Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease Accuracy of Fall Prediction in Parkinson Disease: Six-Month and 12-Month Prospective Analyses The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial. Clinical and posturographic correlates of falling in Parkinson's disease. Three simple clinical tests to accurately predict falls in people with Parkinson's disease. Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study Diagnosis of Fall Risk in Parkinson Disease: An Analysis of Individual and Collective Clinical Balance Test Interpretation Comparative Utility of the BESTest, Mini-BESTest, and Brief-BESTest for Predicting Falls in Individuals With Parkinson Disease: A Cohort Study Predicting Fallers in a Community-Based Sample of People with Parkinson’s Disease Validity of the Functional Gait Assessment in Patients With Parkinson Disease: Construct, Concurrent, and Predictive Validity An exercise intervention to prevent falls in people with Parkinson's disease: a pragmatic randomised controlled trial Effects of vibratory orthosis on balance in idiopathic Parkinson's disease External validation of a simple clinical tool used to predict falls in people with Parkinson disease. Virtual Reality–Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson’s Disease Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. Exercise therapy for prevention of falls in people with Parkinson's disease: A protocol for a randomised controlled trial and economic evaluation Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson’s Disease A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease The Effect of Balance Training on Postural Control in Patients with Parkinson's Disease Using a Virtual Rehabilitation System. Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s Compensatory stepping in Parkinson's disease is still a problem after deep brain stimulation randomized to STN or GPi. Technology-Assisted Balance and Gait Training Reduces Falls in Patients With Parkinson’s Disease
Background Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease ( PD ) . However , the accuracy for predicting falls on the basis of self-report measures has not been widely investigated . Objective The study objectives were : ( 1 ) to compare the accuracy of the  Activities-specific Balance Confidence Scale ( ABC )  and the  Falls Efficacy Scale – International ( FES-I )  with that of the  Berg Balance Scale  ( BBS ) , Dynamic Gait Index  ( DGI ) , Functional Reach Test ( FRT ) , and Timed “ Up & Go ” Test ( TUG ) for predicting recurrent falls in people with PD and ( 2 ) to explore the ability of combinations of up to 3 tests to predict recurrent falls . Design This was a prospect i ve cohort study involving 225 people with PD . Methods Participants were assessed with the  ABC , FES-I , BBS , FRT , TUG , and DGI . Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers . Areas under the receiver operating characteristic curves were determined , and the Akaike information criterion was used to select the best predictive model . Results Eighty-four participants ( 37.3 % ) were classified as recurrent fallers . Areas under the receiver operating characteristic curves for the ABC , FES-I , TUG , FRT , DGI , and BBS were 0.73 , 0.74 , 0.72 , 0.74 , 0.76 , and 0.79 , respectively . Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models , particularly the combination of the BBS with the FES-I. Limitations The lack of an external validation sample was a limitation of this study . Conclusions The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures , especially the FRT and the TUG . Two-test models showed performance similar to that of 3-test models , suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD . Specifically , the combination of the BBS with the FES-I may be considered Background The correct identification of patients with Parkinson disease ( PD ) at risk for falling is important to initiate appropriate treatment early . Objective This study compared the Fullerton Advanced Balance ( FAB ) scale with the Mini-Balance Evaluation Systems Test ( Mini-BESTest ) and Berg Balance Scale ( BBS ) to identify individuals with PD at risk for falls and to analyze which of the items of the scales best predict future falls . Design This was a prospect i ve study to assess predictive criterion-related validity . Setting The study was conducted at a university hospital in an urban community . Patients Eighty-five patients with idiopathic PD ( Hoehn and Yahr stages : 1–4 ) participated in the study . Measurements Measures were number of falls ( assessed prospect ively over 6 months ) , FAB scale , Mini-BESTest , BBS , and Unified Parkinson 's Disease Rating Scale . Results The FAB scale , Mini-BESTest , and BBS showed similar accuracy to predict future falls , with values for area under the curve ( AUC ) of the receiver operating characteristic ( ROC ) curve of 0.68 , 0.65 , and 0.69 , respectively . A model combining the items “ t and em stance , ” “ rise to toes , ” “ one-leg stance , ” “ compensatory stepping backward , ” “ turning , ” and “ placing alternate foot on stool ” had an AUC of 0.84 of the ROC curve . Limitations There was a dropout rate of 19/85 participants . Conclusions The FAB scale , Mini-BESTest , and BBS provide moderate capacity to predict “ fallers ” ( people with one or more falls ) from “ nonfallers . ” Only some items of the 3 scales contribute to the detection of future falls . Clinicians should particularly focus on the item “ t and em stance ” along with the items “ one-leg stance , ” “ rise to toes , ” “ compensatory stepping backward , ” “ turning 360 ° , ” and “ placing foot on stool ” when analyzing postural control deficits related to fall risk . Future research should analyze whether balance training including the aforementioned items is effective in reducing fall risk Introduction . We analyzed the ability of four balance assessment s to predict falls in people with Parkinson Disease ( PD ) prospect ively over six and 12 months . Material s and Methods . The BESTest , Mini-BESTest , Functional Gait Assessment ( FGA ) , and Berg Balance Scale ( BBS ) were administered to 80 participants with idiopathic PD at baseline . Falls were then tracked for 12 months . Ability of each test to predict falls at six and 12 months was assessed using ROC curves and likelihood ratios ( LR ) . Results . Twenty-seven percent of the sample had fallen at six months , and 32 % of the sample had fallen at 12 months . At six months , areas under the ROC curve ( AUC ) for the tests ranged from 0.8 ( FGA ) to 0.89 ( BESTest ) with LR+ of 3.4 ( FGA ) to 5.8 ( BESTest ) . At 12 months , AUCs ranged from 0.68 ( BESTest , BBS ) to 0.77 ( Mini-BESTest ) with LR+ of 1.8 ( BESTest ) to 2.4 ( BBS , FGA ) . Discussion . The various balance tests were effective in predicting falls at six months . All tests were relatively ineffective at 12 months . Conclusion . This pilot study suggests that people with PD should be assessed biannually for fall risk This r and omized controlled trial with blinded assessment aim ed to determine the effect of a 6-month minimally supervised exercise program on fall risk factors in people with Parkinson 's disease ( PD ) . Forty-eight participants with PD who had fallen or were at risk of falling were r and omized into exercise or control groups . The exercise group attended a monthly exercise class and exercised at home three times weekly . The intervention targeted leg muscle strength , balance , and freezing . The primary outcome measure was a PD falls risk score . The exercise group had no major adverse events and showed a greater improvement than the control group in the falls risk score , which was not statistically significant ( between group mean difference = -7 % , 95 % CI -20 to 5 , P = 0.26 ) . There were statistically significant improvements in the exercise group compared with the control group for two secondary outcomes : Freezing of Gait Question naire ( P = 0.03 ) and timed sit-to-st and ( P = 0.03 ) . There were statistically nonsignificant trends toward greater improvements in the exercise group for measures of muscle strength , walking , and fear of falling , but not for the measures of st and ing balance . Further investigation of the impact of exercise on falls in people with PD is warranted Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson 's disease ( IPD ) .  Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling . The purpose of this study was to determine the efficacy of clinical tests , balance scales , and  stable-platform posturography  in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort . Forty-eight PD subjects ( Hoehn & Yahr stage 1 - 3 ) and 17 age-matched controls had the following assessment s : Activities-specific Balance Confidence scale , Berg Balance Scale , Unified Parkinson 's Disease Rating Scale ( UPDRS ) ( motor ) , pull-test , timed up- and -go , static posturography , and dynamic posturography to assess multidirectional leaning balance . Of the clinical assessment s , all but the pull-test were closely correlated with a history of falling .  Static posturography  discriminated between PD fallers and controls but not between PD fallers and non-fallers , whereas  dynamic posturography ( reaction time , velocity , and target hit-time ) also discriminated between fallers and non-fallers . Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospect i ve assessment of falls risk in PD patients . A further prospect i ve study is now required to assess their predictive value . © 2013 Movement Disorder Society Falls are a major cause of morbidity in Parkinson 's disease ( PD ) . The objective of this study was to identify predictors of falls in PD and develop a simple prediction tool that would be useful in routine patient care . Potential predictor variables ( falls history , disease severity , cognition , leg muscle strength , balance , mobility , freezing of gait [ FOG ] , and fear of falling ) were collected for 205 community-dwelling people with PD .  Falls were monitored prospect ively for 6 months using monthly falls diaries . In total , 125 participants ( 59 % ) fell during follow-up . A model that included a history of falls , FOG , impaired postural sway , gait speed , sit-to-st and , st and ing balance with narrow base of support , and coordinated stability had high discrimination in identifying fallers ( area under the receiver-operating characteristic curve [ AUC ] , 0.83 ; 95 % confidence interval [ CI ] , 0.77 - 0.88 ) . A clinical tool that incorporated 3 predictors easily determined in a clinical setting ( falling in the previous year : odds ratio [ OR ] , 5.80 ; 95 % CI , 3.00 - 11.22 ; FOG in the past month : OR , 2.39 ; 95 % CI , 1.19 - 4.80 ; and self-selected gait speed < 1.1 meters per second : OR , 1.86 ; 95 % CI , 0.96 - 3.58 ) had similar discrimination ( AUC , 0.80 ; 95 % CI , 0.73 - 0.86 ) to the more complex model ( P = 0.14 for comparison of AUCs ) . The absolute probability of falling in the next 6 months for people with low , medium , and high risk using the simple , 3-test tool was 17 % , 51 % , and 85 % , respectively . In people who have PD without significant cognitive impairment , falls can be predicted with a high degree of accuracy using a simple , 3-test clinical tool . This tool enables individualized quantification of the risk of falling . © 2013 Movement Disorder Society Objectives : To accurately establish the incidence of falls in Parkinson 's disease ( PD ) and to investigate predictive risk factors for fallers from baseline data . Methods : 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data , disease specific rating scales , physiotherapy assessment , tests of visual , cardiovascular and autonomic function , and bone densitometry . Patients were then prospect ively followed up for one year using weekly prepaid postcards along with telephone follow up . Results : Falls occurred in 68.3 % of the subjects . Previous falls , disease duration , dementia , and loss of arm swing were independent predictors of falling . There were also significant associations between disease severity , balance impairment , depression , and falling . Conclusions : Falls are a common problem in PD and some of the major risk factors are potentially modifiable . There is a need for future studies to look at interventions to prevent falls in PD Background and Purpose : Parkinson disease ( PD ) results in an increased frequency of falls relative to the frequency in neurologically healthy people . The purpose of this study was to compare the accuracy of PD fall risk diagnosis based on one test with that based on the collective interpretation of multiple tests . Participants : Seventy people with PD ( mean age=73.91 years ) participated in this study . Method : Clinical balance tests were conducted during the initial examinations of people with PD .  Validity indices were calculated for individual tests and compared with validity indices calculated for a combination of multiple tests . Results : Thirty-six participants reported a fall history . Analysis of individual tests revealed broad variations in validity indices , whereas the collective interpretation of multiple tests improved sensitivity and negative likelihood ratios . Discussion and Conclusion : Collective interpretation of clinical balance tests result ed in fewer false-negative results and more substantial adjustments to the posttest probability of being a “ faller ” than the interpretation of one test alone . These results should be confirmed in a prospect i ve examination of fall risk in PD Background The newly developed Brief – Balance Evaluation System Test ( Brief-BESTest ) may be useful for measuring balance and predicting falls in individuals with Parkinson disease ( PD ) . Objectives The purpose s of this study were : ( 1 ) to describe the balance performance of those with PD using the Brief-BESTest , ( 2 ) to determine the relationships among the scores derived from the 3 versions of the BESTest ( ie , full BESTest , Mini-BESTest , and Brief-BESTest ) , and ( 3 ) to compare the accuracy of the Brief-BESTest with that of the Mini-BESTest and BESTest in identifying recurrent fallers among people with PD . Design This was a prospect i ve cohort study . Methods Eighty participants with PD completed a baseline balance assessment . All participants reported a fall history during the previous 6 months . Fall history was again collected 6 months ( n=51 ) and 12 months ( n=40 ) later . Results At baseline , participants had varying levels of balance impairment , and  Brief-BESTest scores were significantly correlated with  Mini-BESTest  ( r=.94 , P<.001 ) and  BESTest  ( r=.95 , P<.001 ) scores . Six-month retrospective fall prediction accuracy of the Brief-BESTest was moderately high ( area under the curve [AUC]=0.82 , sensitivity=0.76 , and specificity=0.84 ) . Prospect i ve fall prediction accuracy over 6 months was similarly accurate ( AUC=0.88 , sensitivity=0.71 , and specificity=0.87 ) , but was less sensitive over 12 months ( AUC=0.76 , sensitivity=0.53 , and specificity=0.93 ) . Limitations The sample included primarily individuals with mild to moderate PD . Also , there was a moderate dropout rate at 6 and 12 months . Conclusions All versions of the BESTest were reasonably accurate in identifying future recurrent fallers , especially during the 6 months following assessment . Clinicians can reasonably rely on the Brief-BESTest for predicting falls , particularly when time and equipment constraints are of concern Background : The risk of people with Parkinson ’s disease ( PD ) falling is greater than that of the general population but to date , disease-specific predictors of falling have not been identified . Objectives : To identify one or more features , which would predict individuals at risk of falling during a 3-month prospect i ve follow-up study . Method : A battery of st and ardised tests administered in the home and the laboratory with a 3-month follow-up telephone interview . Results : Sixty-three people with PD were recruited from GP practice s. Eleven interview variables and six gait laboratory variables were used with sub sample s ( 55 and 44 subjects , respectively ) to fit predictive models for identifying future fallers . The number of falls in the previous year was the most important variable , without exception , to be selected as a predictor in various logistic regression models . A history of two or more falls had a sensitivity of 86.4 % ( 95 % CI 67.3–96.2 % ) and a specificity of 85.7 % ( 95 % CI 71.2–94.2 % ) in predicting falling in the next 3 months . Conclusion : Healthcare workers should be asking their patients with PD regularly and carefully about falling , and should consider instigating programmes of fall management for patients with PD who have fallen two or more times in the previous 12 months Background The Functional Gait Assessment ( FGA ) is a vali date d measurement of gait-related activities in certain population s and may be potentially useful to assess balance and gait disorders in patients with Parkinson disease ( PD ) . Objective The purpose of this study was to determine the construct , concurrent , and predictive validity of the FGA in in patients with PD . Design This was a prospect i ve cohort study . Methods One hundred twenty-one in patients with PD were prospect ively enrolled . The FGA and other relevant appraisal s of gait , balance , disease severity , and activities of daily living were performed . Six months later , the patients were interviewed by telephone to have their fall information collected . Principal component analysis was used to determine construct validity . Spearman correlation coefficients were used to determine concurrent validity between the FGA and other measures . Cutoff point , sensitivity , specificity , and positive likelihood ratio were calculated for predictive validity based on the receiver operating characteristic curve . Results One common factor was extracted for construct validity , which cumulatively explained 64.0 % of the total variance . Correlation coefficients for the FGA compared with other measures ranged from .57 to .85 . The cutoff point for predicting falls was 18 , with sensitivity of 80.6 % , specificity of 80.0 % , and positive likelihood ratio of 4.03 . Limitations This study was limited by the length of time of follow-up and self-reports of falls without the requirement of a fall diary . Medication adjustment after the FGA evaluation may have led to a different cutoff score for identifying those patients who were at risk of falling . Conclusions The FGA demonstrated good construct validity in patients with PD . It had moderate to strong correlations with other balance and gait appraisal s. The FGA can be used to predict falls within the subsequent 6 months Objectives To compare the effectiveness of an exercise programme with usual care in people with Parkinson 's disease ( PD ) who have a history of falls . Design Pragmatic r and omised controlled trial . Setting Recruitment was from three primary and four secondary care organisations , and PD support groups in South West Engl and . The intervention was delivered in community setting s. Participants People with PD , with a history of two or more falls in the previous year , who were able to mobilise independently . Intervention 10 week , physiotherapy led , group delivered strength and balance training programme with supplementary home exercises ( intervention ) or usual care ( control ) . Main outcome measure Number of falls during the ( a ) 10 week intervention period and ( b ) the 10 week follow-up period . Results 130 people were recruited and r and omised ( 64 to the intervention ; 66 to usual care ) . Seven participants ( 5.4 % ) did not complete the study . The incidence rate ratio for falls was 0.68 ( 95 % CI 0.43 to 1.07 , p=0.10 ) during the intervention period and 0.74 ( 95 % CI 0.41 to 1.33 , p=0.31 ) during the follow-up period . Statistically significant between group differences were observed in Berg balance , Falls Efficacy Scale-International scores and recreational physical activity levels . Conclusions The study did not demonstrate a statistically significant between group difference in falls although the difference could be considered clinical ly significant . However , a type 2 error can not be ruled out . The findings from this trial add to the evidence base for physiotherapy and exercise in the management of people with PD . Trial registration IS RCT N50793425 Purpose . It was hypothesised that lumbar vibration stimulation applied by a vibratory orthosis improves balance in people with Parkinson 's disease ( PD ) . Methods . The overall stability index and the percent of elapsed time in different zones and quadrants on the platform of Biodex balance system were evaluated . General conditions of eyes-open and eyes-close , each with two situations of motors On and motors Off of vibratory orthosis were considered . Results . Balance in  PD patients improved in eyes-open condition rather than eyes-close . The balance also improved in eyes-open condition with motors On rather than that in motors Off . In eyes-close condition , balance was lesser in motors On than that in motors Off situation . The results also suggest that in PD patients , body trajectories on the platform of Biodex balance system follow a r and om-like chaotic behaviour . Conclusions . A new orthosis in rehabilitation of PD patients was introduced to enhance balance and decrease risk of fall . It promotes new ideas for rehabilitation of similar neurological diseases . The possibility of enhancing balance in PD patients in a short-term setting was evaluated . Results showed balance enhancement in PD patients in eyes-open condition . However , in eyes-close condition , we are not sure of its effectiveness BACKGROUND Assessment of fall risk in an individual with Parkinson disease ( PD ) is a critical yet often time consuming component of patient care . Recently a simple clinical prediction tool based only on fall history in the previous year , freezing of gait in the past month , and gait velocity < 1.1 m/s was developed and accurately predicted future falls in a sample of individuals with PD . METHODS We sought to externally vali date the utility of the tool by administering it to a different cohort of 171 individuals with PD .  Falls were monitored prospect ively for 6 months following predictor assessment . RESULTS The tool accurately discriminated future fallers from non-fallers ( area under the curve [ AUC ] = 0.83 ; 95 % CI 0.76 - 0.89 ) , comparable to the developmental study . CONCLUSION The results vali date d the utility of the tool for allowing clinicians to quickly and accurately identify an individual 's risk of an impending fall Background . Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson ’s disease ( PD ) . However , programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established . Objective . To examine the effects of virtual reality – based exercise on obstacle crossing performance and dynamic balance in participants with PD . Methods . Thirty-six participants with a diagnosis of PD ( Hoehn and Yahr score ranging 1 to 3 ) were r and omly assigned to one of three groups . In the exercise groups , participants received virtual reality – based Wii Fit exercise ( VRWii group ) or traditional exercise ( TE group ) for 45 minutes , followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks . Participants in the control group received no structured exercise program . Primary outcomes included obstacle crossing performance ( crossing velocity , stride length , and vertical toe obstacle clearance ) and dynamic balance ( maximal excursion , movement velocity , and directional control measured by the limits-of-stability test ) . Secondary outcomes included sensory organization test ( SOT ) , Parkinson ’s Disease Question naire ( PDQ39 ) , fall efficacy scale ( FES-I ) , and timed up and go test ( TUG ) . All outcomes were assessed at baseline , after training , and at 1-month follow-up . Results . The VRWii group showed greater improvement in obstacle crossing velocity , crossing stride length , dynamic balance , SOT , TUG , FES-I , and PDQ39 than the control group . VRWii training also result ed in greater improvement in movement velocity of limits-of-stability test than TE training . Conclusions . VRWii training significantly improved obstacle crossing performance and dynamic balance , supporting implementation of VRWii training in participants with PD OBJECTIVES To compare the practicality , reliability , validity , and responsiveness of the timed up and go ( TUG ) , one-leg st and ( OLS ) , functional reach ( FR ) , and Tinetti balance ( TB ) performance measures in people aged 65 and older . DESIGN A prospect i ve study . SETTING Shin-Sher Township of Taichung County , west- central Taiwan . PARTICIPANTS Twelve hundred community-dwelling older people . MEASUREMENTS During an initial assessment at their residences , participants were interviewed for demographics , cognition , fall history , use of a walking aid , and activities of daily living ( ADLs )  , in addition to completing the four balance tests . Falls were ascertained by telephone every 3 months for a 1-year follow-up ; the four balance measures and ADLs were also reassessed at the end of the follow-up year . RESULTS Of the four balance measures , the OLS had the lowest participation rate , and participation of people who were cognitively impaired had fallen in the previous year , used a walking aid , or suffered from an ADL disability was lower than for their counterparts . The time to complete the tests ranged from 58 seconds for OLS , to 160 seconds for the TB . All four balance measures exhibited excellent test-retest reliability and discriminant validity but poor responsiveness to fall status . The TB showed better discriminant , convergent , and predictive validities and responsiveness to ADL changes than the other three tests . CONCLUSION According to psychometric properties , the most suitable performance measure for evaluating balance in community-dwelling older people was the TB , followed by the TUG Background People with Parkinson 's disease are twice as likely to be recurrent fallers compared to other older people . As these falls have devastating consequences , there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson 's disease . The main objective of this r and omised controlled trial is to determine whether fall rates can be reduced in people with Parkinson 's disease using exercise targeting three potentially remediable risk factors for falls ( reduced balance , reduced leg muscle strength and freezing of gait ) . In addition we will establish the cost effectiveness of the exercise program from the health provider 's perspective . Methods / Design 230 community-dwelling participants with idiopathic Parkinson 's disease will be recruited . Eligible participants will also have a history of falls or be identified as being at risk of falls on assessment . Participants will be r and omly allocated to a usual-care control group or an intervention group which will undertake weight-bearing balance and strengthening exercises and use cueing strategies to address freezing of gait . The intervention group will choose between the home-based or support group-based mode of the program . Participants in both groups will receive st and ardized falls prevention advice . The primary outcome measure will be fall rates . Participants will record falls and medical interventions in a diary for the duration of the 6-month intervention period . Secondary measures include the Parkinson 's Disease Falls Risk Score , maximal leg muscle strength , st and ing balance , the Short Physical Performance Battery , freezing of gait , health and well being , habitual physical activity and positive and negative affect schedule . Discussion No adequately powered studies have investigated exercise interventions aim ed at reducing falls in people with Parkinson 's disease . This trial will determine the effectiveness of the exercise intervention in reducing falls and its cost effectiveness . This pragmatic program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12608000303347 ) Background . Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson ’s disease ( PD ) . However , there are inconsistent findings on the effects of balance and gait training on balance confidence . Objective . To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups . Methods . A total of 51 PD patients were r and omly assigned to a balance and gait training ( BAL ) group or to an active control ( CON ) group . The BAL group received balance and gait training with augmented feedback , whereas CON participants received lower-limb strength training for 12 weeks . Outcome measures included Activities-Specific Balance Confidence ( ABC ) Scale , limits-of-stability test , single-leg-stance test , and spatiotemporal gait characteristics . All tests were administered before intervention ( Pre ) , immediately after training ( Post ) , and at 3 months ( Post3 m ) and 12 months ( Post12 m ) after treatment completion . Results . The ABC score improved marginally at Post and significantly at Post3 m and Post12 m only in the BAL group ( P < .017 ) . Both participant groups increased their end point excursion at Post , but only the BAL group maintained the improvement at Post3 m . The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3 m and Post12 m ( P < .05 ) . For gait characteristics , both participant groups increased gait velocity , but only the BAL group increased stride length at Post , Post3 m , and Post12 m ( P < .017 ) . Conclusions . Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD Objective : To evaluate the effectiveness of a personalised home programme of exercises and strategies for repeat fallers with Parkinson ’s disease ( PD ) . Method : Patients with a confirmed diagnosis of idiopathic PD , independently mobile , living at home in the community , experiencing more than one fall in the previous 12 months and with intact gross cognitive function were invited to participate in this r and omised controlled trial . Usual care was compared with a personalised 6 week , home based exercise and strategy programme . The primary outcomes were rates of falling at 8 weeks and 6 months . Whether participants had repeat fallen , nearly fallen or experienced injurious falls were also examined . Functional Reach , the Berg Balance Test , PD Self- assessment Scale and the Euro Quol were rated by a blinded assessor . Results : Participants were r and omised to the exercise ( n = 70 ) and control ( n = 72 ) groups . There was a consistent trend towards lower fall rates in the exercise group at both 8 weeks and 6 months and lower rates of injurious falls needing medical attention at 6 months . Lower rates of repeat near falling were evident for the exercise group at 8 weeks ( p = 0.004 ) and 6 months ( p = 0.007 ) . There was a positive effect of exercises at 6 months on Functional Reach ( p = 0.009 ) and quality of life ( p = 0.033 ) . No significant differences were found on other secondary outcomes measures . Conclusion : There was a trend towards a reduction in fall events and injurious falls with a positive effect of exercises on near falls and quality of life OBJECTIVES Parkinson 's disease ( PD ) is a progressive neurodegenerative disorder characterized by motor clinical alterations among others . Postural problems have serious consequences for patients , not only limiting their daily life but also increasing some risks , like the risk of fall . Inadequate postural control and postural instability is a major problem in PD patients . A Virtual Motor Rehabilitation System ( VMR ) has been tested in patients with PD in the intervention period . Our purpose was to analyze the evolution of the spatial postural control during the intervention period , to see if there are any changes caused precisely by this intervention . METHODS Ten people with PD carried out 15 virtual rehabilitation sessions .  We tested a groundbreaking system based on Virtual Motor Rehabilitation in two periods of time ( baseline evaluation and final evaluation ) . In the training sessions , the participants performed a customizable treatment using a low-cost system , the Active Balance Rehabilitation system ( ABAR ) . We stored the pressure performed by the participants every five hundredths of a second , and we analyzed the patients ' pressure when they maintained their body on the left , on the right , and in the center in sitting position . Our system was able to measure postural control in every patient in each of the virtual rehabilitation sessions . RESULTS There are no significant differences in the performance of postural control in any of the positions evaluated throughout the sessions . Moreover , the results show a trend to an improvement in all positions . This improvement is especially remarkable in the left/right positions , which are the most important positions in order to avoid problems such as the risk of fall . With regard to the suitability of the ABAR system , we have found outst and ing results in enjoyment , success , clarity , and helpfulness . CONCLUSIONS Although PD is a progressive neurodegenerative disorder , the results demonstrate that patients with PD maintain or even improve their postural control in all positions . We think that the main factor influencing these results is that patients use more of their available cognitive processing to improve their postural control . The ABAR system allows us to make this assumption because the system requires the continuous attention of patients , promoting cognitive processing Objective To estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson ’s ( PwP ) . Methods People at risk of falls with confirmed Parkinson ’s were recruited to this multicentre , pragmatic , investigator blind , individually r and omised controlled trial with prespecified subgroup analyses . 474 PwP ( Hoehn and Yahr 1–4 ) were r and omised : 238 allocated to a physiotherapy programme and 236 to control .  All participants had routine care ; the control group received a DVD about Parkinson ’s and single advice session at trial completion . The intervention group ( PDSAFE ) had an individually tailored , progressive home-based fall avoidance strategy training programme with balance and strengthening exercises . The primary outcome was risk of repeat falling , collected by self-report monthly diaries , 0–6 months after r and omisation . Secondary outcomes included Mini-BESTest for balance , chair st and test , falls efficacy , freezing of gait , health-related quality of life ( EuroQol EQ-5D ) , Geriatric Depression Scale , Physical Activity Scale for the Elderly and Parkinson ’s Disease Question naire , fractures and rate of near falling . Results Average age is 72 years and 266 ( 56 % ) were men . By 6 months , 116 ( 55 % ) of the control group and 125 ( 61.5 % ) of the intervention group reported repeat falls ( controlled OR 1.21 , 95 % CI 0.74 to 1.98 , p=0.447 ) . Secondary subgroup analyses suggested a different response to the intervention between moderate and severe disease severity groups . Balance , falls efficacy and chair st and time improved with near falls reduced in the intervention arm . Conclusion PDSAFE did not reduce falling in this pragmatic trial of PwP. Other functional tasks improved and reduced fall rates were apparent among those with moderate disease . Trial registration number IS RCT N48152791 The effects of deep brain stimulation ( DBS ) on balance in people with Parkinson 's disease ( PD ) are not well established . This study examined whether DBS r and omized to the subthalamic nucleus ( STN ; n = 11 ) or globus pallidus interna ( GPi ; n = 10 ) improved compensatory stepping to recover balance after a perturbation . The st and ing surface translated backward , forcing subjects to take compensatory steps forward . Kinematic and kinetic responses were recorded . PD-DBS subjects were tested off and on their levodopa medication before bilateral DBS surgery and retested 6 mo later off and on DBS , combined with off and on levodopa medication . Responses were compared with PD-control subjects ( n = 8) tested over the same timescale and 17 healthy control subjects . Neither DBS nor levodopa improved the stepping response . Compensatory stepping in the best-treated state after surgery ( DBS+DOPA ) was similar to the best-treated state before surgery ( DOPA ) for the PD-GPi group and the PD-control group . For the PD-STN group , there were more lateral weight shifts , a delayed foot-off , and a greater number of steps required to recover balance in DBS+DOPA after surgery compared with DOPA before surgery . Within the STN group five subjects who did not fall during the experiment before surgery fell at least once after surgery , whereas the number of falls in the GPi and PD-control groups were unchanged . DBS did not improve the compensatory step response needed to recover from balance perturbations in the GPi group and caused delays in the preparation phase of the step in the STN group Objective . To examine the effects of technology-assisted balance and gait training on reducing falls in patients with Parkinson ’s disease ( PD ) . Methods . Eligible subjects were r and omly allocated to an experimental group given  technology-assisted balance and gait training ( BAL , n = 26 ) and an active control group undertaking strengthening exercises ( CON , n = 25 ) . The training in each group lasted for 3 months . The number of fallers and fall rate were used as primary outcomes , and single-leg-stance-time , latency of postural response to perturbation , self-selected gait velocity , and stride length as secondary outcomes . Fall incidence was recorded over 15 months after the baseline assessment ( Pre ) . Other tests were performed at Pre , after 3-month intervention ( Post3 m ) , at 3 months ( Post6 m ) , and 12 months ( Post15 m ) after treatment completion . Results . Forty-five subjects who completed the 3-month training were included in the data analysis . There were fewer fallers in the BAL than in the CON group at Post3 m , Post6 m , and Post15 m ( P < .05 ) . In addition , the BAL group had lower fall rate than the CON group at Post3 m and Post6 m ( incidence rate ratio : 0.111 - 0.188 , P < .05 ) , and marginally so at Post15 m ( incidence rate ratio : 0.407 , P = .057 ) . Compared with the CON subjects , the BAL subjects demonstrated greater reduction in the postural response latency and increase in the stride length against baseline at each assessment interval ( P < .05 ) , and marginally more increases of single-leg-stance-time at Post3 m ( P = .064 ) , Post6 m ( P = .041 ) and Post15 m ( P = .087 ) . Conclusions . Our positive findings provide evidence for the clinical use of technology-assisted balance and gait training in reducing falls in people with PD
These measures assess balance and falls risk prediction at the body , structure and function level , falls risk and balance , and falls risk at the activity level .
The motor examination of the Unified Parkinson ’s Disease Rating Scale ( UPDRS-ME ) with robust psychometric analysis is a condition-specific measure with acceptable properties .
Conclusion : Six of the 68 outcome measures have strong psychometric properties for the assessment of balance and falls risk prediction in PD .
Objective : To investigate the psychometric properties of measures of balance and falls risk prediction in people with Parkinson ’s disease ( PD ) .