed E. Camptocormia in Parkinson's disease: new insights. J Neurol Neurosurg Psychiatry. 2006;77(11):1205. 10.1136/jnnp.2006.099184.
Schulz-Schaeffer WJ. Camptocormia in Parkinson's Disease: A Muscle Disease Due to Dysregulated Proprioceptive Polysynaptic Reflex Arch. Front Aging Neurosci. 2016;8:128. 10.3389/fnagi.2016.00128.
Srivanitchapoom P, Hallett M. Camptocormia in Parkinson's disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry. 2016;87(1):75–85. 10.1136/jnnp-2014-310049.
Lena F, Iezzi E, Etoom M, Santilli M, Centonze D, Foti C, et al. Effects of postural exercises in patients with Parkinson's disease and Pisa syndrome: A pilot study. NeuroRehabilitation. 2017;41(2):423–8. 10.3233/nre-162033.
Tan H, Wade C, Brown P. Post-Movement Beta Activity in Sensorimotor Cortex Indexes Confidence in the Estimations from Internal Models. J Neurosci. 2016;36(5):1516–28. 10.1523/jneurosci.3204-15.2016.
Edwards MJ. From Tricks to Treatment-Sensory Input and Dystonic Dyskinesia in Parkinson's Disease. Mov Disord Clin Pract. 2017;4(1):6–7. 10.1002/mdc3.12418.
Moroz A, Edgley SR, Lew HL, Chae J, Lombard LA, Reddy CC et al. Rehabilitation Interventions in Parkinson Disease. PM&R. 2009;1(3, Supplement):S42-S8. doi: https://doi.org/10.1016/j.pmrj.2009.01.018.
Nickel E, Hansen A, Pearlman J, Goldish G. A drive system to add standing mobility to a manual standing wheelchair. Assist Technol. 2016;28(4):218–24. 10.1080/10400435.2016.1165757.
Hubble RP, Naughton GA, Silburn PA, Cole MH. Trunk muscle exercises as a means of improving postural stability in people with Parkinson's disease: a protocol for a randomised controlled trial. BMJ Open. 2014;4(12):e006095. 10.1136/bmjopen-2014-006095.
Aoki R, Shiraishi M, Mikami K, Kamo T. Deterioration of postural deformity in Parkinson's disease patients with punding and hobbyism. J Clin Neurosci. 2019;69:179–83. 10.1016/j.jocn.2019.07.069.
Konrad A, Stafilidis S, Tilp M. Effects of acute static, ballistic, and PNF stretching exercise on the muscle and tendon tissue properties. Scand J Med Sci Sports. 2017;27(10):1070–80. 10.1111/sms.12725.
Guissard N, Duchateau J, Hainaut K. Mechanisms of decreased motoneurone excitation during passive muscle stretching. Exp Brain Res. 2001;137(2):163–9. 10.1007/s002210000648.
Gandolfi M, Tinazzi M, Magrinelli F, Busselli G, Dimitrova E, Polo N, et al. Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson's disease: A single-blinded, randomized controlled trial. Parkinsonism Relat Disord. 2019;64:268–74. 10.1016/j.parkreldis.2019.05.006.
Schroeteler FE, Fietzek UM, Ziegler K, Ceballos-Baumann AO. Upright posture in parkinsonian camptocormia using a high-frame walker with forearm support. Mov Disord. 2011;26(8):1560–1. 10.1002/mds.23585.
Ye BK, Kim HS, Kim YW. Correction of camptocormia using a cruciform anterior spinal hyperextension brace and back extensor strengthening exercise in a patient with Parkinson disease. Ann Rehabil Med. 2015;39(1):128–32. 10.5535/arm.2015.39.1.128.
Lee KH, Kim JM, Kim HS. Back Extensor Strengthening Exercise and Backpack Wearing Treatment for Camptocormia in Parkinson's Disease: A Retrospective Pilot Study. Ann Rehabil Med. 2017;41(4):677–85. 10.5535/arm.2017.41.4.677.
Kim HJ, Jeon BS, Kim SH, Han SH. Reversible antecollis associated with pramipexole in a patient with Parkinson's disease. J Clin Neurosci. 2012;19(6):903–4. 10.1016/j.jocn.2011.09.015.
Oh YS, Kim JS, Ryu DW, Lee KS. Donepezil induced antecollis in a patient with Parkinson's disease dementia. Neurol Sci. 2013;34(9):1685–6. 10.1007/s10072-012-1242-3.

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Video 1. The patient’s poor posture control while walking on the trajectory in the first week.
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Video 2. The patient ambulated on the trajectory more stably in the third week.
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Video 3. The patient accomplished the gait analysis test with confidence and in a relatively good posture in the fifth week.

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Significant improvement after sensory tricks and trunk strength training for Parkinson’s disease with Antecollis and Camptocormia: a case report and literature review

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Abstract

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1. INTRODUCTION

2. INFORMATION AND METHODS

2.1 GENERAL INFORMATION

2.2 REHABILITATION ASSESSMENT

2.3 DIAGNOSIS

2.4 INTERVENTION METHODS

3. RESULTS

4. DISCUSSION

5. CONCLUSION

Declarations

References

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