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Effects of a sensory-motor orthotic on postural instability rehabilitation in Parkinson's disease: a pilot study.

ABSTRACT: Proprioceptive deficits have been largely documented in PD patients, thus external sensory signals (peripheral sensory feedback) are often used to compensate the abnormalities of proprioceptive integration. This pilot study aims to evaluate the feasibility and the effectiveness of a rehabilitation-training program, combined with the use of a sensory-motor orthotic in improving balance in a small sample of PD patients.Twenty PD patients were randomly allocated into two groups: (i) the Experimental group, where participants were asked to wear a sensory-motor orthotic during the balance training program and (ii) the Control group, where subjects performed an identical training program without wearing any kind of orthotics. In all, the training program lasted 10 sessions (5 days a week for 2 weeks) and the clinical and instrumental assessments were performed at baseline, immediately after the end of the training and 4 weeks after the rehabilitative program was stopped.All clinical outcome measures tested improved significantly at post and follow-up evaluations in both groups. Interestingly, at the end of the training, only the experimental group obtained a significant improvement in the functional reaching test (sway area - eyes closed) measured by means of stabilometric platform and this result was maintained in the follow-up evaluation.Our preliminary results suggested that the use of a sensory-motor orthotic, in combination with a tailored balance training, is feasible and it seems to positively impact on balance performance in Parkinson's disease.EudraCT N. 003020-36 - 2013.

SUBMITTER: Volpe D

PROVIDER: S-EPMC5498915 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:BackgroundMuscle spindles endings are extremely sensitive to externally applied vibrations, and under such circumstances they convey proprioceptive inflows to the central nervous system that modulate the spinal reflexes excitability or the muscle responses elicited by postural perturbations. The aim of this pilot study is to test the feasibility and effectiveness of a balance training program in association with a wearable proprioceptive stabilizer (Equistasi) that emits focal mechanical vibrations in patients with PD.MethodsForty patients with PD were randomly divided in two groups wearing an active or inactive device. All the patients received a 2-month intensive program of balance training. Assessments were performed at baseline, after the rehabilitation period (T1), and two more months after (T2). Posturographic measures were used as primary endpoint; secondary measures of outcome included the number of falls and several clinical scales for balance and quality of life.ResultsBoth groups improved at the end of the rehabilitation period and we did not find significant between-group differences in any of the principal posturographic measures with the exception of higher sway area and limit of stability on the instrumental functional reach test during visual deprivation at T1 in the Equistasi group. As for the secondary outcome, we found an overall better outcome in patients enrolled in the Equistasi group: 1) significant improvement at T1 on Berg Balance Scale (+45.0%, p = .026), Activities-specific Balance Confidence (+83.7, p = .004), Falls Efficacy Scale (-33.3%, p = .026) and PDQ-39 (-48.8%, p = .004); 2) sustained improvement at T2 in terms of UPDRS-III, Berg Balance Scales, Time Up and Go and PDQ-39; 3) significant and sustained reduction of the falls rate.ConclusionsThis pilot trial shows that a physiotherapy program for training balance in association with focal mechanical vibration exerted by a wearable proprioceptive stabilizer might be superior than rehabilitation alone in improving patients' balance.Trial registrationEudraCT 2013-003020-36 and ClinicalTrials.gov (number not assigned).

Project description:Background: Postural instability is a debilitating and largely treatment-resistant symptom of Parkinson's disease (PD). A better understanding of the neural substrates contributing to postural instability could lead to new targets for improved pharmacological and neurosurgical interventions. However, investigating these neural substrates necessitates the use of functional MRI scanners, which are almost exclusively horizontally-based. Objective: We aimed to develop, and validate the use of, an MRI compatible balance simulator to study static and dynamic balance control in PD patients and elderly controls. Methods: Our MRI compatible balance simulator allowed participants to actively balance an inverted pendulum by activating postural muscles around the ankle joint while supine. Two studies were performed to compare static and dynamic balance performance between upright stance and simulated stance in PD patients and controls. Study 1 (14 PD; 20 controls) required participants to maintain static balance during upright and simulated stance for 120 s with eyes open and closed. In study 2 (20 PD; 22 controls) participants repeated the static balance task (80 s, eyes closed only), and also completed a dynamic balance task which required maintaining balance while experiencing random anterior-posterior perturbations applied to the trunk/pendulum. Postural sway of the body/pendulum was measured using an angular velocity sensor (SwayStarTM, study 1) and Optotrak motion capture (study 2). Outcome measures were amplitude and frequency of center of mass sway for static balance, and peak and time-to-peak of center of mass displacement and velocity for dynamic balance. Results: PD patients had larger sway amplitude during both upright and simulated static balance compared to controls. PD patients had larger peak and time-to-peak sway, and larger time-to-peak sway velocity, during simulated, but not upright, dynamic balance compared to controls. Conclusions: Deficits in static and dynamic balance control can be detected in PD patients using a novel MRI compatible balance simulator. This technique allows for functional neuroimaging to be combined with balance-relevant tasks, and provides a new means to create insights into the neural substrates contributing to postural instability in PD.

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Effects of a sensory-motor orthotic on postural instability rehabilitation in Parkinson's disease: a pilot study.

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