{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:24:16Z","timestamp":1789575856210,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T00:00:00Z","timestamp":1748131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Spinal deformities, particularly thoracolumbar kyphosis, affect approximately one-third of patients with Parkinson\u2019s disease (PD) and significantly impair their quality of life and mobility. Conventional treatments, including levodopa and surgical interventions, have limited efficacy, necessitating alternative therapies. In this report, a 76-year-old woman with PD and severe thoracolumbar kyphosis (TK: 77.7\u00b0; sagittal vertical axis [SVA]: 95.55 mm) experienced postural instability and gait impairment. She underwent integrative postural rehabilitation (acupuncture, pharmacopuncture, Chuna spinal manual therapy, thermotherapy, and bodyweight exercises). A 4-week inpatient treatment improved spinal alignment (TK: 61.1\u00b0; SVA: 77.84 mm), gait, postural stability (MDS-UPDRS score improved by 3 points), and functional outcomes, with reductions in the Oswestry Disability Index (70 to 31) and pain severity (Numeric Rating Scale: 50 to 40). No adverse events were observed. Integrative postural rehabilitation can mitigate paraspinal muscle atrophy and fatty infiltration by promoting protein synthesis, neurotrophic factor expression, and proprioceptive neuromodulation. Our literature review suggests that proprioceptive stimulation and exercise enhances postural stability and gait, aligning with the outcomes of this case. This report suggests that integrative rehabilitation may improve kyphotic deformities and related motor dysfunctions in patients with PD. Further research is warranted to validate the treatment\u2019s efficacy and long-term benefits.<\/jats:p>","DOI":"10.3390\/jcm14113705","type":"journal-article","created":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T20:26:50Z","timestamp":1748204810000},"page":"3705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Integrative Postural Rehabilitation for Kyphotic Deformity in a Patient with Parkinson\u2019s Disease: A Case Report and Literature Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Ye-Rim","family":"Yun","sequence":"first","affiliation":[{"name":"Department of Acupuncture & Moxibustion, Jaseng Korean Medicine Hospital, Seoul 06110, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Sung","family":"Yeom","sequence":"additional","affiliation":[{"name":"Department of Acupuncture & Moxibustion, Jaseng Korean Medicine Hospital, Seoul 06110, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Acupuncture & Moxibustion, Jaseng Korean Medicine Hospital, Seoul 06110, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doori","family":"Kim","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1532-0942","authenticated-orcid":false,"given":"Yoon Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5020-6723","authenticated-orcid":false,"given":"In-Hyuk","family":"Ha","sequence":"additional","affiliation":[{"name":"Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7293-5396","authenticated-orcid":false,"given":"Do-Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Acupuncture & Moxibustion, Jaseng Korean Medicine Hospital, Seoul 06110, Republic of Korea"},{"name":"Department of Public Health Science, Seoul National University, Seoul 08826, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1002\/mds.21058","article-title":"Joint and skeletal deformities in Parkinson\u2019s disease, multiple system atrophy, and progressive supranuclear palsy","volume":"21","author":"Ashour","year":"2006","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"650","DOI":"10.4103\/ijmr.IJMR_1166_16","article-title":"Understanding of skeletal deformities in Parkinson\u2019s disease","volume":"144","author":"Baik","year":"2016","journal-title":"Indian J. Med. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00586-017-5052-4","article-title":"Sagittal balance is correlated with Parkinson\u2019s Disease clinical parameters: An overview of spinopelvic alignment on 175 consecutive cases","volume":"26","author":"Bissolotti","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1136\/jnnp.69.3.308","article-title":"What contributes to quality of life in patients with Parkinson\u2019s disease?","volume":"69","author":"Schrag","year":"2000","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s004150200032","article-title":"How common are complications of Parkinson\u2019s disease?","volume":"249","author":"Schrag","year":"2002","journal-title":"J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1001\/jama.297.1.77","article-title":"Will my patient fall?","volume":"297","author":"Ganz","year":"2007","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1212\/WNL.0000000000002768","article-title":"Postural instability and gait are associated with severity and prognosis of Parkinson disease","volume":"86","author":"Marinus","year":"2016","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1212\/WNL.0000000000002350","article-title":"Accuracy of clinical diagnosis of Parkinson disease: A systematic review and meta-analysis","volume":"86","author":"Rizzo","year":"2016","journal-title":"Neurology"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Palakurthi, B., and Burugupally, S.P. (2019). Postural instability in Parkinson\u2019s disease: A review. Brain Sci., 9.","DOI":"10.3390\/brainsci9090239"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1007\/s00586-010-1370-5","article-title":"Camptocormia: The bent spine syndrome, an update","volume":"19","author":"Lenoir","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_11","first-page":"247","article-title":"The cross-sectional area of paraspinal muscles predicts the efficacy of deep brain stimulation for camptocormia","volume":"7","author":"Sakai","year":"2017","journal-title":"J. Park. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1097\/01.brs.0000138306.02425.21","article-title":"Spinal surgery in patients with Parkinson\u2019s disease: Construct failure and progressive deformity","volume":"29","author":"Babat","year":"2004","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3171\/2018.4.JNS173032","article-title":"Surgical management of camptocormia in Parkinson\u2019s disease: Systematic review and meta-analysis","volume":"131","author":"Chan","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"238","DOI":"10.15188\/kjopp.2017.08.31.4.238","article-title":"Effects of Daoyin Exercise Therapy Combined with Korean Medicine Treatment on the Pain and Function Improvement of Low Back Pain Patients Diagnosed with Lumbar Disc Herniation: A Retrospective Observational Study","volume":"31","author":"Kim","year":"2017","journal-title":"J. Physiol. Pathol. Korean Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s12883-023-03205-7","article-title":"Characteristics of sagittal spinopelvic alignment in patients with Parkinson\u2019s disease presenting with dropped head syndrome: A case series study","volume":"23","author":"Terashi","year":"2023","journal-title":"BMC Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.spinee.2018.06.346","article-title":"Sagittal spinal alignment deviation in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry","volume":"19","author":"Uehara","year":"2019","journal-title":"Spine J."},{"key":"ref_17","unstructured":"Goetz, C.G., Poewe, W., Dubois, B., Schrag, A., Stern, M., and Lang, A. (2024, August 01). MDS-Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS). Available online: https:\/\/www.movementdisorders.org\/MDS\/MDS-Rating-Scales\/MDS-Unified-Parkinsons-Disease-Rating-Scale-MDS-UPDRS.htm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry disability index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine"},{"key":"ref_19","first-page":"155","article-title":"EuroQol-5D (EQ-5D): An instrument for measuring quality of life","volume":"78","author":"Balestroni","year":"2012","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_20","unstructured":"Seo, B.K. (2020). Korean Medicine Clinical Practice Guideline for lumbar disc herniation, National Institute for Korean Medicine Development."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9926445","DOI":"10.1155\/2021\/9926445","article-title":"Acupuncture for Parkinson\u2019s disease: Efficacy evaluation and mechanisms in the dopaminergic neural circuit","volume":"2021","author":"Zhao","year":"2021","journal-title":"Neural Plast."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e27566","DOI":"10.1371\/journal.pone.0027566","article-title":"Acupuncture enhances the synaptic dopamine availability to improve motor function in a mouse model of Parkinson\u2019s disease","volume":"6","author":"Kim","year":"2011","journal-title":"PLoS ONE"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1467769","DOI":"10.3389\/fendo.2024.1467769","article-title":"Efficacy of acupuncture for lumbar disc herniation: Changes in paravertebral muscle and fat infiltration\u2013a multicenter retrospective cohort study","volume":"15","author":"Yan","year":"2024","journal-title":"Front. Endocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"142","DOI":"10.56986\/pim.2023.10.002","article-title":"An Umbrella Review of Systematic Reviews for Chuna (or Tuina) Manual Therapy on Musculoskeletal Disorders","volume":"2","author":"Kim","year":"2023","journal-title":"Perspect. Integr. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.apmr.2014.01.020","article-title":"Postural rehabilitation and Kinesio taping for axial postural disorders in Parkinson\u2019s disease","volume":"95","author":"Capecci","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_26","first-page":"799","article-title":"Perceptive rehabilitation and trunk posture alignment in patients with Parkinson disease: A single blind randomized controlled trial","volume":"52","author":"Morrone","year":"2016","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s11517-021-02373-3","article-title":"Changes of biomechanics induced by Equistasi\u00ae in Parkinson\u2019s disease: Coupling between balance and lower limb joints kinematics","volume":"59","author":"Romanato","year":"2021","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S1474-4422(11)70067-9","article-title":"Postural deformities in Parkinson\u2019s disease","volume":"10","author":"Doherty","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1002\/mds.26081","article-title":"Effect of neurostimulation on camptocormia in Parkinson\u2019s disease depends on symptom duration","volume":"30","author":"Margraf","year":"2015","journal-title":"Mov. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Schulz-Schaeffer, W.J. (2016). Camptocormia in Parkinson\u2019s disease: A muscle disease due to dysregulated proprioceptive polysynaptic reflex arch. Front. Aging Neurosci., 8.","DOI":"10.3389\/fnagi.2016.00128"},{"key":"ref_31","unstructured":"Chatilow, L., and DeLany, J. (2002). Clinical Application of Neuromuscular Techniques: The Lower Body, Churchill Livingstone."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"143","DOI":"10.51507\/j.jams.2022.15.2.143","article-title":"Trigger point acupuncture and exercise for chronic low back pain in older adult: A preliminary randomized clinical trial","volume":"15","author":"Minakawa","year":"2022","journal-title":"J. Acupunct. Meridian Stud."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1177\/0269215511399476","article-title":"Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: A randomized controlled trial","volume":"25","year":"2011","journal-title":"Clin. Rehabil."},{"key":"ref_34","first-page":"467","article-title":"Feasibility and positive effects of scalp acupuncture for modulating motor and cerebral activity in Parkinson\u2019s disease: A pilot study","volume":"51","author":"Sun","year":"2022","journal-title":"NeuroRehabilitation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1111\/j.1755-5949.2012.00363.x","article-title":"Acupuncture Stimulation on GB 34 Activates Neural Responses Associated with P arkinson\u2019s Disease","volume":"18","author":"Yeo","year":"2012","journal-title":"CNS Neurosci. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1002\/mds.22673","article-title":"Parsing brain activity associated with acupuncture treatment in Parkinson\u2019s diseases","volume":"24","author":"Chae","year":"2009","journal-title":"Mov. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1186\/s12891-024-07649-x","article-title":"Association of MRI findings with paraspinal muscles fat infiltration at lower lumbar levels in patients with chronic low back pain: A multicenter prospective study","volume":"25","author":"Gu","year":"2024","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_38","first-page":"593","article-title":"Effect of electroacupuncture on lumbar disc herniation with different multifidus fatty infiltration rates","volume":"41","author":"Lv","year":"2021","journal-title":"Zhongguo Zhen Jiu = Chin. Acupunct. Moxibustion"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/jcsm.13123","article-title":"\u03b1-Synuclein aggregation causes muscle atrophy through neuromuscular junction degeneration","volume":"14","author":"Yang","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"100949","DOI":"10.1016\/j.imr.2023.100949","article-title":"Attenuation of skeletal muscle atrophy via acupuncture, electro-acupuncture, and electrical stimulation","volume":"12","author":"Symons","year":"2023","journal-title":"Integr. Med. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"894","DOI":"10.22246\/jikm.2023.44.5.894","article-title":"A Case Report of Scalp Acupuncture and Chuna Manual Therapy for a Patient with Idiopathic Parkinson\u2019s Disease with Walking Disorders due to Lower Extremity Rigidity","volume":"44","author":"Song","year":"2023","journal-title":"J. Intern. Korean Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1097\/00007632-199606010-00011","article-title":"Lumbar range of motion: Reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility","volume":"21","author":"Saur","year":"1996","journal-title":"Spine"},{"key":"ref_43","first-page":"14","article-title":"Effectiveness of moxibustion alone on lumbar disc herniation: A Meta-analysis of randomized controlled trials","volume":"43","author":"Yao","year":"2023","journal-title":"J. Tradit. Chin. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"112866","DOI":"10.1016\/j.biopha.2022.112866","article-title":"The potential applications of traditional Chinese medicine in Parkinson\u2019s disease: A new opportunity","volume":"149","author":"Chen","year":"2022","journal-title":"Biomed. Pharmacother."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.47391\/JPMA.6710","article-title":"Effects of conventional physical therapy with and without proprioceptive neuromuscular facilitation on balance, gait, and function in patients with Parkinson\u2019s disease","volume":"73","author":"Mazhar","year":"2023","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"102983","DOI":"10.1016\/j.ctim.2023.102983","article-title":"Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis","volume":"77","author":"Luan","year":"2023","journal-title":"Complement. Ther. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1152\/japplphysiol.00541.2020","article-title":"\u201cImposed\u201d and \u201cobtained\u201d ankle proprioception across the life span\u2014Commentary on Djajadikarta et al","volume":"129","author":"Han","year":"2020","journal-title":"J. Appl. Physiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3705\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:40:09Z","timestamp":1760031609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,25]]},"references-count":47,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113705"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113705","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,25]]}}}