Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

Abstract

We hypothesised that rehabilitation specifically addressing balance in Parkinson's disease patients might improve not only balance but locomotion as well. Two balance-training protocols (standing on a moving platform and traditional balance exercises) were assessed by assigning patients to two groups (Platform, n = 15, and Exercises, n = 17). The platform moved periodically in the anteroposterior, laterolateral, and oblique direction, with and without vision in different trials. Balance exercises were based on the Otago Exercise Program. Both platform and exercise sessions were administered from easy to difficult. Outcome measures were (a) balancing behaviour, assessed by both Index of Stability (IS) on platform and Mini-BESTest, and (b) gait, assessed by both baropodometry and Timed Up and Go (TUG) test. Falls Efficacy Scale-International (FES-I) and Parkinson's Disease Questionnaire (PDQ-8) were administered. Both groups exhibited better balance control, as assessed both by IS and by Mini-BESTest. Gait speed at baropodometry also improved in both groups, while TUG was less sensitive to improvement. Scores of FES-I and PDQ-8 showed a marginal improvement. A four-week treatment featuring no gait training but focused on challenging balance tasks produces considerable gait enhancement in mildly to moderately affected patients. Walking problems in PD depend on postural instability and are successfully relieved by appropriate balance rehabilitation. This trial is registered with ClinicalTrials.gov NCT03314597.

Proposal of a new conceptual gait model for patients with Parkinson’s disease based on factor analysis

“…In the future, it might be interesting also to validate our model with accelerometers that offer a series of advantages such as lower cost and applicability in free-living situations. However, right now we believe it is important to have a model usable with electronic walkways since they are still frequently used in scientific studies and clinical practice [7,[65][66][67][68].…”

“…Page 2 of 18 Arcolin et al BioMed Eng OnLine (2019) 18:70 Electronic walkways are an easy instrument for assessing gait that provide a large number of spatiotemporal variables of gait. Even if these systems are expensive and led to evaluate gait only in the laboratory context, they have been often used to assess gait of patients with PD in clinical practice [6][7][8][9]. In particular, the GAITRite ® system was demonstrated to be a reliable instrument [10] and showed an excellent concurrent validity for measuring individual footstep data [11].…”

Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed

“…Gait organization per se would be instead unimpaired, as inferred from normal muscle activation patterns in the lower extremities during turns in people with PD [ 134 ]. Most interestingly, we observed recently in a different cohort of PD patients that walking speed increased after a rehabilitation training exclusively aimed at improving balance [ 135 ]. This suggests that better equilibrium control has a positive effect on walking—or that the subtle walking abnormalities exhibited by the present PD patients are a sign of balance, not gait impairment.…”

Human Balance in Response to Continuous, Predictable Translations of the Support Base: Integration of Sensory Information, Adaptation to Perturbations, and the Effect of Age, Neuropathy and Parkinson’s Disease

“…Patients with Parkinson's disease show minor adaptation problems that can contribute to their balance dysfunction [8,85,102]. A balance training with a continuous, predictable translation of the support base has improved their balance and coordination capacities as much as training based on standardized exercises [103]. Interestingly, gait speed was also improved in both cases.…”