Protocol: Balance Training in Parkinson's Disease
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      Postural instability is a particularly incapacitating disorder, where loss of motor
      independence by Parkinson´s Disease (PD) patients marks a significant stage of disease onset.
      Evidence suggests that deficits in automatic motor control, sensory integration and attention
      are associated with lack of balance in PD. Physiotherapy, together with medication, plays an
      important role in the treatment of this state, although no consensus has been reached on the
      best treatment modality. The aim of this randomized controlled trial protocol is to evaluate
      the effects of balance training with rhythmical (BRT), which is a motor program to improve
      balance associated with rhythmical auditory cues (RACs)
    

Detailed description: 
      A total of 150 PD patients at H&Y stages II-III and asymptomatic for depression and dementia
      are enrolled in a single-blind randomized study. Randomization is achieved via a
      computer-generated random-sequence table. All patients should also present a fall
      history.They will be assigned into one of three groups, and their balance and gait will be
      assessed before and after 10 training sessions, and after 4 and 30 weeks subsequent to the
      end of the training. Balance will be assess by Mini BESTest (MBESTest), BERG Test (BBS) and
      Postural Stress Test (PST). Gait will be evaluate by the Timed Up and Go test (TUG).
      Independence in Activities of Daily Living (ADLs) will be assess through interviews; and
      UPDRS, through motor performance. The BRT group received a motor program to improve balance
      associated with RACs, the MT group performed motor training with the same aims as those in
      the BRT group but without RACs, and the control group (CG) was trained only in orientations.
      The exercise program specific to balance is of 5 weeks' duration with two sessions per week,
      45 minutes each, and consists of general physiotherapy exercises. Each session is divided
      into five warm-up minutes-30 minutes for the main part and 10 minutes for the cool down. The
      training progresses and intensifies each week depending on the individual's performance. The
      subjects should be able to execute 10 repetitions of the exercise sequences correctly to
      progress to the next movement.

      The training progressed and increased in intensity on each week. On the first week, before
      the training, each exercise was explained and demonstrated by the physiotherapist, who
      demanded special attention on the most difficult aspects of movement execution. The subjects
      performed 05 repetitions (5 RM) of each exercise.

      On the first phase the patients may present some mistakes and might need specific information
      to correct the movement that is on execution. The exercises will be repeat in the next
      sessions in order to consolidate learning. The subjects must have been capable of associating
      the corrections to the exercises that will proposs on the first week. In each group
      repetition, for both groups, the physiotherapist will use a verbal command before each
      movement change, anticipating it and requesting attention to the most difficult ones. Only
      the GBRT will be oriented to focus on the rhythmical auditory cues. On the second week, the
      subjects will perform a series of 10 repetitions (10 RM) and on the third week, 2 series of
      10 repetitions (20RM). On the fourth week, subjects must have been able to execute 20RM of
      the exercise sequences with an increase in speed.
    

Intervention name(s): Balance Training; Screening to prevent falls
Intervention type(s): Other; Other
Intervention description(s): Balance training with rhythmical (BRT), is a motor program to improve balance associated with rhythmical auditory cues (RACs).; Questionary to Scheduled screening falls and progression in training will be used to indicate the capacity to continue to progress.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Parkinson´s disease; Physicaltherapy; Postural Balance; Gait; Rehabilitation