The Effect of Thoracolumbar Brace use on Trunk Muscle Activity in a Patient with Parkinson's-related Camptocormia: A Case Report
Ahmed Shahbain1, Cirus Shiran1, Jacek Cholewicki1, Angela Lee1, John Popovich1, John Goudreau1
1Michigan State University
Objective:
Patients with Parkinson’s disease (PD) frequently develop postural deformities such as camptocormia, often resistant to standard treatments like levodopa. Thoracolumbar bracing has been proposed as an alternative therapy, but its use is limited by poor tolerance, commonly attributed to discomfort. Discomfort may relate to increased involuntary muscle contraction, though little is known about trunk muscle activity in PD while bracing. This case report examines muscle activity during brace use to contextualize its physiologic effects.
Results:
A 68-year-old woman (69.8 kg, 170 cm) with PD-related camptocormia underwent a 4-week trial with a thoracolumbar brace. Forward trunk flexion improved from 24° at baseline to 21° at follow-up, and quality of life (EQ-5D index) increased 35% (0.51 to 0.69). Electromyography (EMG) recorded bilateral activity in rectus abdominis, external oblique, and erector spinae muscles under two conditions: (A) standing without a brace and (B) standing with a brace. EMG signals were normalized to three reference conditions without the brace: (C) holding a 4.5-kg weight with outstretched arms, (D) holding a 2.7-kg weight in left shoulder abduction at 90°, and (E) holding a 2.7-kg weight in right shoulder abduction at 90°. Normalized trunk muscle EMG increased only 3% with the brace compared to no brace (0.45 mV avg to 0.42 mV avg). Comfort, rated on a 0–10 scale with 10 most comfortable, declined from 6/10 at baseline to 1/10 at trial completion.
Conclusions:
Findings suggest discomfort during bracing is unlikely due to increased involuntary muscle contraction. Instead, the anterior brace component appeared to restrict mobility and impede daily activities. For this patient with mild camptocormia (24°), functional benefit was limited. However, individuals with more severe camptocormia (>60° flexion) or alternative abnormalities such as Pisa syndrome may derive greater benefit. Further research is warranted to clarify the therapeutic role of thoracolumbar bracing in PD-related postural deformities.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.