A novel conceptual framework for balance training in Parkinson's disease-study protocol for a randomised controlled trial

David Conradsson, Niklas Löfgren, Agneta Ståhle, Maria Hagströmer, Erika Franzén, David Conradsson, Niklas Löfgren, Agneta Ståhle, Maria Hagströmer, Erika Franzén

Abstract

Background: There is increasing scientific knowledge about the interaction between physiological (musculoskeletal, neuromuscular, cognitive and sensory) systems and their influence on balance and walking impairments in Parkinson's disease. We have developed a new conceptual framework for balance training, emphasising specific components of balance control related to Parkinson's disease symptoms by using highly challenging, progressive and varying training conditions. The primary aim of this proposed randomised controlled trial will be to investigate the short-term and long-term effects of a 10-week balance training regime in elderly with Parkinson's disease.

Methods/design: Eighty participants with mild to moderate idiopathic Parkinson's disease will be recruited and randomly allocated to an intervention group receiving balance training or a control group whose participants will continue to receive their usual care. The intervention will consist of a 10-week group training regime (1-hour training, three times per week), which will be led by two physiotherapists to ensure training progression and safety. The conceptual framework will be applied by addressing specific balance components (sensory integration, anticipatory postural adjustments, motor agility, stability limits) through varying training conditions and structured progression. Assessment will be conducted through a multi-dimensional battery of outcomes, prior to and immediately after the 10-week intervention, and at 9 and 15 months' follow-up after entering the study. Primary outcome measures will be balance performance (assessed using the Mini Balance Evaluation Systems Test), change in gait velocity (m/s) between single and dual task walking, and fear of falling (evaluated using the Fall Efficacy Scale International).

Discussion: This study has the potential to provide new insight and knowledge of the effects of specific, varied and challenging balance training on a wide health spectrum in elderly with PD. If found to be effective, this pragmatic approach with translation of theory into practice, can be implemented in existing outpatient care.

Trial registration: NCT01417598.

References

    1. Dorsey ER, Constantinescu R, Thompson JP, Biglan KM, Holloway RG, Kieburtz K, Marshall FJ, Ravina BM, Schifitto G, Siderowf A, Tanner CM. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurol. 2007;68:384–386. doi: 10.1212/01.wnl.0000247740.47667.03.
    1. de Rijk MC, Tzourio C, Breteler MM, Dartigues JF, Amaducci L, Lopez-Pousa S, Manubens-Bertran JM, Alperovitch A, Rocca WA. Prevalence of parkinsonism and Parkinson’s disease in Europe: the EUROPARKINSON Collaborative Study. European Community Concerted Action on the Epidemiology of Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1997;62:10–15. doi: 10.1136/jnnp.62.1.10.
    1. Carpinella I, Crenna P, Calabrese E, Rabuffetti M, Mazzoleni P, Nemni R, Ferrarin M. Locomotor function in the early stage of Parkinson’s disease. IEEE Trans Neural Syst Rehabil Eng. 2007;15:543–551.
    1. Galna B, Murphy AT, Morris ME. Obstacle crossing in people with Parkinson’s disease: foot clearance and spatiotemporal deficits. Hum Mov Sci. 2010;29:843–852. doi: 10.1016/j.humov.2009.09.006.
    1. Beuter A, Hernandez R, Rigal R, Modolo J, Blanchet PJ. Postural sway and effect of levodopa in early Parkinson’s disease. Can J Neurol Sci. 2008;35:65–68.
    1. Suarez H, Geisinger D, Suarez A, Carrera X, Buzo R, Amorin I. Postural control and sensory perception in patients with Parkinson’s disease. Acta Otolaryngol. 2009;129:354–360. doi: 10.1080/00016480802495446.
    1. Tan DM, McGinley JL, Danoudis ME, Iansek R, Morris ME. Freezing of gait and activity limitations in people with Parkinson’s disease. Arch Phys Med Rehabil. 2011;92:1159–1165. doi: 10.1016/j.apmr.2011.02.003.
    1. Ellis T, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Dibble LE. Which measures of physical function and motor impairment best predict quality of life in Parkinson’s disease? Parkinsonism Relat Disord. 2011;17:693–7. doi: 10.1016/j.parkreldis.2011.07.004.
    1. Fertl E, Doppelbauer A, Auff E. Physical activity and sports in patients suffering from Parkinson’s disease in comparison with healthy seniors. J Neural Transm Park Dis Dement Sect. 1993;5:157–161. doi: 10.1007/BF02251206.
    1. Bloem BR, Grimbergen YA, Cramer M, Willemsen M, Zwinderman AH. Prospective assessment of falls in Parkinson’s disease. J Neurol. 2001;248:950–958. doi: 10.1007/s004150170047.
    1. Franzen E, Paquette C, Gurfinkel VS, Cordo PJ, Nutt JG, Horak FB. Reduced performance in balance, walking and turning tasks is associated with increased neck tone in Parkinson’s disease. Exp Neurol. 2009;219:430–438. doi: 10.1016/j.expneurol.2009.06.013.
    1. Horak FB, Frank J, Nutt J. Effects of dopamine on postural control in parkinsonian subjects: scaling, set, and tone. J Neurophysiol. 1996;75:2380–2396.
    1. Wright WG, Gurfinkel VS, King LA, Nutt JG, Cordo PJ, Horak FB. Axial kinesthesia is impaired in Parkinson’s disease: effects of levodopa. Exp Neurol. 2010;225:202–209. doi: 10.1016/j.expneurol.2010.06.016.
    1. Ahlskog JE. Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurol. 2011;77:288–294. doi: 10.1212/WNL.0b013e318225ab66.
    1. Hirsch MA, Farley BG. Exercise and neuroplasticity in persons living with Parkinson’s disease. Eur J Phys Rehabil Med. 2009;45:215–229.
    1. Dibble LE, Addison O, Papa E. The effects of exercise on balance in persons with Parkinson’s disease: a systematic review across the disability spectrum. J Neurol Phys Ther. 2009;33:14–26.
    1. Allen NE, Sherrington C, Paul SS, Canning CG. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord. 2011;26:1605–1615. doi: 10.1002/mds.23790.
    1. Crizzle AM, Newhouse IJ. Is physical exercise beneficial for persons with Parkinson’s disease? Clin J Sport Med. 2006;16:422–425. doi: 10.1097/01.jsm.0000244612.55550.7d.
    1. Keus SH, Bloem BR, Hendriks EJ, Bredero-Cohen AB, Munneke M. Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Mov Disord. 2007;22:451–460. doi: 10.1002/mds.21244.
    1. Kwakkel G, de Goede CJ, van Wegen EE. Impact of physical therapy for Parkinson’s disease: a critical review of the literature. Parkinsonism Relat Disord. 2007;13(Suppl 3):478–487.
    1. Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord. 2008;23:631–640. doi: 10.1002/mds.21922.
    1. Horak F, Macpherson JM. In: Handbook of Physiology: Integration of Motor, Circulatory, Respiratory and Metabolic Control During Exercise. Rowell LB, Shepard JT, editor. Oxford University Press, New York; 1996. Postural orientation and equilibrium; pp. 255–92.
    1. Horak FB, Dimitrova D, Nutt JG. Direction-specific postural instability in subjects with Parkinson’s disease. Exp Neurol. 2005;193:504–521. doi: 10.1016/j.expneurol.2004.12.008.
    1. Bloem BR, Grimbergen YA, van Dijk JG, Munneke M. The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. J Neurol Sci. 2006;248:196–204. doi: 10.1016/j.jns.2006.05.010.
    1. King LA, Horak FB. Delaying mobility disability in people with Parkinson disease using a sensorimotor agility exercise program. Phys Ther. 2009;89:384–393. doi: 10.2522/ptj.20080214.
    1. Bohnen NI, Cham R. Postural control, gait, and dopamine functions in parkinsonian movement disorders. Clin Geriatr Med. 2006;22:797–812. doi: 10.1016/j.cger.2006.06.009.
    1. Konczak J, Corcos DM, Horak F, Poizner H, Shapiro M, Tuite P, Volkmann J, Maschke M. Proprioception and motor control in Parkinson’s disease. J Mot Behav. 2009;41:543–552. doi: 10.3200/35-09-002.
    1. Wright WG, Gurfinkel V, King L, Horak F. Parkinson’s disease shows perceptuomotor asymmetry unrelated to motor symptoms. Neurosci Lett. 2007;417:10–15. doi: 10.1016/j.neulet.2007.02.016.
    1. Paquette C, Franzen E, Jones GM, Horak FB. Walking in circles: navigation deficits from Parkinson’s disease but not from cerebellar ataxia. Neuroscience. 2011;190:177–183.
    1. Salenius S, Avikainen S, Kaakkola S, Hari R, Brown P. Defective cortical drive to muscle in Parkinson’s disease and its improvement with levodopa. Brain. 2002;125:491–500. doi: 10.1093/brain/awf042.
    1. Frank JS, Horak FB, Nutt J. Centrally initiated postural adjustments in parkinsonian patients on and off levodopa. J Neurophysiol. 2000;84:2440–2448.
    1. Rocchi L, Chiari L, Mancini M, Carlson-Kuhta P, Gross A, Horak FB. Step initiation in Parkinson’s disease: influence of initial stance conditions. Neurosci Lett. 2006;406:128–132. doi: 10.1016/j.neulet.2006.07.027.
    1. Schenkman M, Morey M, Kuchibhatla M. Spinal flexibility and balance control among community-dwelling adults with and without Parkinson’s disease. J Gerontol A Biol Sci Med Sci. 2000;55:441–445. doi: 10.1093/gerona/55.8.M441.
    1. Mancini M, Rocchi L, Horak FB, Chiari L. Effects of Parkinson’s disease and levodopa on functional limits of stability. Clin Biomech (Bristol, Avon) 2008;23:450–458. doi: 10.1016/j.clinbiomech.2007.11.007.
    1. Chong RK, Horak FB, Woollacott MH. Parkinson’s disease impairs the ability to change set quickly. J Neurol Sci. 2000;175:57–70. doi: 10.1016/S0022-510X(00)00277-X.
    1. Yehene E, Meiran N, Soroker N. Basal ganglia play a unique role in task switching within the frontal-subcortical circuits: evidence from patients with focal lesions. J Cogn Neurosci. 2008;20:1079–1093. doi: 10.1162/jocn.2008.20077.
    1. Bertram CP, Lemay M, Stelmach GE. The effect of Parkinson’s disease on the control of multi-segmental coordination. Brain Cogn. 2005;57:16–20. doi: 10.1016/j.bandc.2004.08.014.
    1. Chong RK, Jones CL, Horak FB. Postural set for balance control is normal in Alzheimer’s but not in Parkinson’s disease. J Gerontol A Biol Sci Med Sci. 1999;54:129–135. doi: 10.1093/gerona/54.3.M129.
    1. Mak MK, Patla A, Hui-Chan C. Sudden turn during walking is impaired in people with Parkinson’s disease. Exp Brain Res. 2008;190:43–51. doi: 10.1007/s00221-008-1446-1.
    1. Spildooren J, Vercruysse S, Desloovere K, Vandenberghe W, Kerckhofs E, Nieuwboer A. Freezing of gait in Parkinson’s disease: the impact of dual-tasking and turning. Mov Disord. 2010;25:2563–2570. doi: 10.1002/mds.23327.
    1. Ashburn A, Stack E, Ballinger C, Fazakarley L, Fitton C. The circumstances of falls among people with Parkinson’s disease and the use of Falls Diaries to facilitate reporting. Disabil Rehabil. 2008;30:1205–1212. doi: 10.1080/09638280701828930.
    1. Kraemer W. In: ACSM’s Reasource Manual for Guidlines for Exercise Testing and Prescription. 6. dA Ehrman J, Sanderson B, Swain D, Swank A, Womack C, editor. Lippincot Williams & Wilkins, London; 2010. Musculoskeletal Exercise Prescription; pp. 463–475.
    1. Stergiou N, Harbourne R, Cavanaugh J. Optimal movement variability: a new theoretical perspective for neurologic physical therapy. J Neurol Phys Ther. 2006;30:120–129.
    1. Morris ME, Martin CL, Schenkman ML. Striding out with Parkinson disease: evidence-based physical therapy for gait disorders. Phys Ther. 2010;90:280–288. doi: 10.2522/ptj.20090091.
    1. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurol. 1967;17:427–442. doi: 10.1212/WNL.17.5.427.
    1. Rodrigues de Paula F, Teixeira-Salmela LF, de Morais Faria CD C, Rocha de Brito P, Cardoso F. Impact of an exercise program on physical, emotional, and social aspects of quality of life of individuals with Parkinson’s disease. Mov Disord. 2006;21:1073–1077. doi: 10.1002/mds.20763.
    1. States RA, Spierer DK, Salem Y. Long-term group exercise for people with Parkinson’s disease: a feasibility study. J Neurol Phys Ther. 2011;35:122–128.
    1. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55:181–184. doi: 10.1136/jnnp.55.3.181.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Nieuwboer A, Rochester L, Muncks L, Swinnen SP. Motor learning in Parkinson’s disease: limitations and potential for rehabilitation. Parkinsonism Relat Disord. 2009;15(Suppl 3):53–58.
    1. Abbruzzese G, Trompetto C, Marinelli L. The rationale for motor learning in Parkinson’s disease. Eur J Phys Rehabil Med. 2009;45:209–214.
    1. Ståhle A. Physical activity in the prevention and treatment of diseases. Swedish National Institutet of Public Health, Stockholm; 2010.
    1. Halvarsson A, Olsson E, Faren E, Pettersson A, Ståhle A. Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial. Clin Rehabil. 2011;25:1021–1031. doi: 10.1177/0269215511411937.
    1. Brauer SG, Woollacott MH, Lamont R, Clewett S, O’Sullivan J, Silburn P, Mellick GD, Morris ME. Single and dual task gait training in people with Parkinson’s disease: a protocol for a randomised controlled trial. BMC Neurol. 2011;11:90. doi: 10.1186/1471-2377-11-90.
    1. Lebold CA, Almeida QJ. An evaluation of mechanisms underlying the influence of step cues on gait in Parkinson’s disease. J Clin Neurosci. 2011;18:798–802. doi: 10.1016/j.jocn.2010.07.151.
    1. Wulf G, Landers M, Lewthwaite R, Tollner T. External focus instructions reduce postural instability in individuals with Parkinson disease. Phys Ther. 2009;89:162–168. doi: 10.2522/ptj.20080045.
    1. Nieuwboer A, Kwakkel G, Rochester L, Jones D, van Wegen E, Willems AM, Chavret F, Hetherington V, Baker K, Lim I. Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. J Neurol Neurosurg Psychiatry. 2007;78:134–140. doi: 10.1136/jnnp.200X.097923.
    1. Allen NE, Sherrington C, Suriyarachchi GD, Paul SS, Song J, Canning CG. Exercise and motor training in people with Parkinson’s disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. Parkinsons Dis. 2012;2012:854328.
    1. Kallings LV, Leijon M, Hellenius ML, Stahle A. Physical activity on prescription in primary health care: a follow-up of physical activity level and quality of life. Scand J Med Sci Sports. 2008;18:154–161.
    1. Leijon ME, Bendtsen P, Nilsen P, Festin K, Stahle A. Does a physical activity referral scheme improve the physical activity among routine primary health care patients? Scand J Med Sci Sports. 2009;19:627–636. doi: 10.1111/j.1600-0838.2008.00820.x.
    1. Morris ME. Locomotor training in people with Parkinson disease. Phys Ther. 2006;86:1426–1435. doi: 10.2522/ptj.20050277.
    1. Word Health Organization. International Classification of Functioning, Disability and Health. ICF, Geneva; 2001.
    1. Cohen H, Blatchly CA, Gombash LL. A study of the clinical test of sensory interaction and balance. Phys Ther. 1993;73:346–351.
    1. Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med. 2010;42:323–331.
    1. Jacobs JV, Horak FB, Tran VK, Nutt JG. Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006;77:322–326.
    1. Jarnlo GB NE. Reliability of the modified figure of eight – a balance performance test for elderly women. Physiother Theory Pract. 2003;19:35–43. doi: 10.1080/09593980307969.
    1. Hagstromer M, Troiano RP, Sjostrom M, Berrigan D. Levels and patterns of objectively assessed physical activity–a comparison between Sweden and the United States. Am J Epidemiol. 2010;171:1055–1064. doi: 10.1093/aje/kwq069.
    1. Fahn SER. In: Recent Developments in Parkinson Diseases. Fahn SMD, Calne D, editor. Macmillan, London; 1987. Unified Parkinson’s disease rating scale; pp. 153–163.
    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;34:614–9. doi: 10.1093/ageing/afi196.
    1. Brown CA, Cheng EM, Hays RD, Vassar SD, Vickrey BG. SF-36 includes less Parkinson Disease (PD)-targeted content but is more responsive to change than two PD-targeted health-related quality of life measures. Qual Life Res. 2009;18:1219–1237. doi: 10.1007/s11136-009-9530-y.
    1. Sullivan M, Karlsson J, Ware JE Jr. The Swedish SF-36 Health Survey–I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995;41:1349–58. doi: 10.1016/0277-9536(95)00125-Q.
    1. Fitzpatrick R, Peto V, Jenkinson C, Greenhall R, Hyman N. Health-related quality of life in Parkinson’s disease: a study of outpatient clinic attenders. Mov Disord. 1997;12:916–922. doi: 10.1002/mds.870120613.
    1. Duncan RP, Earhart GM. Randomized controlled trial of community-based dancing to modify disease progression in Parkinson disease. Neurorehabil Neural Repair. 2012;26:132–143. doi: 10.1177/1545968311421614.
    1. Yogev-Seligmann G, Giladi N, Brozgol M, Hausdorff JM. A training program to improve gait while dual tasking in patients with Parkinson’s disease: a pilot study. Arch Phys Med Rehabil. 2012;93:176–181. doi: 10.1016/j.apmr.2011.06.005.
    1. Morris ME, Menz HB, McGinley JL, Huxham FE, Murphy AT, Iansek R, Danoudis M, Soh SE, Kelly D, Watts JJ. Falls and mobility in Parkinson’s disease: protocol for a randomised controlled clinical trial. BMC Neurol. 2011;11:93. doi: 10.1186/1471-2377-11-93.
    1. Canning CG, Sherrington C, Lord SR, Fung VS, Close JC, Latt MD, Howard K, Allen NE, O’Rourke SD, Murray SM. Exercise therapy for prevention of falls in people with Parkinson’s disease: a protocol for a randomised controlled trial and economic evaluation. BMC Neurol. 2009;9:4. doi: 10.1186/1471-2377-9-4.
    1. Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord. 2010;25:2649–2653. doi: 10.1002/mds.23429.

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