Effect of Osteopathic Manipulative Medicine on Parkinson Disease

Annually, 60,000 people within the United States are diagnosed with PD.1 The cardinal
features of PD include resting tremor, rigidity, asymmetric onset, and bradykinesia.2 These
characteristics appear to affect balance. Balance is a complex system that involves
maintaining posture, facilitating movement, and recovering equilibrium to control one's body
within its limits of stability. Balance involves the coordination of vestibular, visual,
auditory, motor, and high level premotor systems, many of which are compromised in PD.3
Previous research found that 46% of the PD subjects fell within a three month period, and
that 21% of subjects had their first fall during the three month period.4 Postural
instability is a hallmark sign of PD that compromises balance control and increases the risk
of falling.5,6

Many falls in PD occur because of postural instability and their inability to organize
sensory information. The SOT identifies abnormalities in postural control, somatosensory,
visual, and vestibular sensory systems. It offers a composite score that is a percentage
based on normal age controls. We recently presented an abstract at the World Parkinson's
Conference in Montreal, Canada that showed individual's with PD (n=20) who were categorized
as fallers, scored lower on the SOT than non-fallers with PD.7

The pathogenesis of PD is a progressive neurologic depletion of dopaminergic neurons from the
basal ganglia which manifests as common motor or extrapyramidal signs: tremor, bradykinesia,
and rigidity. As the severity of PD progresses there is frequently postural instability and
further disability. There have been relatively few studies investigating the effect of OMM on
PD patients. One previous research study demonstrated that a single session of osteopathic
manipulative medicine protocol on 10 PD subjects improved gait compared to age-matched
sham-controls, particularly stride length, cadence, and maximum velocities of upper and lower
extremities.8 Other studies on non-PD subjects have shown that OMM can improve subject
balance. In a pilot study 20 elderly subjects with OMM protocol applied weekly for four weeks
showed an improvement in postural instability, as measured by changes in anterior-posterior
and medial-lateral sway on force plate observations.9 OMM has also been shown to improve
subjects with dizziness. The outcomes were measured using the SMART Balance Master©. It was
found that the composite score on the SMART Balance Master© significantly improved
immediately after intervention as well as one week later. (P<.001)10

OMM utilized in improving gait in PD patients addressed muscle hypertonicity and joint motion
restrictions by using muscle energy and articulatory techniques for the spine and the
extremities.8 OMM techniques that were used to address balance focused on removing muscle
spasms and restrictions of the spine and cranium. Based on our experience of treating PD
patients in our clinical practice and the improvement of symptoms in the forementioned
studies we developed a PARK-OMM protocol to utilize in this study. The protocol starts with a
CV4 technique, which helps to address cranial restrictions, and can potentially affect
patient's autonomic function.11,12 The protocol then proceeds to address each major spinal
region and the extremities by decreasing muscle hypertonicity and increasing joint range of
motion with direct OMM articulatory and muscle energy techniques. These techniques were
selected due to their document efficacy in improving joint mobility in the general population
as well as in PD both in clinical practice and documented prior studies.13

Hypothesis: OMM treatments twice a week over a 6-week period on PD subjects using a defined
OMM protocol will produce a prolonged improvement in motor function measured by the Movement
Disorders Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and balance measured
by the NeurCom SMART Balance Master© Sensory Organization Test (SOT) leading to a reduced
number of falls. We are also going to screen for serum biomarker changes to investigate the
potential effects of OMM. We expect that the OMM cohort will have significantly improved
motor function scores, balance, and an associated decrease in falls. This would help to
establish the role of OMM in the treatment of PD. Positive findings may also lead to
additional studies investigating how OMM impacts the quality of life in PD patients. It could
also promote further investigation on the potential mechanisms of OMM amongst the PD
population.

Inclusion Criteria:

- Medically diagnosed with Parkinson's Disease

- Over the age of 40

Exclusion Criteria:

- no clinical diagnosis of Parkinson's Disease

- having other diagnosed neurological diseases or disorders

- being completely wheelchair bound or having physical deformities that would prevent
completion of the assessment tools