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Exploring the Effects of Using an Oral Appliance to Reduce Movement Dysfunction in an Individual With Parkinson Disease: A Single-Subject Design Study

Lane, Hillary PT, DPT; Rose, Lindsey E. PT, DPT; Woodbrey, Megan PT, DPT; Arghavani, David DDS; Lawrence, Michael MS; Cavanaugh, James T. PT, PhD

Journal of Neurologic Physical Therapy: January 2017 - Volume 41 - Issue 1 - p 52–58
doi: 10.1097/NPT.0000000000000160
Research Articles
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Background and Purpose: Clinical reports suggest that wearing an oral appliance can improve the gait and balance of an individual with Parkinson disease (PD). Our primary purpose was to systematically explore this effect using a single-subject study design and quantitative motion analysis. Secondarily, we sought to examine the quality-of-life outcomes following 1-month of routine oral appliance wear.

Methods: The participant was a 73-year-old ambulatory man with mid-stage PD. Using an A-B-A design, for which a custom-made oral appliance served as the intervention, kinematic and kinetic data were captured during performance of Four Square Step Test, serpentine walk, and tandem walk tasks. Grip strength was quantified with a dynamometer. Quality-of-life outcomes were collected after 1 month of appliance wear using the Parkinson Disease Questionnaire-39 (PDQ-39). Perceived changes in balance, mobility, and quality of life were captured from the participant using an 11-point Global Rate of Change (GRC) scale.

Results: Changes in mobility, postural control, and grip strength during appliance wear were suggestive of reduced movement dysfunction. The PDQ-39 revealed a significant improvement in quality of life, primarily related to increased emotional well-being, decreased stigma, and increased communication. GRC scores indicated a clinically significant improvement in ease of movement in the community (+3), ease of movement during the performance of activities of daily living (+4), and in standing balance while performing activities of daily living (+4).

Discussion and Conclusions: Study findings provided quantitative evidence supporting the effectiveness of oral appliance wear for reducing movement dysfunction in a patient with mid-stage PD.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1,

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Morrison Center, Scarborough & Wells, Maine (H.L.); Achieve Orthopedic Rehabilitation Institute, Naperville, Illinois (L.E.R.); Orthopaedic Associates, Portland, Maine (M.W.); Department of Cariology and Comprehensive Care, College of Dentistry, New York University, New York (D.A.); and Department of Physical Therapy, University of New England, Portland, Maine (M.L., J.T.C.).

Correspondence: James T. Cavanaugh, PT, PhD, Department of Physical Therapy, University of New England, 716 Stevens Ave, Portland, ME 04103 (

The study was funded by the Westbrook College of Health Professions at the University of New England.

All authors contributed to the planning and execution of this study and in the preparation of the manuscript. MW, HL, LER, and ML collected and analyzed study data. DA created the recommendations and model for design of the oral appliance. MW, HL, and LER conducted the study to fulfill a graduation requirement in the Doctor of Physical Therapy Degree program at the University of New England.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2017 Academy of Neurologic Physical Therapy, APTA