Effects of supervised slackline training on postural instability, freezing of gait, and falls efficacy in people with Parkinson’s disease

Freezing of gait (FOG) and postural instability are challenging motor symptoms that present a serious therapeutic dilemma in Parkinson’s disease. Appropriate distinction between FOG subtypes may be difficult during routine clinical visits, as shown in the case we present. The patient was examined in three different states in relation to levodopa (L-DOPA) and apomorphine subcutaneous (sc) tests with video documentation: (1) ‘overnight-off’, after 12 hours without medication; (2)‘on’, 60 min after intake of regular levodopa dose (200 mg) and 20 min after 2 mg of apomorphine sc; and (3) ‘supra-on’, after 350 mg of L-DOPA and 3 mg of apomorphine sc. The patient clearly showed a dose-dependent paradoxical response to L-DOPA treatment with the emergence of severe FOG and postural instability. The tendency to develop these axial symptoms was less pronounced with apomorphine at doses that achieved similar improvements of other Parkinsonian features.

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Postural and Balance Disorders in Patients with Parkinson’s Disease: A Prospective Open-Label Feasibility Study with Two Months of Action Observation Treatment

Parkinson s Disease ◽

10.1155/2015/902738 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Andrea Santamato ◽

Maurizio Ranieri ◽

Nicoletta Cinone ◽

Lucia Anna Stuppiello ◽

Giovanni Valeno ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Feasibility Study ◽

Action Observation ◽

Freezing Of Gait ◽

Postural Instability ◽

Open Label ◽

Balance Disorders ◽

The Impact

Action observation treatment has been proposed as therapeutic option in rehabilitation of patients affected by Parkinson’s disease (PD) to improve freezing of gait episodes. The purpose of this prospective open-label feasibility study was to evaluate the impact of 8-week action observation training (video-therapy) for the treatment of postural instability and balance impairment in PD patients. Fifteen PD patients aged under 80 years with scores of 1 to 3 on the Hoehn and Yahr staging and without evidence of freezing of gait were recruited. They underwent 24 sessions of video-therapy training based on carefully watching video clips on motor tasks linked to balance, subsequently performing the same observed movements. No statistically significant differences were observed in the identified outcome measures with the Berg Balance Scale and the Activities-Specific Balance Confidence Scale after two months of follow-up. In the present study, a short course of action observation treatment seems to be not effective in reducing balance impairments and postural instability in patients affected by mild to moderate PD. Further studies with larger samples, longer follow-up period, and standardized protocols of action observation treatment are needed to investigate the effects of this rehabilitation technique in the management of postural and balance disorders of PD patients.

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The Methods of Detection of Gait Disturbance and Postural Instability in Case of Parkinson’s Disease

Science and Innovations in Medicine ◽

10.35693/2500-1388-2018-0-2-37-40 ◽

2018 ◽

Vol 3 (2) ◽

pp. 37-40

Author(s):

IE E Poverennova ◽

VA A Kalinin ◽

SA A Shpileva

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scales ◽

Rating Scale ◽

Neurological Diseases ◽

Freezing Of Gait ◽

Postural Instability ◽

Motor Disorders ◽

Medication Therapy ◽

Disease Rating

Parkinson’s disease takes first place among neurological diseases of senior persons and its prevalence consists of 2% among people elderly than 65 years old. Disturbance of gait and postural instability are the most important motor disorders in case of Parkinson’s disease. Aim - to reveal factors which influence on the falling down of patients with Parkinson’s disease. Materials and methods. The use of unified Parkinson’s disease rating scale for examination of patients with Parkinson’s disease was performed. Results of rating scales were analyzed due to regression analysis. Results. It was revealed that the most important factor of falling down is the disturbance of gait. Freezing of gait has little influence on falling. Conclusion. The use of such diagnostic tests in the routine neurological examination allows to optimize medication therapy and to use modern non- medication methods of correction of gait.

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Do Patients With Parkinson’s Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality?

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320912756 ◽

2020 ◽

Vol 34 (5) ◽

pp. 440-449 ◽

Cited By ~ 3

Author(s):

Esther M. J. Bekkers ◽

Anat Mirelman ◽

Lisa Alcock ◽

Lynn Rochester ◽

Freek Nieuwhof ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Virtual Reality ◽

Evaluation System ◽

Freezing Of Gait ◽

Secondary Analysis ◽

Postural Instability ◽

Treadmill Walking ◽

Treadmill Training ◽

Trail Making

Background. People with Parkinson’s disease and freezing of gait (FOG+) have more falls, postural instability and cognitive impairment compared with FOG−. Objective. To conduct a secondary analysis of the V-TIME study, a randomized, controlled investigation showing a greater reduction of falls after virtual reality treadmill training (TT + VR) compared with usual treadmill walking (TT) in a mixed population of fallers. We addressed whether these treadmill interventions led to similar gains in FOG+ as in FOG−. Methods. A total of 77 FOG+ and 44 FOG− were assigned randomly to TT + VR or TT. Participants were assessed pre- and posttraining and at 6 months’ follow-up. Main outcome was postural stability assessed by the Mini Balance Evaluation System Test (Mini-BEST) test. Falls were documented using diaries. Other outcomes included the New Freezing of Gait Questionnaire (NFOG-Q) and the Trail Making Test (TMT-B). Results. Mini-BEST scores and the TMT-B improved in both groups after training ( P = .001), irrespective of study arm and FOG subgroup. However, gains were not retained at 6 months. Both FOG+ and FOG− had a greater reduction of falls after TT + VR compared with TT ( P = .008). NFOG-Q scores did not change after both training modes in the FOG+ group. Conclusions. Treadmill walking (with or without VR) improved postural instability in both FOG+ and FOG−, while controlling for disease severity differences. As found previously, TT + VR reduced falls more than TT alone, even among those with FOG. Interestingly, FOG itself was not helped by training, suggesting that although postural instability, falls and FOG are related, they may be controlled by different mechanisms.

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