Prevention of Early Immobility in Patients with Parkinson's Disease: A Cognitive Strategy Training for Turning in Bed and Rising from a Chair

In this study it was attempted to develop a method of intervention with regard to specific motor impairments in Parkinson’s disease (PD) that do not respond well to pharmacological treatment and may lead to early invalidity: execution of global postural changes such as turning in bed and rising from a chair. In a first experiment, turning in bed and rising from a chair, were kinesiologically assessed in ten healthy young subjects (20–30 yrs), ten healthy elderly (60–70 yrs) and ten PD patients. In healthy subjects, turning can be characterised as a complex motor task, in which the components need delicate tuning in terms of sequential and simultaneous execution. Essential is the formation of an “arch”, formed by one leg and one shoulder, which enables a person to lift the body from the mattress and rotate the body along this arch. This results in a stable position of lying on the side without lateral displacement. PD patients show difficulties in the tuning and execution of the components. Formation of an arch is problematical and this affects the quality of turning to a great extent. Also, they tend to execute the components in a fragmented and ineffective manner and frequently components are not executed at all. In rising from a chair, similar problems in the execution of the components of this global postural change were 246observed. In healthy controls, rising from a chair occurs fluently with initial displacement of legs and arms, eventually shifting to a support function, and acceleration of the trunk leading to horizontal and vertical displacement of the body’s centre of gravity. In a second experiment, alternative movement strategies for turning and rising from a chair were taught to ten, not demented, PD patients: three mildly affected, three moderately affected and four strongly affected. These strategies had to meet demands imposed on them on neuropsychological and kinesiological grounds: the large complex movement was divided into simple partial movements, each leading to a stable in-between-position and with a logical and strict sequence. An individual training of six sessions of one hour duration was set up to teach these new movement strategies. After the training, patients of mild and moderate severity showed good results: they hardly made any errors in the execution of the learned strategies that lead to better movement results. The strongly affected patients performed less successfully. Improvement was present but not sufficient.