Effect of Osteopathic Manipulative Medicine on Parkinson Disease
Effect of Osteopathic Manipulative Medicine on Parkinson Disease
Parkinson's disease (PD) is defined as a progressive disorder of the nervous system that
 affects the patient's mobility, balance and cognition. Tremor, slowed movements, and rigidity
 are physical symptoms which contribute to postural and gait abnormalities seen in many PD
 patients. Other symptoms include loss of balance and restricted range of motion, increasing
 the risk of falling. Osteopathic manipulative medicine (OMM) is a form of manual treatment
 provided by osteopathic physicians. This form of treatment aims to help decrease muscle
 spasms and improve joint range of motion and movement. We are proposing a pilot study to
 investigate the impact of OMM on balance, motor function, and falling in PD patients. We are
 also going to screen for serum biomarker changes to investigate the potential effects of OMM.
 Our research team and institution have experience in providing osteopathic care and physical
 rehabilitation for PD patients. In this study, balance and motor function will be evaluated
 for each subject throughout the study period. We will also keep track of the number of falls.
 Balance will be measured using Sensory Organization Test (SOT) and motor function will be
 measured using Movement Disorder Society Unified Parkinson's Disease Rating Scale
 (MDS-UPDRS). Both tools are non-invasive and clinically proven methods for measuring balance
 and motor function.
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