Kinematic analysis of trunk static posture and dynamic mobility in patients with Parkinson’s Disease with and without Pisa syndrome

Autori

Marina Gjini [Movement Analysis Research Section, IRCCS Mondino Foundation, Pavia]

Luca Martinis [Movement Analysis Research Section, IRCCS Mondino Foundation, Pavia]

Ilaria Campese [Movement Analysis Research Section, IRCCS Mondino Foundation, Pavia]

Valentina Grillo [Department of Brain and Behavioral Sciences, University of Pavia, Pavia; Movement Analysis Research Section, IRCCS Mondino Foundation, Pavia]

Stefano Filippo Castiglia [Department of Medico-Surgical Sciences and Biotechnologies, Università di Roma La Sapienza, Latina]

Dante Trabassi Department of Medico-Surgical Sciences and Biotechnologies, Università di Roma La Sapienza, Latina

Mariano Serrao Department of Medico-Surgical Sciences and Biotechnologies, Università di Roma La Sapienza, Latina

Cristina Tassorelli [Department of Brain and Behavioral Sciences, University of Pavia, Pavia; Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation]

Roberto De Icco [Department of Brain and Behavioral Sciences, University of Pavia, Pavia; Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation]

Background and aims

Pisa Syndrome (PS) may represent a postural complication of Parkinson’s Disease (PD)[1].

Kinematic motion analysis is a reliable and sensitive method for assessing both static posture and dynamic trunk mobility.

This study aimed to perform a kinematic analysis of trunk static posture and dynamic mobility in patients with PD, with and without PS, as well as in healthy subjects (HC).

Methods

This is a cross-sectional study. All participants underwent a trunk kinematic analysis performed with a 6-camera optoelectronic system (ELITE, BTS Engineering, Milan, Italy) and seven reflective markers placed on specific trunk landmarks [2]. Synchronized acquisition and data processing were performed using analyzer software (BTS, Milan, Italy). The kinematic assessment included a static upright recording and evaluation of trunk range of motions (ROMs) during four dynamic tasks: forward flexion, lateral flexion toward the right and left sides, and trunk extension.

Results

We enrolled 130 patients diagnosed with PD, divided in two subgroups: 48 with PS (PD-Pisa) (73.2±5.0 years; 31 males) and 82 without PS (pwPD) (70.8±7.6 years, 59 males). We included 40 HC matched for age and gender (71.4±5.9, 23 males).

During static upright standing, PD-Pisa showed greater lateral trunk inclination compared to both pwPD and HC (p < 0.001 for both), as well as a higher forward trunk inclination compared to pwPD and HC (p < 0.001 for both). The lateral trunk inclination did not differ between pwPD and HC (p=0.064), while the forward trunk inclination was higher in pwPD compared to HC (p=0.005).

Regarding dynamic tasks, PD-Pisa were characterized by lower ROMs of the lateral trunk flexion contralateral to the side of static inclination and of trunk extension when compared to HC (p=0.006; p<0.001). The ROMs of right and left lateral trunk bending and trunk extension did not differ between PD-Pisa and pwPD (p>0.050 for all comparisons), while the ROM of the forward trunk flexion was higher in PD-Pisa compared to pwPD (p<0.001). For all the four dynamic tasks, trunk ROMs in pwPD were lower compared to HCs (p<0.050 for all comparisons).

Conclusion

PD-Pisa group exhibited a complex trunk postural disorder, with a more pronounced camptocormia compared to pwPD subjects in addition to the well-known lateral trunk inclination. However, these static alterations did not correspond to greater impairment of dynamic trunk mobility compared to PD subjects without PS. These findings suggest that the characteristic lateral misalignment of PS does not necessarily translate into a functional limitation of trunk dynamics.

REFERENCES

[1] Tinazzi M, et al. Movement disorders clinical practice; 2022; vol. 9,5: 594-603.

[2] De Icco R, et al. Frontiers in Neurology; 2022; doi: 10.3389/fneur.2022.849820.