Postural and Kynematic effect of a new custom-made foot insole called “Prodynamic” in a cohort of patients affected by extrapiramidal disease

Abstract

Background: The use of a custom-made orthotic plantar device is referenced as a true sensor-motor facilitation tool for the control of the postural orthostatic and orthodynamic position in patients with Parkinson’s disease. Aim: To outline the postural and kinematic effect of a pro-ergonomic multilayer foot insole versus a custommade carbon-kevlar dynamic foot insole in a cohort of patients affected by extrapyramidal disease. Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders. Methods: A sample of 8 patients (mean age of 82.6), of whom 4 affected by Parkinson’s disease (P) and 4 by Parkinsonism (PS) were recruited for the aim of this study. In line with our inclusion criteria (clinical-functional diagnosis of Parkinson’s disease or Parkinsonism, Webster scale ≤ 20, Mini-mental State Examination (MMSE) ≥ 18), the study design developed in 2 times: a. time T1 (or evaluation time), in which recruited patients affected by Parkinson’s disease or Parkinsonism were evaluated at the Hospital and Noble Resting House Paolo Richiedei through an accurate functional (Conley scale, Barthel Index scale, Tinetti scale and the Berg Balance Scale), postural evaluation (VPA) and walking examination (VGA, baropodometric evaluation, kinematic gait evaluation through WIVA system); to each group of patients of our study were therefore entrusted 4 foot-insoles, of which 2 synthetic and 2 carbon-kevlar custom-made foot-insoles called PRODYNAMIC; at the end of this step, patients started with our integrated rehabilitative treatment course. b. time T2 (or experimental time; 90 days from T1), a new clinical-instrumental evaluation of each patient was performed, repeating the clinical-functional and instrumental evaluation performed at the time T1 in a specular way; this assessment was performed in FW condition, with personal footwear and previously acquired foot-insoles used during the evaluation at the T1 time. Results: Most of our patients have been able to fi nd benefi t from the use of the plantar orthosis and integrated rehabilitation treatment so as to bring some modifi cations within personal postural attitude, recording an improvement but not uniform change within the sample. The results obtained by comparing the VPA at time T1 and at time T2 explain how patients affected by both clinical forms tend to establish incorrect postural attitudes due to stiffness and appearance of hypertonic plasticity, which become then structured and only partially modifi able. There was a general performance improvement in line with the VGA: within the P.B group, we observed with the use of the Prodynamic insole a partial or even complete normalization of the dynamic heel-contact phase, a better alignment of the COP in its excursion from the 1st to the 2nd rocker phase of the step, a notable facilitation to the inertial thrust in progress in the 3rd and 4th rocker phase, an improvement in the eccentric control of the patellofemoral alignment in the acceptance phase of the so-called load-response in stance and, fi nally, the acquisition of a more physiological propulsion structure of the trunk basin unit with an improvement of the clearance and fi xation skills in the sequential phases of the step. This trend was evident but not uniform in the other groups considered. Analysis of the evolution of the degree of functionality in the daily life activities expressed by the Barthel index, passing from time T1 to the time T2, showed an improvement and consistent change in all groups considered within our study that we can fi nd in a more or less way for the other clinical outcome data. An objective time-related and intra-group comparison of the raw static and dynamic baropodometric data acquired in our 4 study conditions showed different time-related trends for the two groups taken into consideration. A specifi c WIVA profi le was found for each pathology group, highlighting different Research Article Postural and Kynematic effect of a new custom-made foot insole called “Prodynamic” in a cohort of patients affected by extrapiramidal disease Maurizio Falso1*, Matilde Grillo2, Anna Righetti2, Franco Lopa3, Lisa Rocco3 and Emanuela Facchi2 1Middle Cares Rehabilitation Unit, Madonna del Corlo Foundation, Lonato (Bs), Italy 2Middle Cares Rehabilitation Unit, Richiedei Foundation, Gussago (Bs), Italy 3Ortopedia Signori, Desenzano d / G, Italy *Address for Correspondence: Maurizio Falso, MD, Physical Medicine and Rehabilitation, Middle Cares Rehabilitation Unit, Madonna del Corlo Foundation, Corso Garibaldi 3, 25017, Lonato (Bs), Italy, Tel: 349.4971729; Email: falsomaurizio@libero.it Submitted: 16 April 2019 Approved: 22 May 2019 Published: 23 May 2019 Copyright: © 2019 Falso M, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited