Blindfolded Balance Training in Patients with Parkinson's Disease: A Sensory-Motor Strategy to Improve the Gait

Aim. Recent evidence suggested that the use of treadmill training may improve gait parameters. Visual deprivation could engage alternative sensory strategies to control dynamic equilibrium and stabilize gait based on vestibulospinal reflexes (VSR). We aimed to investigate the efficacy of a blindfolded balance training (BBT) in the improvement of stride phase percentage reliable gait parameters in patients with Parkinson's Disease (PD) compared to patients treated with standard physical therapy (PT). Methods. Thirty PD patients were randomized in two groups of 15 patients, one group treated with BBT during two weeks and another group treated with standard PT during eight weeks. We evaluated gait parameters before and after BBT and PT interventions, in terms of double stance, swing, and stance phase percentage. Results. BBT induced an improvement of double stance phase as revealed (decreased percentage of double stance phase during the gait cycle) in comparison to PT. The other gait parameters swing and stance phase did not differ between the two groups. Discussion. These results support the introduction of complementary rehabilitative strategies based on sensory-motor stimulation in the traditional PD patient's rehabilitation. Further studies are needed to investigate the neurophysiological circuits and mechanism underlying clinical and motor modifications.

[1]  Bradford J. McFadyen,et al.  Vestibular contributions across the execution of a voluntary forward step , 2002, Experimental Brain Research.

[2]  Ann Ashburn,et al.  Developing methods to evaluate how people with Parkinson's Disease turn 180°: an activity frequently associated with falls , 2004 .

[3]  A. Mulavara,et al.  Effects of Stochastic Vestibular Galvanic Stimulation and LDOPA on Balance and Motor Symptoms in Patients With Parkinson's Disease , 2015, Brain Stimulation.

[4]  B. Bloem,et al.  Allied health care interventions and complementary therapies in Parkinson's disease. , 2007, Parkinsonism & related disorders.

[5]  J. Friedman,et al.  Effects of fatigue on physical activity and function in patients with Parkinson’s disease , 2003, Neurology.

[6]  C Caltagirone,et al.  Does gait analysis quantify motor rehabilitation efficacy in Parkinson's disease patients? , 2007, Gait & posture.

[7]  R. Peterka,et al.  Sensory reweighting dynamics in human postural control. , 2014, Journal of neurophysiology.

[8]  Luc Janssens,et al.  A new method to analyze postural stability during a transition task from double-leg stance to single-leg stance. , 2013, Journal of biomechanics.

[9]  R. B. Davis,et al.  A gait analysis data collection and reduction technique , 1991 .

[10]  L. King,et al.  Effects of exercise on mobility in people with Parkinson's disease , 2013, Movement disorders : official journal of the Movement Disorder Society.

[11]  Q. Almeida,et al.  Proprioceptive deficits in Parkinson's disease patients with freezing of gait , 2011, Neuroscience.

[12]  L. Ada,et al.  Walking capacity in mild to moderate Parkinson's disease. , 2006, Archives of physical medicine and rehabilitation.

[13]  Heather Gage,et al.  Rehabilitation for Parkinson's disease: a systematic review of available evidence , 2004, Clinical rehabilitation.

[14]  Michael R. Ibbotson,et al.  The role of visual deprivation and experience on the performance of sensory substitution devices , 2015, Brain Research.

[15]  Nikolaus R. McFarland,et al.  Defining the Clinically Meaningful Difference in Gait Speed in Persons With Parkinson Disease , 2014, Journal of neurologic physical therapy : JNPT.

[16]  N. A. Abu Osman,et al.  Are the spatio-temporal parameters of gait capable of distinguishing a faller from a non-faller elderly? , 2014, European journal of physical and rehabilitation medicine.

[17]  G. G. Stokes.  "J." , 1890, The New Yale Book of Quotations.

[18]  Alexander Storch,et al.  Treadmill training for patients with Parkinson's disease. , 2010, The Cochrane database of systematic reviews.

[19]  Catherine Sackley,et al.  Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis , 2012, BMJ : British Medical Journal.

[20]  S. Fahn.  Members of the UPDRS Development Committee. Unified Parkinson's Disease Rating Scale , 1987 .

[21]  Thomas Rosemeier,et al.  Interaction of vestibular, somatosensory and visual signals for postural control and motion perception under terrestrial and microgravity conditions—a conceptual model , 1998, Brain Research Reviews.

[22]  F. Horak,et al.  Abnormal proprioceptive-motor integration contributes to hypometric postural responses of subjects with parkinson’s disease , 2006, Neuroscience.

[23]  J. T. Inglis,et al.  Vestibular Contributions during Human Locomotor Tasks , 2005, Exercise and sport sciences reviews.

[24]  Q. Almeida,et al.  Can sensory attention focused exercise facilitate the utilization of proprioception for improved balance control in PD? , 2015, Gait & posture.

[25]  P. Terrier,et al.  Role of visual input in the control of dynamic balance: variability and instability of gait in treadmill walking while blindfolded , 2014, Experimental Brain Research.

[26]  H. Vankova.  Mini Mental State , 2010 .

[27]  Shahram Attarian,et al.  A motor cortex excitability and gait analysis on Parkinsonian patients , 2010, Movement disorders : official journal of the Movement Disorder Society.

[28]  Lynn Rochester,et al.  Progression of gait dysfunction in incident Parkinson's disease: Impact of medication and phenotype , 2015, Movement disorders : official journal of the Movement Disorder Society.

[29]  K Matsuyama,et al.  Vestibulospinal and reticulospinal neuronal activity during locomotion in the intact cat. I. Walking on a level surface. , 2000, Journal of neurophysiology.

[30]  Robert A Koeppe,et al.  Thalamic cholinergic innervation and postural sensory integration function in Parkinson's disease. , 2013, Brain : a journal of neurology.

[31]  Mahmoud Saghaei,et al.  An Overview of Randomization and Minimization Programs for Randomized Clinical Trials , 2011, Journal of medical signals and sensors.

[32]  K Matsuyama,et al.  Vestibulospinal and reticulospinal neuronal activity during locomotion in the intact cat. II. Walking on an inclined plane. , 2000, Journal of neurophysiology.

[33]  W. Marsden.  I and J , 2012 .

[34]  F Huxham,et al.  Defining spatial parameters for non-linear walking. , 2006, Gait & posture.

[35]  Madhuri Behari,et al.  Role of Sensory Input and Muscle Strength in Maintenance of Balance, Gait, and Posture in Parkinson’s Disease: A Pilot Study , 2004, American journal of physical medicine & rehabilitation.

[36]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[37]  Herman van der Kooij,et al.  Gait disorders and balance disturbances in Parkinson's disease: clinical update and pathophysiology , 2008, Current opinion in neurology.

[38]  F. Horak,et al.  Effects of dopamine on postural control in parkinsonian subjects: scaling, set, and tone. , 1996, Journal of neurophysiology.

[39]  Aaas News,et al.  Book Reviews , 1893, Buffalo Medical and Surgical Journal.

[40]  Kathleen E Norman,et al.  Effects of visual and auditory cues on gait initiation in people with Parkinson's disease , 2006, Clinical rehabilitation.

[41]  Marco Schieppati,et al.  The control of equilibrium in Parkinson's disease patients: Delayed adaptation of balancing strategy to shifts in sensory set during a dynamic task , 2007, Brain Research Bulletin.