Home-based balance training for dynamic balance in independent-living individuals with Parkinson's disease

[摘要] ENGLISH ABSTRACT : Background: Individuals with Parkinson's disease (PD), are presented with a variety of motor and nonmotorsymptoms which progressively affect their independence. As a result surgical andpharmacological interventions are often ineffective, especially for postural instability. Poor locomotionand balance dysfunction in PD ultimately leads to disability, which includes the loss of their ability toperform automated movements in a controlled manner (Floriano et al., 2015, Rinalduzzi et al., 2015).Accordingly dynamic balance and gait are considered to be one of the most relevant rehabilitationoutcomes, and non-pharmacological interventions like exercise should be explored. Home-basedbalance exercises might be a viable mode of exercise delivery for PD individuals. However researchon PD exercise interventions rarely indicate best practices to deliver exercises (King et al., 2015).Aim: The aim of this study was to compare an eight-week home-based balance programme with anequivalent therapist-supervised programme on dynamic balance, functional gait, and self-perceivedmeasures of fall risk and balance confidence, disease severity, and motivation regarding the exerciseinterventions in individuals with mild to moderate PD.Methods: Forty participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7 years) weredivided into a Therapist-supervised group (n=24) and Home-based group (n=16). Groups receivedeight weeks of balance training that including somatosensory cues, three times a week for an hour,either with an exercise therapist or via a DVD. Outcome measures were dynamic balance (FGA), gaitand mobility (ITUG), dual-tasking gait and mobility (CTUG), freezing of gait (FoGQ), self-perceivedbalance confidence (ABC), self-perceived fall risk (FES-I), disease severity (MDS-UPDRS II & III) andintrinsic motivation (IMI).Results: Treatment effects were observed for the Home-based group with MDS-UPDRS total,subscore II and III (p < 0.01), and for the Therapist-supervised group for cadence (p = 0.047). Bothgroups improved (p < 0.05) in FGA (>9%, medium effect sze), stride length (>4%, small to mediumeffect size) and FoGQ (>16%, small effect size). Over the 8 weeks the Therapist-supervised groupfurthermore improved cadence and balance confidence (p < 0.05) with small effect size, stride andturn velocity (p < 0.05) with medium effect size, and turn-to-sit duration (p < 0.0001) with a huge effectsize. The Home-based group improved by 23% in MDS-UPDRS III (p < 0.001), but gait deterioratedwith dual-tasking. No significant differences observed for FES-I (p > 0.05). The therapist supervisedgroup perceived the intervention to be 17% more enjoyable/interesting than Home-based (IMI; p =0.002). Conclusion: An eight-week balance training programme with somatosensory cues at home mayimprove dynamic balance, stride length and freezing of gait. However greater improvements areachieved when exercising under supervision of a trained exercise therapist. Therapist-supervisedtraining showed superior improvement in dynamic balance, gait, dual-tasking, balance confidence andmotivation.

[发布机构] Stellenbosch University