Two weeks of twice-daily prism adaptation treatment does not improve posture or gait in Parkinson's disease: a double-blind randomized controlled trial

Janet H Bultitude, Dawna M Pidgeon, Pauline R LeBlanc, Charlotte A Jeffreys, Faith P Alexandre, Stephen L Lee, Janet H Bultitude, Dawna M Pidgeon, Pauline R LeBlanc, Charlotte A Jeffreys, Faith P Alexandre, Stephen L Lee

Abstract

Background: Gait difficulties in Parkinson's disease have been related to problems shifting the center of gravity forward. We previously showed reduced forward stepping latencies for people with Parkinson's disease after one session of adaptation to upward visual shifts, which produces downward motor after-effects and potentially shifts the center of gravity forward. Here we tested if repeated prism adaptation improved gait and postural control in Parkinson's disease through a parallel, double-blind, randomized, sham-controlled trial.

Methods: We recruited participants with idiopathic Parkinson's disease aged 40-85 and meeting any one of three clinical criteria: (1) Hoehn and Yahr Stage II.5-IV; (2) scoring > 0 on the gait, freezing of gait, and/or postural stability items of the Movement Disorder Society Unified Parkinson's Disease Rating Scale; or (3) Timed Up and Go > 12 s. Sealed envelope style randomization allocated participants to two weeks of twice-daily prism adaptation or sham treatment. Participants, care givers, and those assessing the outcomes were blinded to group assignment. Primary outcomes were changes in postural control measured using the Berg Balance Scale and the Limits of Stability, Sensory Organization, and Motor Control tests from the Smart EquiTest system. Secondary outcomes included other physiotherapy and questionnaire measures. Outcomes were assessed at the Dartmouth Hitchcock Medical Center immediately before and after the treatment period, with further long-term postal follow-up over 3 months. Outcomes were analyzed using analyses of variance with follow-up t tests.

Results: Eighteen participants were allocated to undergo prism adaptation, of which sixteen were analyzed. Thirteen participants were allocated to undergo sham treatment, and all were analyzed. The prism adaptation group showed increased forward stepping velocity on the Limits of Stability test (pre: M=2.33, SEM=0.24; post: M=2.88, SEM=0.26; t(15)=3.2, p=.005, d=.819). The sham group showed no such change (pre: M=2.13, SEM=0.22; 1d post: M=2.24, SEM=0.22; t(13)=.636, p=.537, d=.176). However, there were no group differences for any other outcome measures and no indications that prism adaptation produced functional improvements in posture, gait, or activities of daily living.

Conclusions: Prism adaptation does not improve gait or postural control in Parkinson's disease.

Trial registration: ClinicalTrials.gov NCT02380859 . Registered prospectively on 5 March 2015.

Keywords: Clinical trial; Freezing of gait; Gait; Parkinson’s disease; Prism adaptation; Rehabilitation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Participant flow through the study
Fig. 2
Fig. 2
Results for the Berg Balance Scale, Timed Up and Go, and Functional Gait Assessment. Abbreviations: BBS, Berg Balance Scale; TUAG, Timed Up and Go; FGA, Functional Gait Assessment. Error bars represent ±1 SEM
Fig. 3
Fig. 3
Results of mechanized measures for the real and sham treatment groups. A Mean reaction time (RT), maximum velocity, and maximum extension on the Limit of Stability (LOS) test for forward and backward stepping, B Mean composite scores and forward-backward center of gravity (COG) alignment on the Sensory Organization Test (SOT), C Mean composite latency scores on the Motor Control Test (MCT), D Mean step length and step speed on the Walk Across (WA) test. * = p < .05. Error bars represent ±1 SEM
Fig. 4
Fig. 4
Results for questionnaire measures. Abbreviations: NFOG, New Freezing of Gait Questionnaire; RES, Falls Efficacy Scale; ABC, Activities-specific Balance Confidence scale; PDQ-39, total Parkinson’s Disease Questionnaire 39. Results of the analysis of the mobility and activities of daily living subscales of the PDQ-39 were qualitatively similar to those for the total PDQ-39. Greater symptom severity or impact on activities is indicated by higher scores on the ABC, and lower scores on the other three measures. Error bars represent ±1 SEM

References

    1. Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A. Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol. 2011;10(8):734–744. doi: 10.1016/S1474-4422(11)70143-0.
    1. Hass CJ, Waddell DE, Fleming RP, Juncos JL, Gregor RJ. Gait initiation and dynamic balance control in Parkinson’s disease. Arch Phys Med Rehabil. 2005;86(11):2172–2176. doi: 10.1016/j.apmr.2005.05.013.
    1. Martin M, Shinberg M, Kuchibhatla M, Ray L, Carollo JJ, Schenkman ML. Gait initiation in community-dwelling adults with Parkinson disease: comparison with older and younger adults without the disease. Phys Ther. 2002;82(6):566–577. doi: 10.1093/ptj/82.6.566.
    1. Martin JP, Hurwitz LJ. Locomotion and the Basal Ganglia. Brain. 1962;85(2):261–276. doi: 10.1093/brain/85.2.261.
    1. De Oliveira CB, De Medeiros IRT, Frota NAF, Greters ME, Conforto AB. Balance control in hemiparetic stroke patients: main tools for evaluation. J Rehabil Res Dev. 2008;45(8):1215–1226. doi: 10.1682/JRRD.2007.09.0150.
    1. Tilikete C, Rode G, Rossetti Y, Pichon J, Li L, Boisson D. Prism adaptation to rightward optical deviation improves postural imbalance in left-hemiparetic patients. Curr Biol. 2001;11(7):524–528. doi: 10.1016/S0960-9822(01)00151-8.
    1. Nijboer TCW, Olthoff L, Van Der Stigchel S, Visser-Meily JMA. Prism adaptation improves postural imbalance in neglect patients. Neuroreport. 2014;25(5):307–311. doi: 10.1097/WNR.0000000000000088.
    1. Redding GM, Rossetti Y, Wallace B. Applications of prism adaptation: A tutorial in theory and method. Neurosci Biobehav Rev. 2005;29(3):431–444. doi: 10.1016/j.neubiorev.2004.12.004.
    1. Bultitude JH, Rafal RD, Tinker C. Moving forward with prisms: Sensory-motor adaptation improves gait initiation in Parkinson’s disease. Front Neurol. 2012;3:132. doi: 10.3389/fneur.2012.00132.
    1. Rusconi ML, Carelli L. Long-term efficacy of prism adaptation on spatial neglect: Preliminary results on different spatial components. Sci World J. 2012;2012:1–8. doi: 10.1100/2012/618528.
    1. Serino A, Angeli V, Frassinetti F, Làdavas E. Mechanisms underlying neglect recovery after prism adaptation. Neuropsychologia. 2006;44(7):1068–1078. doi: 10.1016/j.neuropsychologia.2005.10.024.
    1. Serino A, Barbiani M, Rinaldesi ML, Làdavas E. Effectiveness of prism adaptation in neglect rehabilitation: A controlled trial study. Stroke. 2009;40(4):1392–1398. doi: 10.1161/STROKEAHA.108.530485.
    1. Frassinetti F, Angeli V, Meneghello F, Avanzi S, Làdavas E. Long-lasting amelioration of visuospatial neglect by prism adaptation. Brain. 2002;125(3):608–623. doi: 10.1093/brain/awf056.
    1. Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt P, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten J, LaPelle N, Movement Disorder Society UPDRS Revision Task Force Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Mov Disord. 2008;23(15):2129–2170. doi: 10.1002/mds.22340.
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699. doi: 10.1111/j.1532-5415.2005.53221.x.
    1. Nisenzon AN, Robinson ME, Bowers D, Banou E, Malaty I, Okun MS. Measurement of patient-centered outcomes in Parkinson’s disease: What do patients really want from their treatment? Parkinsonism Relat Disord. 2011;17(2):89–94. doi: 10.1016/j.parkreldis.2010.09.005.
    1. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: Validation of an instrument. Can J Public Health. 1992;83(suppl 2):S7–11.
    1. Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther. 2004;84(10):906–918. doi: 10.1093/ptj/84.10.906.
    1. Leddy AL, Crowner BE, Earhart GM. Functional Gait Assessment and Balance Evaluation System Test: Reliability, Validity, Sensitivity, and Specificity for Identifying Individuals With Parkinson Disease Who Fall. Phys Ther. 2010;91(1):102–113. doi: 10.2522/ptj.20100113.
    1. Nieuwboer A, Rochester L, Herman T, Vandenberghe W, Emil GE, Thomaes T, Giladi N. Reliability of the new freezing of gait questionnaire: Agreement between patients with Parkinson’s disease and their carers. Gait Posture. 2009;30(4):459–463. doi: 10.1016/j.gaitpost.2009.07.108.
    1. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I) Age Ageing. 2005;34(6):614–619. doi: 10.1093/ageing/afi196.
    1. Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol. 1995;50A(1):M28–M34. doi: 10.1093/gerona/50A.1.M28.
    1. Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N. The Parkinson’s disease questionnaire (PDQ-39): Development and validation of a Parkinson’s disease summary index score. Age Ageing. 1997;26(5):353–357. doi: 10.1093/ageing/26.5.353.
    1. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther. 2004;27(1):26–35. doi: 10.1016/j.jmpt.2003.11.003.
    1. Canavan AGM, Passingham RE, Marsden CD, Quinn N, Wyke M, Polkey CE. Prism adaptation and other tasks involving spatial abilities in patients with Parkinson’s disease, patients with frontal lobe lesions and patients with unilateral temporal lobectomies. Neuropsychologia. 1990;28(9):969–984. doi: 10.1016/0028-3932(90)90112-2.
    1. Fernandez-Ruiz J, Diaz R, Hall-Haro C, Vergara P, Mischner J, Nuñez L, et al. Normal prism adaptation but reduced after-effect in basal ganglia disorders using a throwing task. Eur J Neurosci. 2003;18(3):689–694. doi: 10.1046/j.1460-9568.2003.02785.x.
    1. Sato E, Onitsuka T, Ninomiya H, Nakamura I, Kanba S. Prism Adaptation and Perceptual Skill Learning Deficits in Early-Stage Parkinson’s Disease. Neuropsychobiology. 2014;70:165–172. doi: 10.1159/000365485.
    1. Goedert KM, Zhang JY, Barrett AM. Prism adaptation and spatial neglect: the need for dose-finding studies. Front Hum Neurosci. 2015;9(April):1–7. doi: 10.3389/fnhum.2015.00243.
    1. Rossetti Y, Kitazawa S, Nijboer TCW. Prism adaptation: From rehabilitation to neural bases. Cortex. 2019;111:A1–A6. doi: 10.1016/j.cortex.2019.01.002.
    1. Caselli P, Conforto S, Schmid M, Accornero N, D’Alessio T. Difference in sensorimotor adaptation to horizontal and vertical mirror distortions during ballistic arm movements. Hum Mov Sci. 2006;25(3):310–325. doi: 10.1016/j.humov.2005.12.003.
    1. Serino A, Bonifazi S, Pierfederici L, Làdavas E. Neglect treatment by prism adaptation: What recovers and for how long. Neuropsychol Rehabil. 2007;17(6):657–687. doi: 10.1080/09602010601052006.

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