Neurophysiological and biomechanical investigations of postural disorders in patients with Parkinson disease: implications for rehabilitation.

Postural deformities are a common and disabling complication of Parkinson’s disease (PD). These deformities include Pisa syndrome, camptocormia, antecollis and scoliosis.In particular, Pisa Syndrome (PS) has been clinically defined as a lateral trunk flexion of 10° which can be alleviated completely by passive mobilization or on lying supine and can be concomitant or not with other postural deformities such as scoliosis, camptocormia and antecollis. In our recent multicenter observational study involving 1631 PD patients, we estimated its prevalence in Italy of 8.8%. The evidence to date suggests that postural deformities have two different pathophysiologic mechanisms: (1) a central mechanism, sustained by both animal studies and clinical findings and related to a defect in basal ganglia functioning with dystonia along with impaired sensory-motor integration; and (2) a peripheral mechanism, referred to spinal tissues changes and paraspinal myopathy.My PhD research program intends to evaluate the neurophysiological and biomechanical aspects of PS in patients with PD. Improved understanding of the mechanisms underlying postural deformities in PD might ultimately lead us to more effective rehabilitation strategies for these disabling and drug-refractory complications.