Parkinson's disease (PD) is a neurodegenerative disease characterised by the loss of dopaminergic neurons in the basal ganglia leading to a progressive and neurodegenerative movement disorder, with symptoms reflecting various impairments and functional limitations, such as postural instability, gait disorders, immobility, and falls.

Applied on the skin as a rehabilitative therapy aid for patients affected by this disease, the Equistasi® device allows the stimulation of the proprioceptive system, helping patients reacquire their body perception and perform more correct movements, reducing the falls rate and improving general balance.

From the literature (Volpe et al. 2014), it is clear how the nano-vibrations of the Equistasi amplify proprioceptive afferents (observations with eyes closed) with better patient stability as a consequence.

What is Parkinson's Disease?

The origins of Parkinson's disease date back to 1817, when Dr James Parkinson spoke about it for the first time. Although its causes are still unknown, genetic and environmental factors are believed to contribute to its development.

Environmental factors include pesticides, hydrocarbons-solvents, and heavy metals. Prolonged exposure to these factors could increase the risk of developing the disease. Genetic factors include mutations related to alpha-synuclein (PARK 1/PARK 4), parkin (PARK-2), PINK1 (PARK-6), DJ-1 (PARK-7), LRRK2 (PARK-8) and GBA glucocerebrosidase.

A faulty gene has been identified in 20% of patients with a family history of Parkinson's that allegedly triggers the disease to a greater frequency than in other people.

The brain has a system named ubiquitin-proteasome that detoxifies and cleans neurotoxic metabolites; it cleans the brain of proteins, turning them into amino acids that the body can reuse. In Parkinson’s disease, the mechanism just described seems to get stuck as a result of an autophagy defect, leading to the accumulation of the alpha-synuclein protein, which spreads the disease throughout the brain.

Oxidative stress caused by the combined action of pro-oxidant neurotransmitters (such as dopamine) and environmental neurotoxic factors (such as the Paraquat herbicide, the rotenone pesticide, or methamphetamine-related drugs) is thought to be the main cause of neuron death, where an accumulation is observed of aggregated proteins and damaged mitochondria that are not readily disposed of by the autophagy system.

Who is affected by Parkinson's Disease?

Today this disease affects approximately 4 per thousand of the general population of all ethnic groups, and about 1% of people over 65. It is found in both sexes, with perhaps a slight male prevalence.

The average age of onset is around 58-60, but about 5% of patients may present a juvenile onset between 21 and 40. Before the age of 20 it is extremely rare. It affects 1-2% of the population over 60, rising to 3-5% in people over 85 years of age.

There are about 300,000 people with Parkinson's disease in Italy, mostly males (1.5 times more), with the age of onset between 59 and 62. Moreover, it is believed that the onset of brain damage should be backdated on average by at least 6 years compared to the time of the first diagnosis.

What are the symptoms of Parkinson's Disease?

Parkinson's disease can be defined as a progressive neurodegenerative disease that is gradual and invalidating, therefore characterised by a series of stages. The symptoms are difficult to determine exactly, precisely because of its gradual onset. Some symptoms are so slight a clinical evaluation is nearly impossible.

Hoehn and Yahr (1967) broke down the symptoms of the disease into five progressive clinical stages:

Stage 1. It is characterised by the appearance of a mild tremor, stiffness and soreness in the upper limbs at rest, the slowing down of rapid alternating movements and worsening in the repetition of the same movement, facial hypomimia and, rarely, frontal seborrhoea.

These symptoms are detected specifically during the act of writing, when alterations are manifested such as trembling, difficulty in making roundish strokes, and micrography.

Stage 2. It is characterised by the gradual slowing down of the patient's movements, with a tendency to maintain a fixed posture and slight ankle and knee flexion and even bradykinesia. Often, reactive depression occurs.

Stage 3. It is characterised by significant gait impairment with a tendency to take short and quick steps while tilting the trunk forward, resulting in generalised disability and retropulsion or propulsion that induce the first falls.

Walking slows down significantly and bradykinesia increases.

Stage 4. It is characterised by a particularly high degree of disability. Patients cannot perform routine daily activities independently and are no longer able to live on their own. Falls become increasingly frequent.

Stage 5. It is characterised by complete invalidity of the person affected, who is no longer able to walk or stand upright and is forced to remain in bed for prolonged periods of time. This stage manifests symptoms such as dysphagia, difficulty swallowing and eating, dehydration, cachexia, and a series of variable consequences related to the inactivity.

In conclusion, the classic symptoms of Parkinson's disease may be summarised as follows:

• Tremor (generally present when the limbs are at rest and, in most cases, on one side only)

• Bradykinesia (slow walking and movements, and muscular weakness)

• Stiffness and physical pain

• Balance disorders and consequent falls

• Postural disorders (with tendency to bend forward)

• Freezing of movements (sudden motor blocks occurring when limbs no longer respond to commands)

• Akinesia (total absence of movement)

• Cognitive decline (with symptoms such as psychic disorders, hallucinations, insomnia and depression)

This clinical picture refers to an individual suffering from Parkinson's disease who has not undergone any pharmacological treatment.

Equistasi and the rehabilitation of Parkinson's patients

The clinical picture illustrated above shows that one of the most serious degenerative consequences of Parkinson's disease is motor instability in the patient’s movements and general gait.

Parkinson's affects the patient’s quality of daily life in serious ways and varying degrees, causing frequent falls and fractures that require hospitalisation, invasive treatments and - in the most critical cases - surgical interventions.

Major clinical studies show that, applied on the skin as a rehabilitative therapy aid for patients affected by this disease, the Equistasi® device allows the stimulation of the proprioceptive system, helping patients to reacquire their body perception and perform more correct movements, reducing the falls rate and improving general balance. From Dr. Volpe’s article, it is clear how the nano-vibrations of Equistasi amplify proprioceptive afferents (observations with eyes closed) with better patient stability as a consequence.

Consult all publications and clinical studies on this topic, in the dedicated section.