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Capato T.1,2, Tornai J.1,2, Avila P.2, Barbosa E.R.3, Piemonte M.E.1
1University of São Paulo, Physicaltherapy, São Paulo, Brazil, 2PHYSICAL, Physicaltherapy, Sāo Paulo, Brazil, 3University of São Paulo, Neuroloy, São Paulo, Brazil
Background: Postural instability is a particularly incapacitating disorder, where loss of motor independence by Parkinson´s Disease (PD) patients marks a significant stage of disease onset. Evidence suggests that deficits in automatic motor control, sensory integration and attention are associated with lack of balance in PD. Physiotherapy, together with medication, plays an important role in the treatment of this state, although no consensus has been reached on the best treatment modality.
Purpose: Is to evaluate the effects of balance training with rhythmical (BRT), which is a motor program to improve balance associated with rhythmical auditory cues (RACs). This study is ongoing in the stage 1 to 2.
Methods: A total of 150 PD patients at H&Y stages IIIII and asymptomatic for depression and dementia were enrolled in a single-blind randomized study. Randomization was achieved via a computer-generated random-sequence table. All patients should also present a fall history. They were assigned into one of three groups, and their balance and gait were assessed before and after 10 training sessions, and after 4 and 30 weeks subsequent to the end of the training. The BRT group received a motor program to improve balance associated with RACs, the MT group performed motor training with the same aims as those in the BRT group but without RACs, and the control group (CG) was trained only in orientations. The exercise program specific to balance is of 5 weeks duration with two sessions per week, 45 minutes each, and consists of general physiotherapy exercises. Each session is divided into five warm-up minutes30 minutes for the main part and 10 minutes for the cool down. The training progresses and intensifies each week depending on the individuals performance. The subjects should be able to execute 10 repetitions of the exercise sequences correctly to progress to the next movement.
Results: The effect sizes (ES) were calculated for all comparisons at alpha = 0.05. A Tukey HSD post-hoc test will be used for multiple comparisons. The results showed improvement after treatment on BRT and MT Groups TUG (p=0,01), 6 min walk (p=0,00). To BBS (p=0,00), Mini BESTest (p=0,00) only to BRT showed significative difference. A strong correlation was found between dosage (improve number of repetitions) and improve balance and reduced falls. Over the long term (P=0.05), there was evidence the decrease the number of falls and improve balance and gait performance.
Conclusion(s): This protocol could be effective to improve balance and gait; evaluate the effects of a motor program to improve balance associated with RACs and assess whether balance training leads to activation of balance reactions. We suggest that balance training should be started early.
Implications: The physiotherapy proposed to improve balance in PD is effective, low-cost, and easy to apply. This study contributes to the subject knowledge, with specific knowledge about balance in PD patients and the mechanisms involved in motor control. It also provides data about functional diagnosis, prognosis, clinical programs, and the management of balance treatment programs. This program may also be allied to different sorts of parkinsonisms and other motor disorders that influence balance.
Funding acknowledgements: FMUSP
Topic: Neurology: Parkinson's disease
Ethics approval: Clinicaltrials.gov NCT02488265; Ethics Committee of the University of São Paulo Faculty of Medicine Clinics Hospital
All authors, affiliations and abstracts have been published as submitted.
