Effects of an Innovative Balance Training Programme in Enhancing Postural Control and Reducing Falls in Patients With Parkinson's Disease

Study Overview
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Brief Summary
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Falling is a complex and most disabling feature for patients with Parkinson's disease (PD). Previous studies suggested that falls in patients with PD are related to postural instability characterized by deficits in anticipatory postural adjustment (APA) for postural orientation in walking and standing and inadequate postural response to perturbation. The present study developed an innovative balance treatment with focus of anticipatory and compensatory postural control and examined its effects on enhancing balance and gait performance and decreasing fall rate in people with PD.

Detailed Description
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Participants: Forty-two eligible subjects with PD were randomly allocated into balance with focus of anticipatory and compensatory postural control (EXP) or control (CON) group with strength-focused training, with 26 subjects in each group. Methods: Subjects in the EXP group were trained the speed and amplitude of anticipatory postural adjustment during stepping and walking and postural response to perturbation during walking. Subjects In the CON group were trained to improve the strength of lower limb muscles. Treatment period in both groups lasted for 12 weeks, which consisted of 4-week laboratory-based training (phase 1), 4-week home-based exercise (phase 2) and final 4-week laboratory-based training (phase 3). Outcome measures included reaction time(RT), movement velocity (MV) and endpoint excursion (EPE) of limit-of-stability test, one-leg-stance (OLS) time, gait velocity, stride length (SL), cadence, and fall rate. All tests were conducted for 6 time intervals including baseline, after each training phase, at 3-month follow-up and at 12-month follow-up.

Conditions
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Parkinson's Disease

Intervention / Treatment
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* Other: experimental
* Other: control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diagnosed as parkinson's disease 45 years old or above stable on anti-parkinsonian medications for at least 6 weeks prior to entry into the study, which will remain unchanged for the duration of the study able to walk a 10 meter distance at least 3 times with or without walking aids independently at stage 2 or 3 of the Hoehn and Yahr staging able to provide informed consent Exclusion Criteria: neurological conditions other than PD uncompensated cardiovascular disease less than 23 score on the Mini-Mental State examination, History of fracture or recent musculoskeletal disorders in back or lower limbs which would interfere with the balance during exercise and daily activities visual disturbance or vestibular dysfunction limiting locomotion or balance participation in other balance-related training program more than one time per week

Ages Eligible for Study
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Minimum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: anticipatory and compensatory postural control training<br>Subjects in the experimental group were trained the speed and amplitude of anticipatory postural adjustment during fall-prone activities and postural response to perturbation during walking. Training was provided with preparatory cues, computerized machines and treadmill. | Other: experimental<br>* Subjects in the experimental group were trained the speed and amplitude of anticipatory postural adjustment during fall-prone activities and postural response to perturbation during walking. Training was provided with preparatory cues, computerized machines and treadmill.<br>|
| Active Comparator: strength-focused training<br>Subjects in control group were provided with strength training of leg muscles using machines and during functional activities. | Other: control<br>* Subjects in control group were provided with strength training of leg muscles using machines and during functional activities.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| reaction time of limits of stability test |  | One year | 
| one-leg-stance time |  | one year | 
| pull test | it reflects the ability of compensatory postural control in patients with Parkinson's disease | one year | 
| fall rate |  | previous one year before baseline assessment, each following one month for 3-month of training and 12-month of follow-up | 
| movement velocity of limit of stability test |  | one year | 
| end point excursion of limits of stability test |  | One year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unified Parkinson's Disease rating scale- motor examination subscale | it reflects motor impairment of patients with Parkinson's disease | one year | 
| Gait velocity |  | one year | 
| Stride length |  | One year | 
| Cadence |  | One year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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parkinson's disease, balance, anticipatory postural adjustment, componsatory postural adjustment, falls