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Resistance versus Balance Training to Improve Postural Control in Parkinson's Disease: A Randomized Rater Blinded Controlled Study.

ABSTRACT: Reduced muscle strength is an independent risk factor for falls and related to postural instability in individuals with Parkinson's disease. The ability of resistance training to improve postural control still remains unclear.To compare resistance training with balance training to improve postural control in people with Parkinson's disease.40 patients with idiopathic Parkinson's disease (Hoehn&Yahr: 2.5-3.0) were randomly assigned into resistance or balance training (2x/week for 7 weeks). Assessments were performed at baseline, 8- and 12-weeks follow-up: primary outcome: Fullerton Advanced Balance (FAB) scale; secondary outcomes: center of mass analysis during surface perturbations, Timed-up-and-go-test, Unified Parkinson's Disease Rating Scale, Clinical Global Impression, gait analysis, maximal isometric leg strength, PDQ-39, Beck Depression Inventory. Clinical tests were videotaped and analysed by a second rater, blind to group allocation and assessment time.32 participants (resistance training: n = 17, balance training: n = 15; 8 drop-outs) were analyzed at 8-weeks follow-up. No significant difference was found in the FAB scale when comparing the effects of the two training types (p = 0.14; effect size (Cohen's d) = -0.59). Participants from the resistance training group, but not from the balance training group significantly improved on the FAB scale (resistance training: +2.4 points, Cohen's d = -0.46; balance training: +0.3 points, Cohen's d = -0.08). Within the resistance training group, improvements of the FAB scale were significantly correlated with improvements of rate of force development and stride time variability. No significant differences were found in the secondary outcome measures when comparing the training effects of both training types.The difference between resistance and balance training to improve postural control in people with Parkinson's disease was small and not significant with this sample size. There was weak evidence that freely coordinated resistance training might be more effective than balance training. Our results indicate a relationship between the enhancement of rate of force development and the improvement of postural control.ClinicalTrials.gov ID: NCT02253563.

SUBMITTER: Schlenstedt C

PROVIDER: S-EPMC4621054 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Resistance versus Balance Training to Improve Postural Control in Parkinson's Disease: A Randomized Rater Blinded Controlled Study.

Schlenstedt Christian C Paschen Steffen S Kruse Annika A Raethjen Jan J Weisser Burkhard B Deuschl Günther G

PloS one 20151026 10

<h4>Background</h4>Reduced muscle strength is an independent risk factor for falls and related to postural instability in individuals with Parkinson's disease. The ability of resistance training to improve postural control still remains unclear.<h4>Objective</h4>To compare resistance training with balance training to improve postural control in people with Parkinson's disease.<h4>Methods</h4>40 patients with idiopathic Parkinson's disease (Hoehn&Yahr: 2.5-3.0) were randomly assigned into resista ...[more]

PMID: 26501562

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Project description:BackgroundPostural 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.Methods and designA 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.DiscussionThis 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.Trial registrationClinicaltrials.gov NCT02488265 ; Ethics Committee of the University of São Paulo Faculty of Medicine Clinics Hospital 1.102.464.

Project description:Performance appraisal is a complex process by which an organization can determine the extent to which employees are performing their work effectively. However, this appraisal may not be accurate if there is no reduction in the impact of problems caused by possibly subjective rater judgements. The main objective of this work is to check the effectiveness-separately and jointly-of the following four training programmes in the extant literature aimed at improving the accuracy of performance assessment: 1) Performance Dimension Training, 2) Frame-of-Reference, 3) Rater Error Training, and 4) Behavioural Observation Training. Based on these training strategies, three programmes were designed and applied separately. A fourth programme was a combination of the other three. We analyzed two studies using different samples (85 students and 42 employees) for the existence of differences in the levels of knowledge of performance and its dimensions, rater errors, observational accuracy, and accuracy of task and citizenship performance appraisal, according to the type of training raters receive. First, the main results show that training based on performance dimensions and the creation of a common framework, in addition to the training that includes the four programmes (Training_4_programmes), increases the level of knowledge of performance and its dimensions. Second, groups that receive training in rater error score higher in knowledge of biases than the other groups, whether or not they have received training. Third, participants' observational accuracy improves with each new moment measure (post-training and follow-up), though not because of the type of training received. Fourth, participants who receive training through the programme that combine the other four gave a task performance appraisal that was closer to the one undertaken by the judges-experts than the other groups. And finally, students' citizenship performance appraisal does not vary according to type of training or to different moment measures, whereas the group of employees who received all four types of training gave a more accurate citizenship performance assessment.

Project description:BackgroundBalance challenges are associated with not only the aging process but also a wide variety of psychiatric and neurological disorders. However, relatively little is known regarding the neural basis of balance and the effects of balance interventions on the brain.Research questionThis review synthesizes the existing literature to answer the question: What are the key brain structures associated with balance?MethodsThis review examined 37 studies that assessed brain structures in relation to balance assessment or intervention. These studies provided 234 findings implicating 71 brain structures. The frequency of implication for each structure was examined based upon specific methodological parameters, including study design (assessment/intervention), type of balance measured (static/dynamic), population (clinical/non-clinical), and imaging analysis technique (region of interest [ROI]/voxel-based morphometry [VBM]).ResultsAlthough a number of structures were associated with balance across the brain, the most frequently implicated structures included the cerebellum, basal ganglia, thalamus, hippocampus, inferior parietal cortex, and frontal lobe regions. Findings in the cerebellum and brainstem were most common in studies with clinical populations, studies that used an ROI approach, and studies that measured dynamic balance. Findings in the frontal, occipital, and parietal regions were also more common in studies that measured dynamic compared to static balance.SignificanceWhile balance appears to be a whole-brain phenomenon, a subset of structures appear to play a key role in balance and are likely implicated in balance disorders. Some of these structures (i.e., the cerebellum, basal ganglia and thalamus) have a well-appreciated role in balance, whereas other regions (i.e., hippocampus and inferior parietal cortex) are not commonly thought to be associated with balance and therefore may provide alternative explanations for the neural basis of balance. Key avenues for future research include understanding the roles of all regions involved in balance across the lifespan and in different clinical populations.

Dataset Information

Resistance versus Balance Training to Improve Postural Control in Parkinson's Disease: A Randomized Rater Blinded Controlled Study.

Publications

Resistance versus Balance Training to Improve Postural Control in Parkinson's Disease: A Randomized Rater Blinded Controlled Study.

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