EFFECT OF ENHANCED EXTERNAL COUNTER PULSATION (EECP) ON BALANCE, MOTOR AND EXECUTIVE FUNCTION IN VASCULAR PARKINSONISM - A CASE REPORT

N. Thrishala¹, V Jeyaganesh¹, M Anitha¹

¹Institute of Physiotherapy, Srinivas University, Department of Neurorehabilitation, Mangaluru, India

Background: Vascular Parkinsonism (VP) is an atypical form of Parkinsonism associated with several causes apart from primary neurodegenerative process. It can be differentiated from PD by an abrupt onset and development of Parkinsonism, evidence of neurovascular disease and ineffective response to dopamine therapy. Mostly, the disorder manifests as a slow gait with short steps, which gradually worsens and may also show abnormal pyramidal reflex responses and cognitive decline. Enhanced External Counter Pulsation (EECP) is a non-invasive treatment method that has been successful in treating ischemic conditions of the heart and brain. Since there has been less success with pharmacologic treatment and limited evidence for the available rehabilitation programmes in VP, the study aimed to attempt a new approach that may have a positive effect on the outcomes.

Purpose: To find the effects of EECP in a patient of VP on outcomes of balance (Timed up and go Test-TUG); motor speed (finger tapping test-FT test); executive function (verbal fluency test); and motor sequencing (Luria test).

Methods: A 64 year old female patient diagnosed with VP 10 months back, walking with short steps and difficulty in maintaining balance; CT scan report showing evidence of neurovascular disease along with poor response to Levodopa therapy was taken for the study. 15 one hour sessions of EECP (3 sessions/week) and physiotherapy exercise programme (3 sessions/week) was given on alternate days. Outcome assessments were taken at baseline, after 15 sessions of treatment and at one month follow-up.

Results: All outcomes of interest showed improvements post treatment and also at one month follow up. TUG scores at baseline was 98 seconds, post treatment was 66 seconds and at follow up showed further improvement with a score of 34 seconds. In the FT test, the subject was able to do finger tapping 57 times (dominant limb) at baseline which increased to 64 times post treatment and was maintained at follow up. The verbal fluency test also showed changes from baseline to post treatment to follow up as 0, 5 and 10 respectively. Similarly, Luria test sequence completion repetitions also showed differences from baseline-post treatment- follow up as 6, 10 and 14 respectively.

Conclusions: The study concluded that EECP may serve as a beneficial non-invasive therapy which can be applied along with the Physiotherapy exercise programmes for patients with Vascular Parkinsonism. Further high quality trials are required to strengthen the evidence, so that it can be routinely used in clinical practice.

Implications: Based on the result of this study, EECP can be used as an adjunct in neurorehabilitation to improve balance and executive function in patients with Vascular Parkinsonism.

Funding acknowledgements: Funded by Department of Neurorehabilitation, Institute of Physiotherapy, Srinivas University, Mangaluru, Karnataka – 575001, India.

Keywords:
Enhanced External Counter Pulsation (EECP)
Vascular Parkinsonism
Balance

Topics:
Neurology
Neurology: Parkinson's disease
Education: clinical

Did this work require ethics approval? Yes

Institution: Institute of Physiotherapy

Committee: Institutional Review Board, Srinivas University

Ethics number: SUIP/FAC22/103/2022