Randomized controlled trial protocol: balance training with rhythmical cues to improve and maintain balance control in Parkinson’s disease
Tóm tắt
Postural instability is a particularly incapacitating disorder, whose 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 the lack of balance in PD. Physiotherapy together with medication play an important role in the treatment of this state, although no consensus has been reached on the best treatment modality. The aim of this randomized controlled trial protocol 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. A total of 150 PD patients at H&Y stages II–III and asymptomatic for depression and dementia are enrolled in a single-blind randomized study. Randomization is achieved via a computer-generated random-sequence table. All patients should also present a fall history. They will be assigned into one of three groups, and their balance and gait will be assessed before and after 10 training sessions, and after 4 and 30 weeks subsequent to the end of the training. The BRT group will receive a motor program to improve balance associated with RACs, the MT group will perform motor training with the same aims as those in the BRT group but without RACs, and the control group (CG) will be trained only in orientations. The exercise program specific to balance is of 5 weeks’ duration with two sessions per week, 45 min each, and consists of general physiotherapy exercises. Each session will be divided into five warm-up minutes—30 min for the main part and 10 min for the cool down. The training progresses and intensifies each week depending on the individual’s performance. The subjects should be able to execute 10 repetitions of the exercise sequences correctly to progress to the next movement. This randomized study protocol will evaluate the effects of a motor program designed to improve balance associated with RACs, and will also assess whether balance training leads to activation of balance reactions at the appropriate time. We hypothesize that if this motor program is maintained long-term, it will prevent falls. Clinicaltrials.gov
NCT02488265
; Ethics Committee of the University of São Paulo Faculty of Medicine Clinics Hospital 1.102.464.
Tài liệu tham khảo
Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of Gait in Parkinson’s disease: a review of two interconnected, episodic phenomena. Mov Disord. 2004;19(8):871–84.
Nutt JG, Bloem BR, Gilard N, Hallat M, Horak FB, Niewboer A. Freezing of gait: moving forward on mysterious clinical phenomenon. Lancet Neurol. 2011;10:734–44.
Mancini M, Carlson-Kuhta P, Zampieri C, Nutt JG, Chiari L, Horak FB. Postural sway as a marker of progression in Parkinson’s disease: A pilot longitudinal study. Gait & Posture. 2012;36:471–6.
Mancini M, Horak FB, Zampieri C, Carlson-Kuhta P, Nutt JG, Chiari L. Trunk accelerometry reveals postural instability in untreated Parkinson’s disease. Parkinsonism Related Disorders. 2011;17(August (7)):557–62.
Jacobs JV, Horak FB. Abnoirmal proprioceptive motor ntegration contributes to hypometric postural resposnses of subjects with Parkinson´s disease. Neuroscience. 2006;141:999–1009.
Wirght WG, Gurfinkel VS, Nutt J, Horak FB, Cordo PJ. Axial hypertonicity in Parkinson´s Disease:direct measurements of trunk and hip torque. ExplNeurol. 2007;208:38–46.
Franzé E, Paquette C, Gurfinkel VS, Cordo PJ, Nutt, Horak FB. Reduced performance in balance, walking and tourning tasks is associated with increased neck torre in Parkinson´s disease. Ex Neurol. 2009;219:430–8.
Viitasalo MK, Kampman V, Sotaniemi KA, Leppavvori S, Myllyla VV, Korpelainen JT. Analysis of sway in Parkinson´s disease using a new inclinometry based method. Mov Disord. 2002;17:663–9.
Abbruzzese G, Berardelli A. Sensorimotor integration in movement disorders. Mov Disord. 2003;18:231–40.
Ekman U, Eriksson J, Forsgren L, Mo SJ, Riklund K, Nyberg L. Functional brain activity and presynaptic dopamine uptake in patients with Parkinson’s disease and mild cognitive impairment: a cross-sectional study. Lancet Neurol. 2012;11:679–87.
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.
Marchese R, Bove M, Abbruzzese G. Effect Of Cognitive And Motor Tasks On Postural Stability In Parkinson Disease: A Posturographic Study. Movement Disorders. 2003;18(6):652–8.
Maetzler W, Domingos J, Srulijes K, Ferreira JJ, Bloem BR. Movement Disorders. 2013;28(12):1628–37.
Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008;79:368–76.
Tomilison CL, Patel S, Merk C, Herd CP, Clarke CLE, Stowe R, et al. Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis. BMJ. 2012;345:e5004.
Keus SHJ, Munneke M, Graziano M, et al. on behalf of the Guideline Development Group. European Physiotherapy Guideline for Parkinson´s Disease. www.ParkinsonNet.info. Accessed 8 August 2015.
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(4):451–60.
Morris ME. Movement Disorders in people with Parkinson disease: a model for physicaltherapy. Physther. 2000;80:578–97.
Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol. 2013;12:716–26.
Lim I, van Wegen E, Jones D, Rochester L, Nieuwboer A, Willems A, et al. Does Cueing Training Improve Physical Activity in Patients With Parkinson’s Disease? Neurorehabilitation and Neural Repair. 2010;24(5):469–77.
Morris ME. Locomotor training in people with Parkinson´s disease. Physther. 2006;86:1426–35.
Nieuwboer A, Backer, Willems AM, Jones D, Spildooren J, Lim I, et al. The short term effects os different cueing modalities on turn speed in people with Parkinson´s disease. Neurorehabil Neural Repair. 2009;23:831–6.
Nieuwboer A. Cueing for freezing of gait in patients with Parkinson´s Disease: rehabilitation perspective. Mov Disord. 2008;23 Suppl 2:S475–81.
Goodwin VA, Richards SH, Henley W, Ewings P, Taylor AH, Campbell JL. An exercise intervention to prevent falls in people with Parkinson’s disease: a pragmatic randomized controlled trial. J Neurol Neurosurg Psychiatry. 2011;82:1232e1238. doi:10.1136/jnnp-2011-300919.
Allen NA, Sherrington C, Paul SS. BAppScPhty(Hons), Canning,C.G.Balance and Falls in Parkinson’s Disease: A Meta-analysis of the Effect of Exercise and Motor Training. Movement Disorders. 2011;26(9):1605–15.
Capato T, Piemonte M. Global Motor training with rythmical auditory cues improve and maintain balance control in Parkinson´s disease (PD). Mov Disord. 2010;25(2):S292–3.
Smania N, Corato E, Tinazzi M, Stanzani C, Fiaschi A, Girardi P, et al. Effect of balance training on postural instability in patients with idiopathic Parkinson’s Disease. Neurorehabil Neural Repair. 2010;9:826–34.
Rochester L, Baker K, Hetherington V, Jones D, Willems A, Kwakkel G, et al. Evidence for motor learning in Parkinson’s disease: acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues. Brain Res. 2010;1319:103–11.
Li F, Harmer P, Liu Y, Eckstrom E, Fitzgerald K, Stock R, et al. A Randomized Controlled Trial of Patient-Reported Outcomes With Tai Chi Exercise in Parkinson’s Disease. Movement Disorders. 2014;29(4):539–45.
Foster ER, Golden L, Duncan RP, Earhart GM. Community-based Argentine tango dance program is associated with increased activity participation among individuals with Parkinson’s disease. Arch Phys Med Rehabil. 2013;94:240–49.
Pompeu JE, Mendes FA, Silva KG, Lobo AM, Oliveira T de P, Zomignani AP, et al. Effect of Nintendo Wii-based motor and cognitive training on activities of daily living in patients with Parkinson’s disease: a randomised clinical trial. Physiotherapy. 2012;98:196–204.
Griffin H, Greenlaw R, Limousin P, Bhatia K, Quinn N, Jahanshahi M. The effect of real and virtual visual cues on walking in Parkinson’s disease. J Neurol. 2011;258:991–1000.
Wu T, Hallett M. Neural correlates of dual task performance in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2008;79:760–6.
Wu T, Hallett M. Cerebellum and Parkinson’s disease. Brain. 2013;136:696–709.
Hoshi E, Trembalay L, Férger J, Carras PL, Strick P. The cerebellum communicates with the basal ganglia. Nature Neuroscience. 2005;8(11):1491–3.
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(3):4.
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;12:189–98.
Berg K, Wood-Dauphinee S, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83 Suppl 2:S7–S11.
Chandler JM, Duncan PW, Studenski SA. Balance Performance on the Postural Stress Test: Comparison of Young Adults, Healthy Elderly, and Fallers. PHYS THER. 1990;70:410–5.
Horak FB, Jacobs JV, Tran VK, Nutt JG. The push and release test: An improved clinical postural stability test for patients with Parkinson's disease. Movement Disorders. 2004;19:S170.
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;42:323–31.
Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.
Giladi N, Shabtai H, Simon ES, Biran S, Tal J, Korczyn AD. Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord. 2000;6:165–70.
Fahn S, Elton RL. Unified Parkinson’s disease rating scale. In: Teychenne P, editor. Recent developments in Parkinson's disease. New York: Raven; 1986.
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):614–9.
Capato TTC. Eficácia de um programa de treinamento motor para melhora do equilíbrio associado a pistas rítmicas e suas repercussões na marcha e aspectos não motores de pacientes portadores de doença de Parkinson. Master's Dissertation, Instituto de Psicologia, University of São Paulo, São Paulo. 2008. Retrieved 2014-03-20, from http://www.teses.usp.br/teses/disponiveis/47/47135/tde-20032009-123412.
Capato T, Souto P, Zan T, Barbosa ER, Piemonte MEP. Balance Rhythmical Training: A new approach to improve Balance in patients with Parkinson s Disease. Physiotherapy. 2011;97:eS187–8.