Clinical and posturographic correlates of falling in Parkinson's disease. Balance versus resistance training on postural control in patients with Parkinson's disease: a randomized controlled trial. The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease Improved asymmetry of gait in Parkinson's disease with DBS: gait and postural instability in Parkinson's disease treated with bilateral deep brain stimulation in the subthalamic nucleus. Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial Effect of Balance Training on Postural Instability in Patients With Idiopathic Parkinson’s Disease Instrumented Test of Sensory Integration for Balance: A Validation Study Influence of Perturbation Velocity on Balance Control in Parkinson’s Disease Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial. The effect of deep brain stimulation randomized by site on balance in Parkinson's disease. PPNa-DBS for gait and balance disorders in Parkinson’s disease: a double-blind, randomised study Three simple clinical tests to accurately predict falls in people with Parkinson's disease. The Effect of Balance Training on Postural Control in Patients with Parkinson's Disease Using a Virtual Rehabilitation System. Validity of the Functional Gait Assessment in Patients With Parkinson Disease: Construct, Concurrent, and Predictive Validity Effect of partial weight-supported treadmill gait training on balance in patients with Parkinson disease. Clinical impact of gait training enhanced with visual kinematic biofeedback: Patients with Parkinson’s disease and patients stable post stroke Working on asymmetry in Parkinson’s disease: randomized, controlled pilot study Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson’s disease Effects of vibratory orthosis on balance in idiopathic Parkinson's disease Concurrent transcranial direct current stimulation and progressive resistance training in Parkinson’s disease: study protocol for a randomised controlled trial A comparison of Irish set dancing and exercises for people with Parkinson’s disease: A phase II feasibility study Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease Technology-Assisted Balance and Gait Training Reduces Falls in Patients With Parkinson’s Disease
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 BACKGROUND Evidence s have shown that physiotherapy programs may improve the balance of individuals with Parkinson 's disease ( PD ) , although it is not clear which specific exercise program is better . AIM The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients . DESIGN R and omized controlled trial . SETTING The study was conducted in a physiotherapy outpatient clinic of a university hospital . POPULATION A total of 40 PD participants were r and omly divided into two groups : balance training ( BT ) and resistance training ( RT ) . METHODS The BT group focused on balance training , functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk , both supervised by trained physiotherapists . Therapy sessions were held twice a week ( at 60 minutes ) , totaling 24 sessions . The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test ( BESTest ) scale to determine the effects of the intervention on postural control . RESULTS Significant improvement of postural control ( pre vs. post 15.1 vs. 9.6 cm2 ) was only reported in favor of BT group ( d=1.17 ) for one-legged st and condition on force platform . The st and ardized mean difference between groups was significantly ( P<0.02 ) , with 36 % of improvement for BT vs. 0.07 % for RT on this condition . Significant improvement ( P<0.05 ) was also observed in favor of BT ( in mean 3.2 % ) for balance gains in some BESTest scores , when compared to RT group ( -0.98 % ) . CONCLUSIONS Postural control in Parkinson 's disease is improved when training by a directional and specific balance program than a resistance training program . CLINICAL REHABILITATION IMPACT Balance training is superior to resistance training in regard to improving postural control of individuals with PD . Gold st and ard instruments ( high in cost and difficult to access ) were used to assess balance , as well as scales with clinical applicability ( low cost , easily acceptable , applicable and valid ) , which can guide the management of physiotherapists both in their decision-making and in clinical practice Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability , dynamic balance and fear of falling in patients with idiopathic Parkinson 's disease . Design : R and omized controlled trial . Setting : Ankara Education and Research Hospital , 2nd PM&R Clinic , Cardiopulmonary Rehabilitation Unit . Subjects : Fifty-four patients with idiopathic Parkinson 's disease in stage 2 or 3 of the Hoehn Yahr staging entered , and 31 patients ( 21 training , 10 control ) had outcome data . Interventions : Postural instability of patients with Parkinson 's disease was assessed using the motor component of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale .  Twenty-one patients with Parkinson 's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training . Before and after the training programme , balance , gait , fear of falling and walking distance and speed on treadmill were assessed in both Parkinson 's disease groups . Main measures : Walking distance and speed on treadmill , UPDRS , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale . Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session ( P < 0.001 ) . Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h ( P < 0.001 ) . Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme ( P < 0.01 ) . There was no significant improvement in any of the outcome measurements in the control group ( P > 0.05 ) . Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility , reduce postural instability and fear of falling in patients with Parkinson 's disease Postural instability is a sign of progression of Parkinson 's disease ( PD ) and often resistant to levodopa treatment . To explore the effect of bilateral deep brain stimulation ( DBS ) of the subthalamic nucleus ( STN ) on postural stability and gait , full body gait analyses were performed without medication , OFF and ON DBS in eight PD patients and 12 healthy age-matched controls . DBS setting was changed at least 3 hours before gait analysis . To describe asymmetry most and least affected sides ( MAS and LAS ) were rated with the Unified Parkinson 's Disease Rating Scale , motor part and quantitative gait analysis with the Vicon 612 gait analysis system . Stride length and gait velocity but not cadence improved ON DBS . The distances between the heel markers and center of mass ( COM ) were asymmetric and reduced OFF DBS . STN DBS  increased the distances significantly and reduced asymmetry . The improvement in heel to COM distance was larger on the MAS compared with the LAS . OFF DBS knee momentum asymmetry was inversed so that LAS was more impaired than MAS . ON DBS asymmetry improved . PD patients OFF  DBS place the heel too close to COM . The most affected body side has the most impaired swing and the result is a smaller knee moment on the opposite and least affected body side and an asymmetric gait pattern with disturbed balance OFF STN DBS . The asymmetry OFF DBS improved ON DBS . We suggest that DBS facilitates symmetric gait and thereby improves balance during gait Introduction Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes . Home-based virtual reality ( VR ) balance training has been shown to reduce postural instability in patients with Parkinson 's disease ( PD ) . The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training ( SIBT ) . Methods In this multicenter study , 76 PD patients ( modified Hoehn and Yahr stages 2.5–3 ) were r and omly assigned to receive either in-home VR telerehabilitation ( n = 38 ) or in-clinic SIBT ( n = 38 ) in 21 sessions of 50 minutes each , 3 days/week for 7 consecutive weeks . VR telerehabilitation consisted of grade d exergames using the Nintendo Wii Fit system ; SIBT included exercises to improve postural stability . Patients were evaluated before treatment , after treatment , and at 1-month follow-up . Results Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group ( p = 0.04 ) and significant Time × Group interactions in the Dynamic Gait Index ( p = 0.04 ) for the in-clinic group . Both groups showed differences in all outcome measures over time , except for fall frequency . Cost comparison yielded between-group differences in treatment and equipment costs . Conclusions VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver Background . Postural instability ( PI ) is a disabling sign of Parkinson ’s disease ( PD ) not easily amenable to treatment with medication . Objective . To evaluate the effects of balance training on PI in patients with PD . Methods . A total of 64 patients with PI were r and omly assigned to the experimental group ( n = 33 ) for balance training or to the control group ( n = 31 ) for general physical exercises . Each patient received 21 treatment sessions of 50 minutes each . Patients were evaluated by a blinded rater before and after treatment as well as 1 month posttreatment using the Berg Balance Scale ( BBS ) , Activities-Specific Balance Confidence Scale ( ABC ) , postural transfer test , self-destabilization of the center of foot pressure test , number of falls , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , modified Hoehn and Yahr ( H&Y ) Staging Scale , and Geriatric Depression Scale ( GDS ) . Results .At the end of treatment , the experimental group showed significant improvements in all outcome measures , except for the UPDRS and the H&Y scale . Improvement was maintained at the 1-month follow-up in all outcome measures except for the GDS . No significant changes in performance were observed in the control group . Conclusions . A program of balance training can improve PI in patients with PD Background and Purpose : Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment . Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative . This is the first study to compare the modified Clinical Test of Sensory Integration for Balance ( i-mCTSIB ) to the laboratory test of the Sensory Organization Test ( SOT ) with dynamic posturography in a group of participants with Parkinson 's disease ( PD ) and subtle balance limitations . The purpose of this study was to ( 1 ) determine the concurrent validity of the i-mCTSIB with the SOT ( 6 and 4 conditions ) and ( 2 ) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months . Methods : This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson 's Disease Rating Scale score of 32.7 ( 13.5 ) out of 108 . Results : The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated : composite scores r = −0.64 ( P ⩽ .001 ) , C1 r = −0.43 ( P = .03 ) , C3 r = −0.60 ( P ⩽ .01 ) , and C4 r = −0.54 ( P ⩽ .001 ) . A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers ( P = .04 ) . In contrast , the SOT composite was not significantly different between fallers and nonfallers ( P = 0.31 ) . Discussion : The results suggest that the i-mCTSIB may be a valid and clinical ly meaningful measure of sensory organization in persons with PD , even those with mild postural instability as measured by the median Hoehn and Yahr score ( 2.0 ) . Future research should evaluate predictive validity of the i-mCTSIB for prospect i ve falls . Conclusion : The instrumented mCTSIB with portable , body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT . Instrumenting mCTSIB may also distinguish between fallers and nonfallers Underlying somatosensory processing deficits of joint rotation velocities may cause patients with Parkinson ’s disease ( PD ) to be more unstable for fast rather than slow balance perturbations . Such deficits could lead to reduced proprioceptive amplitude feedback triggered by perturbations , and thereby to smaller or delayed stabilizing postural responses . For this reason , we investigated whether support surface perturbation velocity affects balance reactions in PD patients . We examined postural responses of seven PD patients ( OFF medication ) and eight age-matched controls following backward rotations of a support-surface platform . Rotations occurred at three different speeds : fast ( 60 deg/s ) , medium ( 30 deg/s ) or slow ( 3.8 deg/s ) , presented in r and om order . Each subject completed the protocol under eyes open and closed conditions . Full body kinematics , ankle torques and the number of near-falls were recorded . Patients were significantly more unstable than controls following fast perturbations ( 26 % larger displacements of the body ’s centre of mass ; P<0.01 ) , but not following slow perturbations . Also , more near-falls occurred in patients for fast rotations . Balance correcting ankle torques were weaker for patients than controls on the most affected side , but were stronger than controls for the least affected side . These differences were present both with eyes open and eyes closed ( P<0.01 ) . Fast support surface rotations caused greater instability and discriminated Parkinson patients better from controls than slow rotations . Although ankle torques on the most affected side were weaker , patients partially compensated for this by generating larger than normal stabilizing torques about the ankle joint on the least affected side . Without this compensation , instability may have been greater BACKGROUND Treadmill training ( with or without robotic assistance ) has been reported to improve balance skills in patients with Parkinson 's disease ( PD ) . However , its effectiveness on postural instability has been evaluated mainly in patients with mild to moderate PD ( Hoehn & Yahr stage ≤3 ) . Patients with more severe disease may benefit from robot-assisted gait training performed by the Gait-Trainer GT1 , as a harness supports them with their feet placed on motor-driven footplates . The aim of this study was to determine whether robot-assisted gait training could have a positive influence on postural stability in patients with PD at Hoehn & Yahr stage 3 - 4 . METHODS Thirty-four patients with PD at Hoehn & Yahr stage 3 - 4 were r and omly assigned into two groups . All patients received twelve , 40-min treatment sessions , three days/week , for four consecutive weeks . The Robotic Training group ( n = 17 ) underwent robot-assisted gait training , while the Physical Therapy group ( n = 17 ) underwent a training program not specifically aim ed at improving postural stability . Patients were evaluated before , immediately after and 1-month post-treatment . Primary outcomes were : Berg Balance scale ; Nutt 's rating . RESULTS A significant improvement was found after treatment on the Berg Balance Scale and the Nutt 's rating in favor of the Robotic Training group ( Berg : 43.44 ± 2.73 ; Nutt : 1.38 ± 0.50 ) compared to the Physical Therapy group ( Berg : 37.27 ± 5.68 ; Nutt : 2.07 ± 0.59 ) . All improvements were maintained at the 1-month follow-up evaluation . CONCLUSIONS Robot-assisted gait training may improve postural instability in patients with PD at Hoehn & Yahr stage 3 - 4 BACKGROUND The effect of the surgical site of DBS on balance and gait in Parkinson 's Disease ( PD ) is uncertain . This is the first double-blind study of subjects r and omized to either the STN ( N = 14 ) or GPi ( N = 14 ) who were assessed on a range of clinical balance measures . METHODS Balance testing occurred before and 6 months postsurgery . A control PD group was tested over the same period without surgery ( N = 9 ) . All subjects were tested on and off medication and DBS subjects were also tested on and off DBS . The Postural Instability and Gait Disability items of the UPDRS and additional functional tests , which we call the Balance and Gait scale , were assessed . Activities of Balance Confidence and Activities of Daily Living question naires were also recorded . RESULTS Balance was not different between the best-treated states before and after DBS surgery for both sites . Switching DBS on improved balance scores , and scores further improved with medication , compared to the off state . The GPi group showed improved performance in the postsurgery off state and better ratings of balance confidence after surgery , compared to the STN group . CONCLUSIONS Clinical measures of balance function for both the STN and GPi sites showed that balance did not improve beyond the best medically treated state before surgery . Both clinical balance testing in the off/off state and self-reported balance confidence after surgery showed better performance in the GPi than the STN group Gait and balance disorders are the major source of motor disabilities in advanced forms of Parkinson ’s disease ( PD ) .  Low-frequency stimulation of the pedunculopontine nucleus area ( PPNa-DBS ) has been recently proposed to treat these symptoms with variable clinical results . To further underst and the effects of PPNa-DBS on resistant gait and balance disorders , we performed a r and omised double-blind cross-over study in six PD patients . Evaluation included clinical assessment of parkinsonian disability , quality of life and neurophysiological recordings of gait . Evaluations were done 1 month before , 4 and 6 months after surgery with four double-blinded conditions assessed : with and without PPNa-DBS , with and without levodopa treatment .  Four patients completed the study and two patients were excluded from the final analysis because of peri-operative adverse events ( haematoma , infection ) . Clinical ly , the combination of PPNa-DBS and levodopa treatment produced a significant decrease of the freezing episodes . The frequency of falls also decreased in three out of four patients . From a neurophysiological point of view , PPNa-DBS significantly improved the anticipatory postural adjustments and double-stance duration , but not the length and speed of the first step . Interestingly , step length and speed improved after surgery without PPNa-DBS , suggesting that the lesioning effect of PPNa-DBS surgery alleviates parkinsonian akinesia . Quality of life was also significantly improved with PPNa-DBS . These results suggest that PPNa-DBS could improve gait and balance disorders in well-selected PD patients . However , this treatment may be riskier than others DBS surgeries in these patients with an advanced form of PD 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 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 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 OBJECTIVE To investigate the role of conventional gait training and partial weight-supported treadmill gait training ( PWSTT ) in improving the balance of patients with Parkinson disease ( PD ) . DESIGN Prospect i ve r and omized controlled design . SETTING National-level university tertiary hospital for mental health and neurosciences . PATIENTS Sixty patients with PD fulfilling the United Kingdom Brain Bank PD diagnostic criteria were recruited from the neurology outpatient department and movement disorder clinic . METHODOLOGY The patients were r and omly assigned into 3 equal groups : ( 1 ) a control group that only received a stable dosage of dopaminomimetic drugs ; ( 2 ) a conventional gait training ( CGT ) group that received a stable dosage of dopaminomimetic drugs and conventional gait training ; and ( 3 ) a PWSTT group that received a stable dosage of dopaminomimetic drugs and PWSTT with unloading of 20 % of body weight . The sessions for the CGT and PWSTT groups were provided for 30 minutes per day , 4 days per week , for 4 weeks ( 16 sessions ) . OUTCOME MEASURES The Unified Parkinson Disease Rating Scale ( UPDRS ) motor score , dynamic posturography , Berg Balance Scale , and Tinetti performance-oriented mobility assessment ( POMA ) were used as main outcome measures . RESULTS A significant interaction effect was observed in the UPDRS motor score , mediolateral index , Berg Balance Scale , limits of stability ( LOS ) total score , POMA gait score , and balance score . Post-hoc analysis showed that in comparison with the control group , the PWSTT group had a significantly better UPDRS motor score , balance indices , LOS in 8 directions , POMA gait , and balance score . The CGT group had a significantly better POMA gait score compared with control subjects . Compared with the CGT group , the PWSTT group had a significantly better UPDRS motor score , mediolateral index , POMA gait score , and LOS total score . CONCLUSION PWSTT may be a better interventional choice than CGT for gait and balance rehabilitation in patients with PD As the world 's population ages , falls , physical inactivity , decreased attention and impairments in balance and gait arise as a consequence of decreased sensation , weakness , trauma and degenerative disease . Progressive balance and gait training can facilitate postural righting , safe ambulation and community participation . This small r and omized clinical trial evaluated if visual and kinematic feedback provided during supervised gait training would interfere or enhance mobility , endurance , balance , strength and flexibility in older individuals greater than one year post stroke ( Gobbi et al. , 2009 ) or Parkinson 's disease ( PD ) ( Gobbi et al. , 2009 ) . Twenty-four individuals consented to participate . The participants were stratified by diagnosis and r and omly assigned to a control ( usual gait training ( Gobbi et al. , 2009 ) ) or an experimental group ( usual gait training plus kinematic feedback ( Gobbi et al. , 2009 ) ) . At baseline and 6 weeks post training ( 18 h ) , subjects completed st and ardized tests ( mobility , balance , strength , range of motion ) . Gains were described across all subjects , by treatment group and by diagnosis . Then they were compared for significance using nonparametric statistics . Twenty-three subjects completed the study with no adverse events . Across all subjects , by diagnosis ( stroke and PD ) and by training group ( control and experimental ) , there were significant gains in mobility ( gait speed , step length , endurance , and quality ) , balance ( Berg Balance ) , range of motion and strength . There were no significant differences in the gain scores between the control and experimental groups . Subjects chronic post stroke made greater strength gains on the affected side than subjects with PD but otherwise there were no significant differences . In summary , during supervised gait training , dynamic visual kinematic feedback from wireless pressure and motion sensors had similar , positive effects as verbal , therapist feedback . A wireless kinematic feedback system could be used at home , to provide feedback and motivation for self correction of gait while simultaneously providing data to the therapist ( at a distance ) Abstract Posture , gait and balance problems are very disabling symptoms in Parkinson ’s disease ( PD ) . An increased stride-to-stri de variability , reduction of automaticity and asymmetry of lower limbs function characterize parkinsonian gait . These features predispose to freezing of gait ( FOG ) , which often leads to falls . The aim of this study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and reduce FOG , thus preventing falls .  Twenty-eight PD patients entered a double-blind pilot feasibility controlled study and were evaluated at baseline and after 3 months of a rehabilitative program ( performed twice a week ) by means of the motor part of the Unified Parkinson ’s Disease Rating Scale ( UPDRS-III ) , Gait and Falls Question naire , Tinetti balance and gait scale , Short Physical Performance Battery ( SPPB ) , European Quality of Life question naire . Patients were r and omly assigned to three treatment arms : ( 1 ) worst side improvement ; ( 2 ) best side improvement ; ( 3 ) st and ard therapy . All study arms showed a significant improvement of the Tinetti and SPPB scores . BSI led to a greater improvement than ST in terms of UPDRS-III ( p = 0.01 ) ; Tinetti total score ( p = 0.05 ) and Tinetti gait subscore ( p = 0.01 ) . Our study confirms the efficacy of physical therapy in the treatment of PD and , more importantly , suggests that specific intervention tailored on individual feature ( e.g. , asymmetry of motor condition ) might be even more effective than st and ard rehabilitative programs Background : Impaired postural stability places individuals with Parkinson ’s at an increased risk for falls . Given the high incidence of fall-related injuries within this population , ongoing assessment of postural stability is important . Objective : To evaluate the validity of the Nintendo Wii ® balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson ’s . Subjects : Twenty individuals with Parkinson ’s participated . Intervention : Subjects completed testing on two balance tasks with eyes open and closed on a Wii ® balance board and biomechanical force platform . Main Measures : Bl and –Altman plots and a two-way , r and om-effects , single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data . Results : Concurrent validity was demonstrated to be excellent across balance tasks ( intraclass correlation coefficients = 0.96 , 0.98 , 0.92 , 0.94 ) . Conclusions : This study suggests that the Wii ® balance board is a valid tool for the quantification of postural stability among individuals with Parkinson ’s 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 Parkinson ’s disease ( PD ) results from a loss of dopamine in the brain , leading to movement dysfunctions such as bradykinesia , postural instability , resting tremor and muscle rigidity . Furthermore , dopamine deficiency in PD has been shown to result in maladaptive plasticity of the primary motor cortex ( M1 ) . Progressive resistance training ( PRT ) is a popular intervention in PD that improves muscular strength and results in clinical ly significant improvements on the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) . In separate studies , the application of anodal transcranial direct current stimulation ( a-tDCS ) to the M1 has been shown to improve motor function in PD ; however , the combined use of tDCS and PRT has not been investigated . Methods / design We propose a 6-week , double-blind r and omised controlled trial combining M1 tDCS and PRT of the lower body in participants ( n = 42 ) with moderate PD ( Hoehn and Yahr scale score 2–4 ) . Supervised lower body PRT combined with functional balance tasks will be performed three times per week with concurrent a-tDCS delivered at 2 mA for 20 minutes ( a-tDCS group ) or with sham tDCS ( sham group ) . Control participants will receive st and ard care ( control group ) . Outcome measures will include functional strength , gait speed and variability , balance , neurophysiological function at rest and during movement execution , and the UPDRS motor subscale , measured at baseline , 3 weeks ( during ) , 6 weeks ( post ) , and 9 weeks ( retention ) . Ethical approval has been granted by the Deakin University Human Research Ethics Committee ( project number 2015 - 014 ) , and the trial has been registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12615001241527 ) . Discussion This will be the first r and omised controlled trial to combine PRT and a-tDCS targeting balance and gait in people with PD . The study will eluci date the functional , clinical and neurophysiological outcomes of combined PRT and a-tDCS . It is hypothesised that combined PRT and a-tDCS will significantly improve lower limb strength , postural sway , gait speed and stride variability compared with PRT with sham tDCS . Further , we hypothesise that pre-frontal cortex activation during dual-task cognitive and gait/balance activities will be reduced , and that M1 excitability and inhibition will be augmented , following the combined PRT and a-tDCS intervention . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12615001241527 . Registered on 12 November 2015 Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - 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 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
Overall , there are many scales and tests used to assess the balance disorders and disabilities of people with PD .
Postural instability is common in Parkinson ’s disease ( PD ) , often contributing to falls , injuries , and reduced mobility .
In the clinical setting , balance disorder is commonly diagnosed using clinical tests and balance scales , but it is suggested that the most sensitive measurement is the force platform .
The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD .