Improvements in Average Stability Score, and a Decrease in Subjective Balance Issues Following Neurological Rehabilitation for a 62-year-old Male Patient with Parkinson’s Disease

Presentation: A 62-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of previously diagnosed Parkinson’s disease identified thirteen years prior. One of his chief complaints was balance issues.

Findings: Upon intake, a Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on both a solid and foamed surface, with eyes opened, eyes closed, and with multiple head positions. The average stability score on intake was calculated as 52.961%. When rating his subjective balance issues, the patient reported a 1 out of 6 in severity (with 0 being none and 6 being severe).

Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions (Carrick 2017)(Antonucci 2016). Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC).

Outcome: Upon exit, the stability scores improved, with the average stability score calculated as 62.503% (+18.02%). When comparing the individual stability scores, upon intake the patient was unable to complete the eyes closed test on a foam surface, upon exit, the patient not only completed the test but scored a 63.32% (+∞). In addition, the patient’s subjective balance score decreased from 1 to 0, indicating subjectively that his balance issues have been resolved.

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to improve average stability scores and decrease subjective balance issue severity in patients with Parkinson’s Disease.

References:

1. Antonucci MM, Link PE, Barton DA and Carrick FR (2016). Improvement of symptoms, balance, and gait in a geriatric male, with a 5-day intensive combination of visual, vestibular, proprioceptive, and non-invasive nerve stimulation. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00050
2. Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414
3. Gdowski GT, McCrea RA. Integration of vestibular and head movement signals in the vestibular nuclei during whole-body rotation. J Neurophysiol (1999) 82:436–49
4. Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, precision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8
5. Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.