Objective: The purpose of our study is to evaluate the effect of postural reeducation with a tilt table in a Parkinson’s disease patient with dropped head syndrome.

Background: The patients with Parkinson’s disease (PD) sometimes complicated with dropped head syndrome (DHS). The previous studies reported that the incidence estimates of DHS in PD were 5-6%. The multiple-cause of DHS has been known as drug-induced, cervical spondylosis, myopathy, or PD-related. The selection of treatment depends on the primal disorder. However, it remains unclear how the efficacy of physical therapy for patients with PD.

Method: Case presentation: A 67-year-old man, his initial symptom was DHS related to PD.  At the age of 62, he was aware of resting tremor of the right upper extremity and gait disturbance. He was diagnosed with PD at the age of 62 with a good response to levodopa/carbidopa. The prescription remained unchanged during the next five years, however, his symptom gradually worsened. At 67 years old, he came to our hospital. We ceased pramipexole due to DHS and alternatively increased the dosage of levodopa/carbidopa to 550 mg per day. Following he was admitted to our hospital to treat the DHS. We adopted physical therapy that focused on the postural reeducation exercise with a tilt table. The postural reeducation mainly consisted of three processes. First, the patient learned how to stretch his neck and trunk flexors in the lying position on the tilt table. Second, the patient learned how to keep his head up position in the leaning position. The more increase the angle of the upward tilt, the more the patient received the effect of gravity load. Third, the patient learned how to keep his upright head position in front of the wall.

Results: We observed the amelioration of the angled of DHS from 58° to 29° on the natural position, and from 35 to 18° on the maximum extension position. The Mini-Balance Evaluation Systems Test score improved from 11 to 15 points, and the Timed Up and Go Test improved from 29.9 seconds and 31 steps to 14.4 seconds and 21 steps, without the alteration of anti-parkinsonian drugs during the physical therapy. The therapeutic effect had remained 6 months after the discharge.

Conclusion: The postural reeducation using a tilt table may have some positive effects for patients with PD complicated with prolonged DHS after withdrawal of dopamine agonists.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-physical-therapy-of-postural-reeducation-with-a-tilt-table-for-a-patient-with-parkinsons-disease-complicated-with-dropped-head-syndrome/