Retropulsion with tilted postural vertical causing backward falls in an individual with Parkinson’s disease: Improvement by specific rehabilitation
Three interlaced axes of rehabilitation were implemented in parallel. One axis was original, intending to modulate and shift postural vertical (PV) forward using 3 techniques applied for a total time of 8 h (Fig. 1B-D); the rationale is detailed in the supplementary material [4, 8-10]. CdR performed 6 sessions of 15 min of body-weight supported (20%) treadmill walking (2.5 km/hr), underwent 80 Hz bilateral vibration of both tibialis anterior tendons every day for 20 min during postural activities that referred to the vertical, and was tilted 30° forward for 15 min every day. The second axis aimed to train the active upright orientation to extend the effects obtained to a biomarker (PV). This consisted of exercises to improve the awareness of trunk abnormali- ties and positioning in space [11,12], strengthen the erector spinae
[12,13], and challenge the backward disequilibrium [11,14], includ- ing relearning to rise from a chair and sit down. The third axis was general training adapted to PD [15,16], with whole-body strength- ening, resistance training, stretching, balance exercises challenging postural stabilization, and education about falls. The results of the study were explored with several outcome measures: 1) fall rates assessed by interviews during the follow-up in Neurology; 2) satis- faction expressed by CdR and his spouse; 3) adherence to treat- ment; comparison of results after and before intensive rehabilitation for: 4) PV, and 5) Five Times Sit-To-Stand Test (5XSST); and 6) adverse effects. Other data were simply indicative (Table 1).
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