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Effects of Medication on Turning Deficits in Individuals with Parkinson's Disease

Hong, Minna PT, PhD; Earhart, Gammon M. PT, PhD

Journal of Neurologic Physical Therapy: March 2010 - Volume 34 - Issue 1 - pp 11-16
doi: 10.1097/NPT.0b013e3181d070fe
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Background and Purpose: People with Parkinson's disease often have difficulty executing turns. To date, most studies of turning have examined subjects ON their anti-Parkinson medications. No studies have examined what specific aspects of turning are modified or remain unchanged when medication is administered. The purpose of this study was to determine how anti-Parkinson medications affect temporal and spatial features of turning performance in individuals with Parkinson's disease.

Methods: We examined turning kinematics in 10 people with Parkinson's disease who were assessed both OFF and ON medication. For both conditions, participants were evaluated with the Unified Parkinson's Disease Rating Scale motor subscale, rated how well their medication was working on a visual analog scale, and performed straight-line walking and 180-degree in-place turns. We determined the average walking velocity, time and number of steps to execute turns, sequence of yaw rotation onsets of the head, trunk, and pelvis during turns, and amplitudes of yaw rotation of the head, trunk, and pelvis during turns.

Results: Medication significantly improved the Unified Parkinson's Disease Rating Scale scores (P = 0.02), visual analog scale ratings (P = 0.03), and walking velocity (P = 0.02). Although improvements in turning were not statistically significant, medication did reduce the time and number of steps required to turn, slightly increased the amplitudes of yaw rotation of the various segments, and increased the rotation of the head relative to the other segments. Medication did not improve the timing of segment rotations, which showed en bloc turn initiation in both the OFF and ON medication conditions.

Discussion and Conclusion: These results suggest that only certain aspects of turning may be responsive to anti-Parkinson medications. As such, additional rehabilitative approaches to address turning are needed because turning may not be effectively addressed by pharmacologic approaches. These results should be interpreted cautiously given the small sample size.

Program in Physical Therapy and Departments of Neurology and Anatomy and Neurobiology (G.M.E.), Washington University School of Medicine, St. Louis, Missouri Spinal Cord Injury Center (M.H.), VA Palo Alto Health Care System, Palo Alto, CA.

Supported by NIH grants 1 K01 HD048437-05 and 1 F31 NS056653, and PODS II from the Foundation for Physical Therapy.

Address correspondence to: Gammon M. Earhart, E-mail: earhartg@wusm.wustl.edu

© 2010 Neurology Section, APTA