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

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.

Study Overview

• Status: Unknown
• Conditions: Parkinson's Disease
• Intervention / Treatment: Other: experimental; Other: control

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Anticipated): 52
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Hong Kong
    • Hong Kong, Hong Kong, China
      • Recruiting
      • The Hong Kong Polytechnic University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 45 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. diagnosed as parkinson's disease
2. 45 years old or above
3. 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
4. able to walk a 10 meter distance at least 3 times with or without walking aids independently
5. at stage 2 or 3 of the Hoehn and Yahr staging
6. able to provide informed consent

Exclusion Criteria:

1. neurological conditions other than PD
2. uncompensated cardiovascular disease
3. less than 23 score on the Mini-Mental State examination,
4. History of fracture or recent musculoskeletal disorders in back or lower limbs which would interfere with the balance during exercise and daily activities
5. visual disturbance or vestibular dysfunction limiting locomotion or balance
6. participation in other balance-related training program more than one time per week

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: anticipatory and compensatory postural control training; 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; 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.
ACTIVE_COMPARATOR: strength-focused training; Subjects in control group were provided with strength training of leg muscles using machines and during functional activities.	Other: control; Subjects in control group were provided with strength training of leg muscles using machines and during functional activities.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: The Hong Kong Polytechnic University
• Investigators: Principal Investigator: Xia SHEN, PHD candidate, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University

Study record dates

Study Major Dates

• Study Start: March 1, 2009
• Primary Completion (ANTICIPATED): March 1, 2012
• Study Completion (ANTICIPATED): June 1, 2012

Study Registration Dates

• First Submitted: August 30, 2011
• First Submitted That Met QC Criteria: August 30, 2011
• First Posted (ESTIMATE): September 1, 2011

Study Record Updates

• Last Update Posted (ESTIMATE): September 1, 2011
• Last Update Submitted That Met QC Criteria: August 30, 2011
• Last Verified: August 1, 2011

More Information

Terms related to this study

• Keywords: falls; balance; parkinson's disease; anticipatory postural adjustment; componsatory postural adjustment
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Parkinson Disease
• Other Study ID Numbers: PD-001