Effects of Korean Medicine Treatment Including PALEX (Parkinson Alignment & Equilibrium eXercise) Delivered through Korean Medicine Doctor-Certified Exercise Specialist Collaboration on Motor Function in Parkinson’s Disease Patients: A Case Serie

Objectives: Parkinson’s disease (PD) is characterized by postural instability, gait disturbance, and left-right asymmetry, and axial motor symptoms often respond poorly to levodopa. We report the effects of PALEX (Parkinson Alignment & Equilibrium eXercise)-a Korean medicine doctor (KMD)-certified exercise specialist (CES) collaborative program targeting postural alignment and dynamic equilibrium-combined with Korean medicine treatment in three outpatients with PD.Case Presentation: Three outpatients with idiopathic PD (Hoehn and Yahr stage 2) received PALEX in combination with acupuncture and either herbal medicine or temporomandibular joint balancing therapy (TBT), depending on individual clinical presentation, for 4 weeks (8 sessions). In cases receiving TBT, PALEX was subsequently applied to consolidate passively restored alignment through active motor learning. The primary outcome was the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Parts I-III, and items 3.13 (posture) and 3.3 (rigidity) were analyzed as clinician-rated measures of alignment and rigidity. Secondary outcomes included the 10-Meter Walk Test (10MWT), Timed Up and Go (TUG) test, 360° turn test, and GAITRite® gait analysis.Results: MDS-UPDRS Part III scores decreased by 47.1% (case 1) and 54.1% (case 2), exceeding the minimal clinically important difference (3.25 points). All three cases showed consistent reductions in item 3.13 (1→0, 2→1, 2→1) and item 3.3 (4→2, 5→2, 5→1), indicating improvements in postural alignment and rigidity. Secondary outcomes improved consistently, with reductions in 10MWT time (-8.5% to -14.5%), TUG time (-6.8% to -14.8%), and 360° turn time (-5.6% to -23.1%), as well as increased gait velocity (+9.6% to +19.3%). No adverse events occurred during the 4-week intervention or the 1-month follow-up.Conclusions: PALEX combined with Korean medicine treatment may improve motor symptoms, postural alignment, and rigidity in outpatients with PD. The KMD-CES collaborative model offers a feasible passive-to-active sequencing approach within integrative PD care.