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Randomized controlled trial protocol: balance training with rhythmical cues to improve and maintain balance control in Parkinson's disease.

Capato TT, Tornai J, Ávila P, Barbosa ER, Piemonte ME - BMC Neurol (2015)

Bottom Line: 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.This 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Physicaltherapy, University of São Paulo, Av Dr Enéias de Aguiar, 255 - 05403.000, São Paulo, São Paulo, Brazi. taminec@yahoo.com.br.

ABSTRACT

Background: Postural 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 design: A 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.

Discussion: This 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 registration: Clinicaltrials.gov NCT02488265 ; Ethics Committee of the University of São Paulo Faculty of Medicine Clinics Hospital 1.102.464.

No MeSH data available.


Related in: MedlinePlus

Design of the study. BRT: Balance Rhythmical Training. MT: Motor Training. CT: Control Group
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Fig1: Design of the study. BRT: Balance Rhythmical Training. MT: Motor Training. CT: Control Group

Mentions: First, we defined the training guidelines and its progression. Subsequently, we developed an exercise program specifically to promote balance (active global exercises and rhythmical auditory cues, generated by a metronome). Subjects were randomly distributed among three groups. The first experimental group will be led by a physiotherapist, it will receive motor skill training with rhythmical auditory cues marked by a metronome (GBRT); the second experimental group will receive the same training without rhythmical cues (MT); and the control group (CT) will receive exercises in general orientation only with a general orientation. To verify retention after the training, subjects will be assessed and reassessed as a follow up 4 and 30 weeks after the end of their training (Fig. 1). The patients will be diagnosed by neurologists in the Movement Disorders Ambulatory Clinic of the University of São Paulo Faculty of Medicine Clinics Hospital (MD HC FMUSP). Physiotherapists will recruit patients on the database of the MD HC FMUSP and Motor-Sensory Learning Laboratory. They will conduct a brief telephone interview based on questions about their personal and medical history and self-perceived balance performance. Then, on a first visit, the subjects will be informed about the procedure and they will sign a consensual form.Fig. 1


Randomized controlled trial protocol: balance training with rhythmical cues to improve and maintain balance control in Parkinson's disease.

Capato TT, Tornai J, Ávila P, Barbosa ER, Piemonte ME - BMC Neurol (2015)

Design of the study. BRT: Balance Rhythmical Training. MT: Motor Training. CT: Control Group
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4561447&req=5

Fig1: Design of the study. BRT: Balance Rhythmical Training. MT: Motor Training. CT: Control Group
Mentions: First, we defined the training guidelines and its progression. Subsequently, we developed an exercise program specifically to promote balance (active global exercises and rhythmical auditory cues, generated by a metronome). Subjects were randomly distributed among three groups. The first experimental group will be led by a physiotherapist, it will receive motor skill training with rhythmical auditory cues marked by a metronome (GBRT); the second experimental group will receive the same training without rhythmical cues (MT); and the control group (CT) will receive exercises in general orientation only with a general orientation. To verify retention after the training, subjects will be assessed and reassessed as a follow up 4 and 30 weeks after the end of their training (Fig. 1). The patients will be diagnosed by neurologists in the Movement Disorders Ambulatory Clinic of the University of São Paulo Faculty of Medicine Clinics Hospital (MD HC FMUSP). Physiotherapists will recruit patients on the database of the MD HC FMUSP and Motor-Sensory Learning Laboratory. They will conduct a brief telephone interview based on questions about their personal and medical history and self-perceived balance performance. Then, on a first visit, the subjects will be informed about the procedure and they will sign a consensual form.Fig. 1

Bottom Line: 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.This 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Physicaltherapy, University of São Paulo, Av Dr Enéias de Aguiar, 255 - 05403.000, São Paulo, São Paulo, Brazi. taminec@yahoo.com.br.

ABSTRACT

Background: Postural 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 design: A 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.

Discussion: This 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 registration: Clinicaltrials.gov NCT02488265 ; Ethics Committee of the University of São Paulo Faculty of Medicine Clinics Hospital 1.102.464.

No MeSH data available.


Related in: MedlinePlus