Somatosensory training for postural control in independent-living individuals with Parkinson's disease

[摘要] ENGLISH ABSTRACT: Introduction: Postural control (PC) impairments in Parkinson's disease(PD) involve proprioceptive processing and integration deficits. Althoughdeficits in proprioception have a negative effect on PC, the precise contributionto postural instability in PD remains unclear. The somatosensory systemincorporates both the proprioceptive and haptic feedback systems, and by applyinglight touch postural sway (PS) can be improved in individuals with PD.The study therefore aimed to determine if an eight-week somatosensory trainingprogram (SSTP) would influence PC in individuals with mild to moderatePD.Study design: Time-series experimental study design.Methods: Thirty-seven participants with idiopathic PD (67 9 years; H&Y:2 1; MDS-UPDRS III: 28 14) were divided into two groups i.e. somatosensorytraining group (EXP; n = 24) and placebo group (PBO; n = 13). Primaryoutcome measures included joint position sense (JPS), sensory integration(mCTSIB), Timed-Up-and-Go (TUG), fear of falling (FES-I) and PS.Secondary outcome measures were quality of life (PDQ-39 SI), part II, III andtotal score of Movement Disorder Society-Unified Parkinson's Disease RatingScale (MDS-UPDRS) and balance confidence (ABC). Participants were testedon medication, at baseline, pre- and post-intervention over a period of 16-weeks. JPS was tested at the ankle joint with the Active Movement ExtentDiscrimination Apparatus (AMEDA) at 10°, 11°, 12°, 13° and 14°. For themodified Clinical Test of Sensory Integration and Balance (mCTSIB) and PSwith and without haptic feedback, the Instrumented Sway tri-axial accelerometerwas used to assess overall PS during eight conditions i.e. eyes open (EO), eyes closed (EC), both off and on a foam pad (+F) as well as all four conditionswith haptic feedback.Results: A statistically significant treatment effect was found in the EC+F(p = 0.0002), TUG (p = 0.0001), FES-I (p = 0.02), part III (p = 0.02), aswell as in total score of MDS-UPDRS (p = 0.02) for the EXP group. TheEXP group improved in JPS (p = 0.02), EC+F JERK (p = 0.002) and RMS(p = 0.01) as well as PDQ-39 SI (p = 0.03) after the intervention. The EXPgroup showed a significant improvement in the TUG before and after the Treatmentphase (p < 0.05). The EXP group also showed a significant improvementfor EC+F JERK (p = 0.002) and TUG (p = 0.01), with a strong tendencyfor better balance confidence (p = 0.07), compared to the PBO group. Bothgroups presented with reduced sway amplitude when receiving haptic feedbackcompared to no manual contact, regardless of the surface area (p < 0.01). However,no group differences were found during the Baseline and Treatment phase(p > 0.05).Conclusion: The positive findings of this study provide evidence that thisSSTP could improve PC in PD individuals. However, haptic feedback cannotbe altered by a SSTP, but it can improve PS in individuals with PD, regardlessof the surface area.

[发布机构] Stellenbosch University