Parkinson Hastalarında Sensoriomotor Eğitimin Üst Ekstremite Fonksiyonları, Aktivite ve Katılımı Üzerine Etkisinin İncelenmesi

Abstract

Parkinson's Disease (PD) is a movement disorder that causes progressive limitations in the upper extremity. The cervical region plays an important role in sensorimotor control because it contains intense proprioceptive afferents. This study aimed to examine the effect of cervical sensorimotor training (C-SMT) on upper extremity function in PD within the framework of the International Classification of Functioning, Disability and Health (ICF). Twenty-seven PD patients (11 women, 16 men, mean age 63.4±8.74 years) were included in the single-blind randomized controlled study. Patients were randomly divided into the control group (CG, n=12) and the C-SMT group (n=15). While CG received well-structured physiotherapy for the upper extremity, the C-SMT group additionally received C-SMT. Both groups were included in a physiotherapy program for a total of 24 sessions, three days a week for eight weeks. Body structure and functions were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) I-III-Total, Fahn Tolesa Marin clinical tremor rating scale, finger tapping test, New York posture rating chart, Parkinson fatigue scale, grip/pinch strength, Craniocervical Flexion Test (CCFT), cervical muscles endurance tests, joint position error, moving two-point discrimination test, Semmes Weinstein Monofilament Test, visual analog scale, and pressure pain threshold. Activity and participation were evaluated with UPDRS-II, Purdue Pegboard Test (PPT), cognitive and motor dual tasks on PPT, Disabilities of the Arm, Shoulder, and Hand Questionnaire, and Parkinson's Disease Questionnaire (PDQ-39). Environmental factors were evaluated with structured questions by the researchers. C-SMT provided improvement in parameters linked with upper extremity (p<0,05). There was a significant improvement in body structure and functions in favor of C-SMT in cervical and upper extremity proprioception, and CCFT (p<0.05). There was a significant improvement in PDQ-39 ADL subscale score in favor of CG in activity and participation (p<0.05). C-SMT was more effective especially for enhancing the strength and endurance of the deep cervical muscles, cervical proprioception, and proprioception of all joints in upper extremity. Since impairments in the control of multi-joint upper extremity movements are observed in PD, increasing proprioception of all joints may be important to increasing motor control. C-SMT program may be effective in reducing upper extremity structure and function impairments and increasing activity and participation in early- and middle-stage PD.