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Perturbation During Treadmill Training Improves Dynamic Balance and Gait in Parkinson's Disease: A Single-Blind Randomized Controlled Pilot Trial.
Neurorehabil Neural Repair. 2017 Aug; 31(8):758-768.NN

Abstract

BACKGROUND

Gait and balance dysfunction are major symptoms in Parkinson's disease (PD). Treadmill training improves gait characteristics in this population but does not reflect the dynamic nature of controlling balance during ambulation in everyday life contexts.

OBJECTIVE

To evaluate whether postural perturbations during treadmill walking lead to superior effects on gait and balance performance compared with standard treadmill training.

METHODS

In this single-blind randomized controlled trial, 43 PD patients (Hoehn & Yahr stage 1-3.5) were assigned to either an 8-week perturbed treadmill intervention (n = 21) or a control group (n = 22) training on the identical treadmill without perturbations. Patients were assessed at baseline, postintervention, and at 3 months' follow-up. Primary endpoints were overground gait speed and balance (Mini-BESTest). Secondary outcomes included fast gait speed, walking capacity (2-Minute Walk Test), dynamic balance (Timed Up-and-Go), static balance (postural sway), and balance confidence (Activities-Specific Balance Confidence [ABC] scale).

RESULTS

There were no significant between-group differences in change over time for the primary outcomes. At postintervention, both groups demonstrated similar improvements in overground gait speed (P = .009), and no changes in the Mini-BESTest (P = .641). A significant group-by-time interaction (P = .048) existed for the Timed Up-and-Go, with improved performance only in the perturbation group. In addition, the perturbation but not the control group significantly increased walking capacity (P = .038). Intervention effects were not sustained at follow-up.

CONCLUSIONS

Our primary findings suggest no superior effect of perturbation training on gait and balance in PD patients. However, some favorable trends existed for secondary gait and dynamic balance parameters, which should be investigated in future trials.

Authors+Show Affiliations

1 Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.1 Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.2 University Hospital Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany.1 Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany. 3 University of Freiburg, Freiburg, Germany.1 Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.2 University Hospital Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany.2 University Hospital Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany.1 Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28758519

Citation

Steib, Simon, et al. "Perturbation During Treadmill Training Improves Dynamic Balance and Gait in Parkinson's Disease: a Single-Blind Randomized Controlled Pilot Trial." Neurorehabilitation and Neural Repair, vol. 31, no. 8, 2017, pp. 758-768.
Steib S, Klamroth S, Gaβner H, et al. Perturbation During Treadmill Training Improves Dynamic Balance and Gait in Parkinson's Disease: A Single-Blind Randomized Controlled Pilot Trial. Neurorehabil Neural Repair. 2017;31(8):758-768.
Steib, S., Klamroth, S., Gaβner, H., Pasluosta, C., Eskofier, B., Winkler, J., Klucken, J., & Pfeifer, K. (2017). Perturbation During Treadmill Training Improves Dynamic Balance and Gait in Parkinson's Disease: A Single-Blind Randomized Controlled Pilot Trial. Neurorehabilitation and Neural Repair, 31(8), 758-768. https://doi.org/10.1177/1545968317721976
Steib S, et al. Perturbation During Treadmill Training Improves Dynamic Balance and Gait in Parkinson's Disease: a Single-Blind Randomized Controlled Pilot Trial. Neurorehabil Neural Repair. 2017;31(8):758-768. PubMed PMID: 28758519.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perturbation During Treadmill Training Improves Dynamic Balance and Gait in Parkinson's Disease: A Single-Blind Randomized Controlled Pilot Trial. AU - Steib,Simon, AU - Klamroth,Sarah, AU - Gaβner,Heiko, AU - Pasluosta,Cristian, AU - Eskofier,Björn, AU - Winkler,Jürgen, AU - Klucken,Jochen, AU - Pfeifer,Klaus, Y1 - 2017/07/31/ PY - 2017/8/2/pubmed PY - 2018/4/24/medline PY - 2017/8/1/entrez KW - Parkinson’s disease KW - balance KW - exercise KW - mobility KW - perturbation KW - physical activity KW - postural instability KW - rehabilitation KW - treadmill SP - 758 EP - 768 JF - Neurorehabilitation and neural repair JO - Neurorehabil Neural Repair VL - 31 IS - 8 N2 - BACKGROUND: Gait and balance dysfunction are major symptoms in Parkinson's disease (PD). Treadmill training improves gait characteristics in this population but does not reflect the dynamic nature of controlling balance during ambulation in everyday life contexts. OBJECTIVE: To evaluate whether postural perturbations during treadmill walking lead to superior effects on gait and balance performance compared with standard treadmill training. METHODS: In this single-blind randomized controlled trial, 43 PD patients (Hoehn & Yahr stage 1-3.5) were assigned to either an 8-week perturbed treadmill intervention (n = 21) or a control group (n = 22) training on the identical treadmill without perturbations. Patients were assessed at baseline, postintervention, and at 3 months' follow-up. Primary endpoints were overground gait speed and balance (Mini-BESTest). Secondary outcomes included fast gait speed, walking capacity (2-Minute Walk Test), dynamic balance (Timed Up-and-Go), static balance (postural sway), and balance confidence (Activities-Specific Balance Confidence [ABC] scale). RESULTS: There were no significant between-group differences in change over time for the primary outcomes. At postintervention, both groups demonstrated similar improvements in overground gait speed (P = .009), and no changes in the Mini-BESTest (P = .641). A significant group-by-time interaction (P = .048) existed for the Timed Up-and-Go, with improved performance only in the perturbation group. In addition, the perturbation but not the control group significantly increased walking capacity (P = .038). Intervention effects were not sustained at follow-up. CONCLUSIONS: Our primary findings suggest no superior effect of perturbation training on gait and balance in PD patients. However, some favorable trends existed for secondary gait and dynamic balance parameters, which should be investigated in future trials. SN - 1552-6844 UR - https://www.unboundmedicine.com/medline/citation/28758519/Perturbation_During_Treadmill_Training_Improves_Dynamic_Balance_and_Gait_in_Parkinson's_Disease:_A_Single_Blind_Randomized_Controlled_Pilot_Trial_ L2 - https://journals.sagepub.com/doi/10.1177/1545968317721976?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -