Balance Training in Parkinson's Disease Using Cues
Condition: Disturbance; Balance, Labyrinth; Parkinson´s Disease
MeSH terms: Parkinson Disease
Study type: Interventional
Phase: Phase 3

Summary: 
      Verifying the efficiency of motor training associated with visual and auditory cues on the
      balance, and postural anticipatory and compensatory adjustments of patients with Parkinson's
      Disease (PD), for prevent fall rate in people with PD. It is a single blinded, randomized
      clinical trial performed at Center of Research of the courses of Speech Therapy, Physical
      Therapy and Occupational Therapy of São Paulo University.
    

Detailed description: 
      The objective of this work is verifying the efficiency of motor training associated with
      visual and auditory cues on the balance, and postural anticipatory and compensatory
      adjustments of patients with Parkinson's Disease (PD), for prevent fall rate in people with
      PD. It is a double blinded, randomized clinical trial performed at Center of Research of the
      courses of Speech Therapy, Physical Therapy and Occupational Therapy of São Paulo University.

      Forty two patients with idiopathic PD will take part in this study, at stages 2 to 3 of the
      Hoehn and Yahr Classification (HY). They are randomly assigned into one of 3 groups: one
      group receiving motor training associated to external cues (ET), the other one group
      performing motor training only (MT) and a third group receiving no treatment just generalize
      orientations. Performance in gait and balance are assessement before and after 10 training
      sessions (two 45-minute sessions per week) for the ET and MT groups, and before and after 5
      weeks for the CG, using the BERG test (BT), Postural Stress Test (PST), Time Up and Go (TUG).
      Patients are also assessment for independence in daily life activities and motor performance
      using section II and III of the Unified Parkinson's Disease Rating Scale (UPDRS); for Quality
      of Life using the Parkinson's Disease Quality of Life (PDQL), and for emotional state by
      Beck's Depression Inventory (BDI). The training consist on: the experimental group receiving
      the motor program to balance associated to rhythmical auditory cues. The directions of the
      training were I. self-perception (strategies - Verbal and visual guidance); II. motor
      performance (Speed variation, Range of motion, Trunk mobility, Turning, balance exercices);
      III. Attention Strategies (Division of attention between guidance, environment and yourself
      movement, Maintenance of attention during all sets); IV. Cues.

      The training program consisted on 5 weeks with 45 minutes duration, divided in 05 minutes
      warm-up, 30 minutes main part, 10 minutes cool down. The control group (CG) wasn't training
      just received orientations. Each session will consist on 05 minutes Warm-Up including: Muscle
      stretching, joint movements, upper and lower global, movement slowly and using wide joint
      movement range, and turning. The Main Part including: Head movement (bending, rotation, and
      leaning sideways), Axial and proximal movements, coordinated movements with Upper and Lower
      range and speed, Functional reach, weight shifts, stationary and walking gait with rhythmic
      and speed variation, postural reactions, trunk rotation, Balance exercises. And the last part
      is the Cool Down, including: Slow walk, breathing exercises associated to Upper limb
      movements and global muscular relaxation and stretching.

      During the study there aren't changes on patient's usual medicine. The subjects will be
      reassessment after 4 and 30 weeks without the program training.
    

Intervention name(s): Physicaltherapy
Intervention type(s): Other
Other intervention name(s): balance training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Balance, Postural; Parkinson´s Disease; H&Y 1-3; Exrecice; Postural adjustments; antecipatory postural; compensatory postural adjustments