Somatosensory Focused Balance Training without cues can improve balance and gait in early Parkinson’s disease – a randomised pilot study

Abstract

This thesis was written for all those who have once lost their foothold in life (as when getting diagnosed with a severe disease), and whose only hope is to keep on fighting.2 ABSTRACT BACKGROUND People with Parkinson's Disease (PD) experience increasing activity limitations in walking, carrying objects, turning around, and dressing. Subtle and often unconscious balance decline may have occurred already at an early stage, even when first diagnosed. At present, no medical treatment can ease the progressive balance impairment. Instead, physical training has become a means to remain physically active and mobile for as long as possible.AIM The overall aim of this thesis was to evaluate if our hypotheses, the training approach of 'Somatosensory Focused Balance Training without Cues', can be effective in supporting people with PD at an early stage (early PD) to maintain their balance ability, so that they can remain physically active, move and walk independently, for as long as possible.METHODS At first, the BDL Balance Scale, a clinical balance assessment, was validated for use in people with early PD. Thereafter, to investigate the effect of 'Somatosensory Focused Balance Training without Cues', people with early PD (n=28) were randomised into two training groups and tested by a blinded assessor before and after the intervention. The training was evaluated with clinical outcomes, laboratory movement outcomes and the result was compared to healthy age-matched controls (n=18). Furthermore, to acquire knowledge of how people with early PD perceived the intervention, an interview study using content analysis was performed. RESULTSThe BDL Balance Scale was found to be valid for use in early PD. It correlated to similar scales and could detect a difference between early PD and healthy controls. The training approach improved balance in the studies population, measured with clinical and movement laboratory outcomes, as well as by participant perceptions. The interviews provided important information on how the group contributed to greater motivation for training and offered a platform for making new friends. CONCLUSION The 'Somatosensory Focused Balance Training without Cues' improves balance in early PD. Notably, the training context is particularly important considering that it can increase the motivation and compliance to the training. In order to understand the underlying mechanisms for the improved balance, further research is needed.

Efeitos de fisioterapia em grupo na função motora no parkinsonismo

“…Apenas 2 estudos (Tollár et al [21,22], com tratamento de 5 sessões semanais por 3 semanas; Kurt et al [23], com 5 sessões semanais por 5 semanas) encontraram que a fisioterapia em grupo tem efeitos sobre o equilíbrio dinâmico, medido pelo teste TUG, com diferenças estatísticas significativas entre as medidas depois e antes do tratamento ou na diferença média entre o grupo de fisioterapia em grupo e o grupo controle sem intervenção motora. Já outros 5 ensaios clínicos (Hashimoto et al [24], com tratamento de 1 sessão semanal por 12 semanas; Hubble et al [25,26], com 1 sessão semanal por 12 semanas; Claesson et al [27], com 2 sessões semanais por 8 semanas; King et al [28], com 3 sessões semanais por 4 semanas) não encontraram diferença estatisticamente significativa entre fisioterapia em grupo e nenhum tratamento motor ou mesmo entre os valores medidos depois e antes do tratamento de fisioterapia em grupo. Observa-se que nos estudos que demonstraram efeitos da fisioterapia em grupo sobre o equilíbrio dinâmico, a frequência semanal de atendimentos era de 5 vezes por semana.…”

“…Todos os estudos que mensuraram o equilíbrio estático encontraram efeitos da fisioterapia em grupo. Na mensuração através da EEB ou do MiniBESTest (Mini Balance Evaluation Systems Test), 8 estudos (Conradsson et al [29], tratamento com 3 sessões semanais por 10 semanas; Sparrow et al [30], 3 sessões semanais por 3 meses; Landers et al [31], com 3 sessões semanais por 8 semanas; Claesson et al [27];…”

“…Os estudos clínicos anteriormente relatados utilizaram variadas estratégias de treinamento motor, como: 45 minutos de treinamento de equilíbrio focado somatossensorial sem dicas/pistas visuais ou sonoras [27]; o programa HiBalance, um regime de 60 minutos de treinamento de equilíbrio altamente desafiador que incorpora componentes de equilíbrio de duas tarefas e específicos de DP [29]; 60 minutos de exercícios de alta intensidade e agilidade usando estímulos sensório-motores e visuais, treinando a mobilidade e o equilíbrio postural [21,22]; programa ABC (Agility Boot Camp) com 60 minutos de atividades que visam sistemas posturais básicos em um modelo de "campo de treinamento" para direcionar restrições biomecânicas, cinestesia, limites de estabilidade, ajustes posturais antecipatórios, bradicinesia e coordenação durante a marcha, com 6 estações (Tai chi, Boxe, Lunges, Caiaque, Curso de Agilidade e Pilates) com atividades que progridem em nível de dificuldade [28]; programa de 90 minutos de exercícios de fortalecimento, amplitude de movimento, atividades de equilíbrio reativo e antecipatório, alteração da entrada sensorial e treino de marcha [30]; campo de treinamento com 90 minutos de exercícios de alta intensidade (aeróbicos, resistidos, equilíbrio e flexibilidade) [31]; programa de 60 minutos de treinamento de aquecimento, alongamento, mobiliza articular e exercícios de marcha [23]; 90 minutos de treinamento da mobilidade do tronco e endurance [25,26]; 60 minutos de treinamento de flexibilidade, equilíbrio, transferência postural (de sentado para de pé e vice-versa, repetidamente) e marcha [24].…”

Group-based exercise for Parkinson’s: a qualitative study of participants and partners’ perceptions of an exercise class delivered through a community-university collaboration

“…Therefore, community-based exercise group sessions led by exercise professionals have been proposed as a solution to reduce healthcare costs [15,16]. Moreover, a recent study described the positive experiences of PwP participating in a group balance exercise programme for 8 weeks, highlighting its safe and inclusive nature, which fulfilled their social and emotional needs [17,18]. Exercising in groups provides PwP with opportunities for social engagement, breaks isolation, allows individuals to share coping strategies (helping to address daily struggles), and thereby promotes a more positive attitude towards life [17,19,20].…”