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Audio-biofeedback training for posture and balance in patients with Parkinson's disease.

Mirelman A, Herman T, Nicolai S, Zijlstra A, Zijlstra W, Becker C, Chiari L, Hausdorff JM - J Neuroeng Rehabil (2011)

Bottom Line: Non-parametric statistics were used to evaluate training effects.The ABF system was well accepted by all participants with no adverse events reported.This is, to our knowledge, the first report demonstrating that audio-biofeedback training for patients with PD is feasible and is associated with improvements of balance and several psychosocial aspects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Laboratory for Gait and Neurodynamics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. anatmi@tasmc.health.gov.il

ABSTRACT

Background: Patients with Parkinson's disease (PD) suffer from dysrhythmic and disturbed gait, impaired balance, and decreased postural responses. These alterations lead to falls, especially as the disease progresses. Based on the observation that postural control improved in patients with vestibular dysfunction after audio-biofeedback training, we tested the feasibility and effects of this training modality in patients with PD.

Methods: Seven patients with PD were included in a pilot study comprised of a six weeks intervention program. The training was individualized to each patient's needs and was delivered using an audio-biofeedback (ABF) system with headphones. The training was focused on improving posture, sit-to-stand abilities, and dynamic balance in various positions. Non-parametric statistics were used to evaluate training effects.

Results: The ABF system was well accepted by all participants with no adverse events reported. Patients declared high satisfaction with the training. A significant improvement of balance, as assessed by the Berg Balance Scale, was observed (improvement of 3% p = 0.032), and a trend in the Timed up and go test (improvement of 11%; p = 0.07) was also seen. In addition, the training appeared to have a positive influence on psychosocial aspects of the disease as assessed by the Parkinson's disease quality of life questionnaire (PDQ-39) and the level of depression as assessed by the Geriatric Depression Scale.

Conclusions: This is, to our knowledge, the first report demonstrating that audio-biofeedback training for patients with PD is feasible and is associated with improvements of balance and several psychosocial aspects.

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Related in: MedlinePlus

A schema of the study procedure.
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Figure 1: A schema of the study procedure.

Mentions: In this pilot intervention study, a repeated measures design with a six week intervention program was used. We aimed to improve posture, static and dynamic balance and activities of daily living (ADLs) such as rising from sit to stand and reaching. Seven patients with PD (mean age 71.4 years, range 59-85 years; 1 female, 6 males) were recruited from the Movement Disorders Unit at Tel Aviv Sourasky Medical Center (TASMC) and enrolled in this intervention study. Inclusion criteria included a diagnosis of idiopathic PD (at least 2 years), the ability to walk independently without a walking aid, and the absence of serious co-morbidities that could impact gait or balance. Patients were excluded if they suffered from major depression, Mini Mental Status Examination [22] score <24, had clinically significant hearing problems which may hinder their ability to hear the feedback sound provided, or were medically unstable. The assessments were performed at baseline (within one week before the beginning of the intervention), immediately post training (within one week after the last training session) and four weeks after the completion of the training (follow-up assessment). Each training session lasted approximately 45 minutes (see Figure 1) and was provided by a physical therapist three times a week at the Laboratory for Gait and Neurodynamics at TASMC. Five patients also received several training sessions (up to 3 training sessions) in their home to explore the possibility for future independent home training with the ABF system. The home sessions were performed in the last 2 weeks of the training, when patients were already familiar with the system and could attempt to use it independently with only the supervision of the therapist. The study was approved by the ethical committee of the local medical center. Written consent form was provided by all participants.


Audio-biofeedback training for posture and balance in patients with Parkinson's disease.

Mirelman A, Herman T, Nicolai S, Zijlstra A, Zijlstra W, Becker C, Chiari L, Hausdorff JM - J Neuroeng Rehabil (2011)

A schema of the study procedure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3142211&req=5

Figure 1: A schema of the study procedure.
Mentions: In this pilot intervention study, a repeated measures design with a six week intervention program was used. We aimed to improve posture, static and dynamic balance and activities of daily living (ADLs) such as rising from sit to stand and reaching. Seven patients with PD (mean age 71.4 years, range 59-85 years; 1 female, 6 males) were recruited from the Movement Disorders Unit at Tel Aviv Sourasky Medical Center (TASMC) and enrolled in this intervention study. Inclusion criteria included a diagnosis of idiopathic PD (at least 2 years), the ability to walk independently without a walking aid, and the absence of serious co-morbidities that could impact gait or balance. Patients were excluded if they suffered from major depression, Mini Mental Status Examination [22] score <24, had clinically significant hearing problems which may hinder their ability to hear the feedback sound provided, or were medically unstable. The assessments were performed at baseline (within one week before the beginning of the intervention), immediately post training (within one week after the last training session) and four weeks after the completion of the training (follow-up assessment). Each training session lasted approximately 45 minutes (see Figure 1) and was provided by a physical therapist three times a week at the Laboratory for Gait and Neurodynamics at TASMC. Five patients also received several training sessions (up to 3 training sessions) in their home to explore the possibility for future independent home training with the ABF system. The home sessions were performed in the last 2 weeks of the training, when patients were already familiar with the system and could attempt to use it independently with only the supervision of the therapist. The study was approved by the ethical committee of the local medical center. Written consent form was provided by all participants.

Bottom Line: Non-parametric statistics were used to evaluate training effects.The ABF system was well accepted by all participants with no adverse events reported.This is, to our knowledge, the first report demonstrating that audio-biofeedback training for patients with PD is feasible and is associated with improvements of balance and several psychosocial aspects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Laboratory for Gait and Neurodynamics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. anatmi@tasmc.health.gov.il

ABSTRACT

Background: Patients with Parkinson's disease (PD) suffer from dysrhythmic and disturbed gait, impaired balance, and decreased postural responses. These alterations lead to falls, especially as the disease progresses. Based on the observation that postural control improved in patients with vestibular dysfunction after audio-biofeedback training, we tested the feasibility and effects of this training modality in patients with PD.

Methods: Seven patients with PD were included in a pilot study comprised of a six weeks intervention program. The training was individualized to each patient's needs and was delivered using an audio-biofeedback (ABF) system with headphones. The training was focused on improving posture, sit-to-stand abilities, and dynamic balance in various positions. Non-parametric statistics were used to evaluate training effects.

Results: The ABF system was well accepted by all participants with no adverse events reported. Patients declared high satisfaction with the training. A significant improvement of balance, as assessed by the Berg Balance Scale, was observed (improvement of 3% p = 0.032), and a trend in the Timed up and go test (improvement of 11%; p = 0.07) was also seen. In addition, the training appeared to have a positive influence on psychosocial aspects of the disease as assessed by the Parkinson's disease quality of life questionnaire (PDQ-39) and the level of depression as assessed by the Geriatric Depression Scale.

Conclusions: This is, to our knowledge, the first report demonstrating that audio-biofeedback training for patients with PD is feasible and is associated with improvements of balance and several psychosocial aspects.

Show MeSH
Related in: MedlinePlus