. 2022 May 9;9(5):594-603.

doi: 10.1002/mdc3.13460. eCollection 2022 Jul.

Task Force Consensus on Nosology and Cut-Off Values for Axial Postural Abnormalities in Parkinsonism

Michele Tinazzi¹, Christian Geroin¹, Roongroj Bhidayasiri^{2

3}, Bastiaan R Bloem⁴, Tamine Capato^{4

5}, Ruth Djaldetti⁶, Karen Doherty^{7

8}, Alfonso Fasano^{9

10

11}, Houyam Tibar¹², Leonardo Lopiano^{13

14}, Nils G Margraf¹⁵, Marcelo Merello¹⁶, Caroline Moreau¹⁷, Yoshikazu Ugawa¹⁸, Carlo Alberto Artusi^{13

14}; International Parkinson and Movement Disorders Society Task Force on Postural Abnormalities

Affiliations

¹ Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy.
² Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok Thailand.
³ The Academy of Science The Royal Society of Thailand Bangkok Thailand.
⁴ Department of Neurology Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior Nijmegen The Netherlands.
⁵ Department of Neurology, Movement Disorders Center University of São Paulo São Paulo Brazil.
⁶ Department of Neurology Rabin Medical Center; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel.
⁷ Department of Neurology Royal Victoria Hospital Belfast Ireland.
⁸ Centre for Medical Education Queens University Belfast Ireland.
⁹ Division of Neurology University of Toronto Toronto Ontario Canada.
¹⁰ Krembil Brain Institute Toronto Ontario Canada.
¹¹ Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman. Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada.
¹² Service de Neurologie B et de Neurogénétique Hôpital des spécialités OTO-Neuro-Ophtalmologique Ibn Sina University hospital, Medical school of Rabat, Mohamed 5 University of Rabat Rabat Morocco.
¹³ Department of Neuroscience "Rita Levi Montalcini" University of Turin Torino Italy.
¹⁴ Neurology 2 Unit A.O.U. Città della Salute e della Scienza di Torino Torino Italy.
¹⁵ Department of Neurology UKSH, Christian-Albrechts-University Kiel Germany.
¹⁶ Movement Disorders Service FLENI, CONICET Buenos Aires Argentina.
¹⁷ Expert center for Parkinson's disease, Neurological department, Inserm UMR 1171 Lille University Hospital Lille France.
¹⁸ Department of Human Neurophysiology, School of Medicine Fukushima Medical University Fukushima Japan.

PMID: 35844289
PMCID: PMC9274349
DOI: 10.1002/mdc3.13460

Task Force Consensus on Nosology and Cut-Off Values for Axial Postural Abnormalities in Parkinsonism

Michele Tinazzi et al. Mov Disord Clin Pract. 2022.

. 2022 May 9;9(5):594-603.

doi: 10.1002/mdc3.13460. eCollection 2022 Jul.

Authors

Affiliations

¹ Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy.
² Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok Thailand.
³ The Academy of Science The Royal Society of Thailand Bangkok Thailand.
⁴ Department of Neurology Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior Nijmegen The Netherlands.
⁵ Department of Neurology, Movement Disorders Center University of São Paulo São Paulo Brazil.
⁶ Department of Neurology Rabin Medical Center; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel.
⁷ Department of Neurology Royal Victoria Hospital Belfast Ireland.
⁸ Centre for Medical Education Queens University Belfast Ireland.
⁹ Division of Neurology University of Toronto Toronto Ontario Canada.
¹⁰ Krembil Brain Institute Toronto Ontario Canada.
¹¹ Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman. Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada.
¹² Service de Neurologie B et de Neurogénétique Hôpital des spécialités OTO-Neuro-Ophtalmologique Ibn Sina University hospital, Medical school of Rabat, Mohamed 5 University of Rabat Rabat Morocco.
¹³ Department of Neuroscience "Rita Levi Montalcini" University of Turin Torino Italy.
¹⁴ Neurology 2 Unit A.O.U. Città della Salute e della Scienza di Torino Torino Italy.
¹⁵ Department of Neurology UKSH, Christian-Albrechts-University Kiel Germany.
¹⁶ Movement Disorders Service FLENI, CONICET Buenos Aires Argentina.
¹⁷ Expert center for Parkinson's disease, Neurological department, Inserm UMR 1171 Lille University Hospital Lille France.
¹⁸ Department of Human Neurophysiology, School of Medicine Fukushima Medical University Fukushima Japan.

PMID: 35844289
PMCID: PMC9274349
DOI: 10.1002/mdc3.13460

Abstract

Background: There is no consensus with regard to the nosology and cut-off values for postural abnormalities in parkinsonism.

Objective: To reach a consensus regarding the nosology and cut-off values.

Methods: Using a modified Delphi panel method, multiple rounds of questionnaires were conducted by movement disorder experts to define nosology and cut-offs of postural abnormalities.

Results: After separating axial from appendicular postural deformities, a full agreement was found for the following terms and cut-offs: camptocormia, with thoracic fulcrum (>45°) or lumbar fulcrum (>30°), Pisa syndrome (>10°), and antecollis (>45°). "Anterior trunk flexion," with thoracic (≥25° to ≤45°) or lumbar fulcrum (>15° to ≤30°), "lateral trunk flexion" (≥5° to ≤10°), and "anterior neck flexion" (>35° to ≤45°) were chosen for milder postural abnormalities.

Conclusions: For axial postural abnormalities, we recommend the use of proposed cut-offs and six unique terms, namely camptocormia, Pisa syndrome, antecollis, anterior trunk flexion, lateral trunk flexion, anterior neck flexion, to harmonize clinical practice and future research.

Keywords: Parkinson's disease; Pisa syndrome; antecollis; atypical parkinsonisms; camptocormia; diagnostic criteria.; postural abnormalities.

PubMed Disclaimer

Figures

**FIG 2**
Pictures of patients with PD presenting a variable degree of lateral trunk flexion, measured according to the perpendicular method (bottom line).

**FIG 3**
Pictures of patients with PD presenting a variable degree of anterior trunk flexion (thoracic fulcrum), measured according to the upper method (bottom line).

**FIG 4**
Pictures of patients with PD presenting a variable degree of anterior trunk flexion (lumbar fulcrum), measured according to the malleolus method (bottom line).

**FIG 5**
Pictures of patients with PD presenting a variable degree of anterior neck flexion, measured according to the perpendicular method (bottom line).

See this image and copyright information in PMC

Cited by

Reply: "Human Pose Estimation Is Approximate: Limitations and Considerations for its Use in Clinical Trials".
Artusi CA, Geroin C, Camozzi S, Aldegheri S, Bombieri N. Artusi CA, et al. Mov Disord Clin Pract. 2025 Aug;12(8):1216-1217. doi: 10.1002/mdc3.70075. Epub 2025 Apr 12. Mov Disord Clin Pract. 2025. PMID: 40219769 Free PMC article. No abstract available.
[Numerical expression of the clinical course of the disease. Data management].
Talavera JO, Roy-García I, Díaz-Torres ST, Palacios-Cruz L, Noguez-Ramos A, Pérez-Rodríguez M, Martínez MÁ, Silva-Guzmán JE, Rivas-Ruiz R. Talavera JO, et al. Rev Med Inst Mex Seguro Soc. 2023 Oct 2;61(Suppl 3):S503-S509. doi: 10.5281/zenodo.8319834. Rev Med Inst Mex Seguro Soc. 2023. PMID: 37935026 Free PMC article. Spanish.
Spinal cord stimulation for postural abnormalities in Parkinson's disease: 1-year prospective pilot study.
Zhou L, Chen F, Pan Y, Wang L, Xu L, Huang P, Wang L, Luo N, Li P, Li D, Liu J. Zhou L, et al. BMC Neurol. 2024 May 21;24(1):167. doi: 10.1186/s12883-024-03673-5. BMC Neurol. 2024. PMID: 38773417 Free PMC article.
Botulinum Toxin for Axial Postural Abnormalities in Parkinson's Disease: A Systematic Review.
Gandolfi M, Artusi CA, Imbalzano G, Camozzi S, Crestani M, Lopiano L, Tinazzi M, Geroin C. Gandolfi M, et al. Toxins (Basel). 2024 May 15;16(5):228. doi: 10.3390/toxins16050228. Toxins (Basel). 2024. PMID: 38787080 Free PMC article.
Five functional domains associated with gait performance in Parkinson's disease and lateral trunk flexion.
Ota K, Mani H, Nochimura K, Nakashiro Y, Hamada S, Moriwaka F. Ota K, et al. Front Neurol. 2025 Apr 8;16:1541970. doi: 10.3389/fneur.2025.1541970. eCollection 2025. Front Neurol. 2025. PMID: 40264652 Free PMC article.

See all "Cited by" articles

References

1. Tinazzi M, Gandolfi M, Ceravolo R, et al. Postural abnormalities in Parkinson's disease: an epidemiological and clinical multicenter study. Mov Disord Clin Pract 2019;6:576–585. - PMC - PubMed
1. Doherty KM, van de Warrenburg BP, Peralta MC, Silveira‐Moriyama L, Azulay JP, Gershanik OS, Bloem BR. Postural deformities in Parkinson's disease. Lancet Neurol 2011;10:538–549. - PubMed
1. Barone P, Santangelo G, Amboni M, Pellecchia MT, Vitale C. Pisa syndrome in Parkinson's disease and parkinsonism: clinical features, pathophysiology, and treatment. Lancet Neurol 2016;15:1063–1074. - PubMed
1. Margraf NG, Granert O, Hampel J, Wrede A, Schulz‐Schaeffer WJ, Deuschl G. Clinical definition of camptocormia in Parkinson's disease. Mov Disord Clin Pract 2017;4:349–357. - PMC - PubMed
1. Geroin C, Artusi CA, Gandolfi M, et al. Does the degree of trunk bending predict patient disability, motor impairment, falls, and back pain in Parkinson's disease? Front Neurol 2020;11:207. - PMC - PubMed

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Task Force Consensus on Nosology and Cut-Off Values for Axial Postural Abnormalities in Parkinsonism

Affiliations

Task Force Consensus on Nosology and Cut-Off Values for Axial Postural Abnormalities in Parkinsonism

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources

Abstract

Figures

Similar articles

Cited by

References

Related information

LinkOut - more resources

Full Text Sources