title: Exercise for falls prevention in Parkinson disease A comparison of Irish set dancing and exercises for people with Parkinson’s disease: A phase II feasibility study The PIT: SToPP Trial—A Feasibility Randomised Controlled Trial of Home-Based Physiotherapy for People with Parkinson's Disease Using Video-Based Measures to Preserve Assessor Blinding Tai chi and postural stability in patients with Parkinson's disease. Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: a placebo controlled study. Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson’s Disease Neurofeedback and physical balance in Parkinson's patients. Randomized Controlled Trial of Community-Based Dancing to Modify Disease Progression in Parkinson Disease The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial. Parkinson's Disease and Forced Exercise: A Preliminary Study Effect of Balance Training on Postural Instability in Patients With Idiopathic Parkinson’s Disease Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Technology-Assisted Balance and Gait Training Reduces Falls in Patients With Parkinson’s Disease Leg muscle power is enhanced by training in people with Parkinson’s disease: a randomized controlled trial Does Integrative Medicine Enhance Balance in Aging Adults? Proof of Concept for the Benefit of Electroacupuncture Therapy in Parkinson's Disease Intensive Rehabilitation Increases BDNF Serum Levels in Parkinsonian Patients Repetitive step training with preparatory signals improves stability limits in patients with Parkinson's disease. Effects of Tai Chi on balance and fall prevention in Parkinson’s disease: a randomized controlled trial Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial. Action Observation Improves Freezing of Gait in Patients With Parkinson’s Disease Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial.
abstract: Objective : To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors , i.e. , poor balance , reduced leg muscle strength , and freezing of gait , in people with Parkinson disease . Methods : Two hundred thirty-one people with Parkinson disease were r and omized into exercise or usual-care control groups . Exercises were practice d for 40 to 60 minutes , 3 times weekly for 6 months . Primary outcomes were fall rates and proportion of fallers during the intervention period . Secondary outcomes were physical ( balance , mobility , freezing of gait , habitual physical activity ) , psychological ( fear of falling , affect ) , and quality -of-life measures . Results : There was no significant difference between groups in the rate of falls ( incidence rate ratio [ IRR ] = 0.73 , 95 % confidence interval [ CI ] 0.45–1.17 , p = 0.18 ) or proportion of fallers ( p = 0.45 ) . Preplanned subgroup analysis revealed a significant interaction for disease severity ( p < 0.001 ) . In the lower disease severity subgroup , there were fewer falls in the exercise group compared with controls ( IRR = 0.31 , 95 % CI 0.15–0.62 , p < 0.001 ) , while in the higher disease severity subgroup , there was a trend toward more falls in the exercise group ( IRR = 1.61 , 95 % CI 0.86–3.03 , p = 0.13 ) . Postintervention , the exercise group scored significantly ( p < 0.05 ) better than controls on the Short Physical Performance Battery , sit-to-st and , fear of falling , affect , and quality of life , after adjusting for baseline performance . Conclusions : An exercise program targeting balance , leg strength , and freezing of gait did not reduce falls but improved physical and psychological health . Falls were reduced in people with milder disease but not in those with more severe Parkinson disease . Classification of evidence : This study provides Class III evidence that for patients with Parkinson disease , a minimally supervised exercise program does not reduce fall risk . This study lacked the precision to exclude a moderate reduction or modest increase in fall risk from exercise . Trial registration : Australian New Zeal and Clinical Trials Registry ( ACTRN12608000303347 ) Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - Purpose . To trial four-week 's physiotherapy targeting chair transfers for people with Parkinson 's disease ( PwPD ) and explore the feasibility of reliance on remote outcome measurement to preserve blinding . Scope . We recruited 47 PwPD and r and omised 24 to a focused home physiotherapy programme ( exercise , movement strategies , and cueing ) and 23 to a control group . We evaluated transfers ( plus mobility , balance , posture , and quality of life ) before and after treatment and at followup ( weeks 0 , 4 , 8 , and 12 ) from video produced by , and question naires distributed by , treating physiotherapists . Participants fed back via end-of- study question naires . Thirty-five participants ( 74 % ) completed the trial . Excluding dropouts , 20 % of question naire data and 9 % of video data were missing or unusable ; we had to evaluate balance in situ . We noted trends to improvement in transfers , mobility , and balance in the physiotherapy group not noted in the control group . Participant feedback was largely positive and assessor blinding was maintained in every case . Conclusions . Intense , focused physiotherapy at home appears acceptable and likely to bring positive change in those who can participate . Remote outcome measurement was successful ; question naire followup and further training in video production would reduce missing data . We advocate a fully powered trial , design ed to minimise dropouts and preserve assessor blinding , to evaluate this intervention BACKGROUND Patients with Parkinson 's disease have substantially impaired balance , leading to diminished functional ability and an increased risk of falling . Although exercise is routinely encouraged by health care providers , few programs have been proven effective . METHODS We conducted a r and omized , controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson 's disease . We r and omly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale ( which ranges from 1 to 5 , with higher stages indicating more severe disease ) to one of three groups : tai chi , resistance training , or stretching . The patients participated in 60-minute exercise sessions twice weekly for 24 weeks . The primary outcomes were changes from baseline in the limits-of-stability test ( maximum excursion and directional control ; range , 0 to 100 % ) . Secondary outcomes included measures of gait and strength , scores on functional-reach and timed up- and -go tests , motor scores on the Unified Parkinson 's Disease Rating Scale , and number of falls . RESULTS The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion ( between-group difference in the change from baseline , 5.55 percentage points ; 95 % confidence interval [ CI ] , 1.12 to 9.97 ; and 11.98 percentage points ; 95 % CI , 7.21 to 16.74 , respectively ) and in directional control ( 10.45 percentage points ; 95 % CI , 3.89 to 17.00 ; and 11.38 percentage points ; 95 % CI , 5.50 to 17.27 , respectively ) . The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach .  Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training . The effects of tai chi training were maintained at 3 months after the intervention . No serious adverse events were observed . CONCLUSIONS Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson 's disease , with additional benefits of improved functional capacity and reduced falls . ( Funded by the National Institute of Neurological Disorders and Stroke ; Clinical Trials.gov number , NCT00611481 . ) INTRODUCTION Pisa syndrome ( PS ) is a tonic lateral flexion of trunk that represents a disabling complication of advanced Parkinson disease ( PD ) . Conventional rehabilitation treatment ( CT ) ameliorates axial posture and trunk mobility in PD patients , but the improvement tends to wane in 4 - 6 months . Botulin toxin ( BT ) may reduce muscle hyperactivity , therefore improving CT effectiveness . We evaluated whether the injection of incabotulinum toxin type A ( iBTA ) into the hyperactive trunk muscles might improve the effectiveness of rehabilitation in a group of PD patients with PS . METHODS Twenty-six PD patients were enrolled in a r and omized placebo-controlled trial . Group A was treated with iBTA before undergoing CT ( a 4-week intensive programme ) , while Group B received saline before the 4-week CT treatment . Patients were evaluated at baseline , at the end of the rehabilitative period , 3 and 6 months with kinematic analysis of movement , UPDRS , Functional Independence Measure and Visual Analog Scale for pain . RESULTS At the end of the rehabilitation period , both groups improved significantly in terms of static postural alignment and of range of motion . Group A showed a significantly more marked reduction in pain score as compared with Group B and a more prolonged efficacy on several clinical and kinematic variables . CONCLUSIONS Our preliminary data suggest that BT may be considered an important addition to the rehabilitation programme for PD subjects with PS for improving axial posture and trunk mobility , as well as for a better control of pain Background Exercise confers short-term benefits for individuals with Parkinson disease ( PD ) . Objective The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program . Design The 16-month r and omized controlled exercise intervention investigated 3 exercise approaches : flexibility/balance/function exercise ( FBF ) , supervised aerobic exercise ( AE ) , and home-based exercise ( control ) . Setting This study was conducted in outpatient clinics . Patients The participants were 121 individuals with PD ( Hoehn & Yahr stages 1–3 ) . Interventions The FBF program ( individualized spinal and extremity flexibility exercises followed by group balance/functional training ) was supervised by a physical therapist . The AE program ( using a treadmill , bike , or elliptical trainer ) was supervised by an exercise trainer . Supervision was provided 3 days per week for 4 months , and then monthly ( 16 months total ) . The control group participants exercised at home using the National Parkinson Foundation Fitness Counts program , with 1 supervised , clinic-based group session per month . Measurements Outcomes , obtained by blinded assessors , were determined at 4 , 10 , and 16 months . The primary outcome measures were overall physical function ( Continuous Scale — Physical Functional Performance [ CS-PFP ] ) , balance ( Functional Reach Test [ FRT ] ) , and walking economy ( oxygen uptake [ mL/kg/min ] ) . Secondary outcome measures were symptom severity ( Unified Parkinson 's Disease Rating Scale [ UPDRS ] activities of daily living [ ADL ] and motor subscales ) and quality of life ( 39-item Parkinson 's Disease Quality of Life Scale [ PDQ-39 ] ) . Results Of the 121 participants , 86.8 % , 82.6 % , and 79.3 % completed 4 , 10 , and 16 months , respectively , of the intervention . At 4 months , improvement in CS-PFP scores was greater in the FBF group than in the control group ( mean difference=4.3 , 95 % confidence interval [CI]=1.2 to 7.3 ) and the AE group ( mean difference=3.1 , 95 % CI=0.0 to 6.2 ) . Balance was not different among groups at any time point . Walking economy improved in the AE group compared with the FBF group at 4 months ( mean difference=−1.2 , 95 % CI=−1.9 to −0.5 ) , 10 months ( mean difference=−1.2 , 95 % CI=−1.9 to −0.5 ) , and 16 months ( mean difference=−1.7 , 95 % CI=−2.5 to −1.0 ) . The only secondary outcome that showed significant differences was UPDRS ADL subscale scores : the FBF group performed better than the control group at 4 months ( mean difference=−1.47 , 95 % CI=−2.79 to −0.15 ) and 16 months ( mean difference=−1.95 , 95 % CI=−3.84 to −0.08 ) . Limitations Absence of a non-exercise control group was a limitation of the study . Conclusions Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy ( up to 16 months ) in the AE group Background . Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson ’s disease ( PD ) . However , there are inconsistent findings on the effects of balance and gait training on balance confidence . Objective . To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups . Methods . A total of 51 PD patients were r and omly assigned to a balance and gait training ( BAL ) group or to an active control ( CON ) group . The BAL group received balance and gait training with augmented feedback , whereas CON participants received lower-limb strength training for 12 weeks . Outcome measures included Activities-Specific Balance Confidence ( ABC ) Scale , limits-of-stability test , single-leg-stance test , and spatiotemporal gait characteristics . All tests were administered before intervention ( Pre ) , immediately after training ( Post ) , and at 3 months ( Post3 m ) and 12 months ( Post12 m ) after treatment completion . Results . The ABC score improved marginally at Post and significantly at Post3 m and Post12 m only in the BAL group ( P < .017 ) . Both participant groups increased their end point excursion at Post , but only the BAL group maintained the improvement at Post3 m . The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3 m and Post12 m ( P < .05 ) . For gait characteristics , both participant groups increased gait velocity , but only the BAL group increased stride length at Post , Post3 m , and Post12 m ( P < .017 ) . Conclusions . Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD The primary goal of the present research is to study the effect of a neurofeedback training ( NFT ) period on  balance problems associated with Parkinson 's disease . Sixteen patients were selected through purposive sampling and were r and omly divided into experimental and control groups . The research procedure included eight sessions . Prior to and after training , pre-tests and post-tests of static and dynamic balance were administered using " limit of stability " for the Biodex as well as the Berg scale . The results revealed that , after neurofeedback training , a statistically significant improvement in both static and dynamic balance in the experimental group was achieved . The means of the Biodex and Berg scores in the experimental group increased from 18.87 to 42.87 and 17.62 to 46.37 , respectively . The means of the Biodex and Berg scores in the control group in the pretest were 18.25 and 17.75 and increased to 20.00 and 20.50 , respectively . The results suggest that NFT can improve static and dynamic balance in PD patients Background . Tango dancing has been effective in improving measures of physical function in people with Parkinson disease ( PD ) . However , all previous studies were institution-based , tested participants on medication , and employed short-term interventions . Objective . To determine the effects of a 12-month community-based tango program for individuals with PD on disease severity and physical function . Methods . Sixty-two participants were r and omly assigned to a twice weekly ,  community-based Argentine Tango program or a Control group ( no intervention ) . Participants were assessed off anti-Parkinson medication at baseline , 3 , 6 , and 12 months . The primary outcome measure was the Movement Disorders Society – Unified Parkinson Disease Rating Scale 3 ( MDS-UPDRS-3 ) . Secondary outcome measures were the MDS-UPDRS-1 , MDS-UPDRS-2 , MiniBESTest balance test ; Freezing of Gait Question naire ( FOG_Q ) ; 6-Minute Walk Test ( 6MWT ) ; gait velocity for comfortable forward , fast as possible forward , dual task , and backward walking ; and Nine-Hole Peg Test ( 9HPT ) . Results . Groups were not different at baseline . Overall , the Tango group improved whereas the Control group showed little change on most measures . For the MDS-UPDRS-3 , there was no significant change in the Control group from baseline to 12 months , whereas the Tango group had a reduction of 28.7 % ( 12.8 points ) . There were significant group by time interactions for MDS-UPDRS-3 , MiniBESTest , FOG_Q , 6MWT , forward and dual task walking velocities , and 9HPT in favor of the dance group . Conclusions . Improvements in the Tango group were apparent off medication , suggesting that long-term participation in tango may modify progression of disability in PD This r and omized controlled trial with blinded assessment aim ed to determine the effect of a 6-month minimally supervised exercise program on fall risk factors in people with Parkinson 's disease ( PD ) . Forty-eight participants with PD who had fallen or were at risk of falling were r and omized into exercise or control groups . The exercise group attended a monthly exercise class and exercised at home three times weekly . The intervention targeted leg muscle strength , balance , and freezing . The primary outcome measure was a PD falls risk score . The exercise group had no major adverse events and showed a greater improvement than the control group in the falls risk score , which was not statistically significant ( between group mean difference = -7 % , 95 % CI -20 to 5 , P = 0.26 ) . There were statistically significant improvements in the exercise group compared with the control group for two secondary outcomes : Freezing of Gait Question naire ( P = 0.03 ) and timed sit-to-st and ( P = 0.03 ) . There were statistically nonsignificant trends toward greater improvements in the exercise group for measures of muscle strength , walking , and fear of falling , but not for the measures of st and ing balance . Further investigation of the impact of exercise on falls in people with PD is warranted Objective . The concept of forced exercise has drawn attention for the treatment of Parkinson 's disease symptoms with anecdotal reports of success . This study sought to ascertain any significant effect of forced exercise using a motorized stationary bicycle when compared to controls on Parkinson 's disease symptoms in a blinded , r and omized , and controlled setting . Setting . Parkinson 's disease outpatient clinic , Veterans Administration Medical Center . Method . We assessed 23 patients ( 13 experimental and 10 controls ) on a number of st and ard Parkinson 's measures at baseline , after participation in eight weeks of twice weekly forced exercise or eight weeks of conventional clinic care  , and then after a three-month period had elapsed . Dependent measures were UPDRS-III , Berg Balance Scale , finger taping test , and the PDQ-39 . Results . Results did not demonstrate any main effect differences between the exercise and control groups on any measure at any point in time . A within subjects effect was demonstrated for the forced exercise group on overall UPDRS-III scores at the three-month end point . No other within group effects were noted . Results suggest that early enthusiasm for forced exercise may need tempering . Limitations of the study are discussed as well as numerous logistical challenges to this type of study Background . Postural instability ( PI ) is a disabling sign of Parkinson ’s disease ( PD ) not easily amenable to treatment with medication . Objective . To evaluate the effects of balance training on PI in patients with PD . Methods . A total of 64 patients with PI were r and omly assigned to the experimental group ( n = 33 ) for balance training or to the control group ( n = 31 ) for general physical exercises . Each patient received 21 treatment sessions of 50 minutes each . Patients were evaluated by a blinded rater before and after treatment as well as 1 month posttreatment using the Berg Balance Scale ( BBS ) , Activities-Specific Balance Confidence Scale ( ABC ) , postural transfer test , self-destabilization of the center of foot pressure test , number of falls , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , modified Hoehn and Yahr ( H&Y ) Staging Scale , and Geriatric Depression Scale ( GDS ) . Results .At the end of treatment , the experimental group showed significant improvements in all outcome measures , except for the UPDRS and the H&Y scale . Improvement was maintained at the 1-month follow-up in all outcome measures except for the GDS . No significant changes in performance were observed in the control group . Conclusions . A program of balance training can improve PI in patients with PD An impaired ability to initiate walking is a common feature of postural instability and gait impairment in Parkinson 's disease . While progressive resistance training ( PRT ) has been proposed to be an effective modality to improve balance and gait function in people with Parkinson 's disease , there are a limited number of r and omized trials and no studies have evaluated gait initiation performance . Thus , the purpose of this study was to examine the potential benefits PRT on GI performance in people with Parkinson 's disease . Eighteen individuals with idiopathic PD were r and omly assigned to either a twice weekly PRT program or a non-contact control group for 10 weeks . Biomechanical analysis of GI was performed pre- and post-intervention . Dependent variables of interest included the displacement of the center-of-pressure ( COP ) during the anticipatory postural phase of GI as well as the initial stride length and velocity . The PRT group demonstrated improvements in the posterior displacement of the COP and the initial stride length and velocity . There were no improvements in any variables for the control subjects . These results suggest that PRT may be an effective non-pharmacological and nonsurgical treatment to improve GI performance in PWP Objective . To examine the effects of technology-assisted balance and gait training on reducing falls in patients with Parkinson ’s disease ( PD ) . Methods . Eligible subjects were r and omly allocated to an experimental group given  technology-assisted balance and gait training ( BAL , n = 26 ) and an active control group undertaking strengthening exercises ( CON , n = 25 ) . The training in each group lasted for 3 months . The number of fallers and fall rate were used as primary outcomes , and single-leg-stance-time , latency of postural response to perturbation , self-selected gait velocity , and stride length as secondary outcomes . Fall incidence was recorded over 15 months after the baseline assessment ( Pre ) . Other tests were performed at Pre , after 3-month intervention ( Post3 m ) , at 3 months ( Post6 m ) , and 12 months ( Post15 m ) after treatment completion . Results . Forty-five subjects who completed the 3-month training were included in the data analysis . There were fewer fallers in the BAL than in the CON group at Post3 m , Post6 m , and Post15 m ( P < .05 ) . In addition , the BAL group had lower fall rate than the CON group at Post3 m and Post6 m ( incidence rate ratio : 0.111 - 0.188 , P < .05 ) , and marginally so at Post15 m ( incidence rate ratio : 0.407 , P = .057 ) . Compared with the CON subjects , the BAL subjects demonstrated greater reduction in the postural response latency and increase in the stride length against baseline at each assessment interval ( P < .05 ) , and marginally more increases of single-leg-stance-time at Post3 m ( P = .064 ) , Post6 m ( P = .041 ) and Post15 m ( P = .087 ) . Conclusions . Our positive findings provide evidence for the clinical use of technology-assisted balance and gait training in reducing falls in people with PD Objective : To determine the effects of leg muscle power training in people with Parkinson ’s disease . Design : R and omized controlled trial . Setting : University laboratory ( outcome measures and experimental intervention ) , community ( control intervention ) . Subjects : Community-dwelling people with Parkinson ’s disease . Interventions : Leg muscle power training using pneumatic variable resistance equipment ( experimental ) was compared with low intensity sham exercise ( control ) . Both groups exercised twice weekly for 12 weeks . Main measures : Primary outcomes were peak power of four leg muscle groups . Secondary outcomes were measures of muscle strength , mobility , balance and falls . Results : Exercise adherence was high in both groups . Leg muscle power was significantly better in the experimental group than the control group in all four primary outcome measures at 12 weeks after adjusting for baseline values : leg extensors ( 57.9 watts , 95 % confidence interval ( CI ) 22.0–93.7 , p = 0.002 ) ; knee flexors ( 29.6 watts , 95 % CI 7.4–51.8 , p = 0.01 ) ; hip flexors ( 68.1 watts , 95 % CI 19.6–116.5 , p = 0.007 ) ; and hip abductors ( 37.4 watts , 95 % CI 19.9–54.9 , p < 0.001 ) . The experimental group performed significantly better on tests of leg muscle strength ( p < 0.001 to 0.07 ) and showed trends toward better performance in the Timed Up and Go ( p = 0.13 ) and choice stepping reaction time ( p = 0.11 ) . There was a non-significant reduction in the rate of falls in the experimental group compared with the control group ( incidence rate ratio 0.84 , p = 0.76 ) . Conclusions : This programme significantly improved muscle power in all trained muscle groups Background : Postural balance and potentially fall risk increases among older adults living with neurological diseases , especially Parkinson 's disease ( PD ) . Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance , interest is growing in evaluating alternative PD therapies . Objective : The purpose of the current study was to assess improvement in postural balance in PD patients following electroacupuncture ( EA ) as an alternative therapy . Methods : 15 aging adults ( 71.2 ± 6.3 years ) with idiopathic PD and 44 healthy age-matched participants ( 74.6 ± 6.5 years ) were recruited . The PD participants were r and omly assigned ( at a ratio of 2:1 ) to an intervention ( n = 10 ) or to a control group ( n = 5 ) . The intervention group received a 30-min EA treatment on a weekly basis for 3 weeks , while the control group received a sham treatment . Outcomes were assessed at baseline and after the final therapy . Measurements included balance assessment , specifically the ratio of medial-lateral ( ML ) center-of-gravity ( COG ) sway to anterior-posterior ( AP ) sway ( COGML/AP ) and ankle/hip sway during eyes-open , eyes-closed , and eyes-open dual-task trials , the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , as well as quality of life , concerns for fall , and pain question naires . Results : No difference was observed for the assessed parameters between the intervention and the control group at baseline . After treatment , an improvement in balance performance was observed in the intervention group . Compared with the healthy population , PD patients prior to treatment had larger COGML/AP sway with more dependency on upper-body movements for maintaining balance . Following EA therapy , COGML/AP sway was reduced by 31 % and ankle/hip sway increased by 46 % in the different conditions ( p = 0.02 for the dual-task condition ) . The clinical rating revealed an overall improvement ( p < 0.01 ) in mentation , behavior , and mood ( UPDRS part I , 49 % ) , activities of daily living ( UPDRS part II , 46 % ) , and motor examination ( UPDRS part III , 40 % ) . There was a significant reduction ( p < 0.02 ) in the specific items regarding UPDRS fall status ( 67 % ) and rigidity ( 48 % ) . Changes were small and nonsignificant in the controls ( p > 0.29 ) . Conclusions : This pilot study demonstrates improvement in rigidity and balance following EA . These preliminary results suggest EA could be a promising alternative treatment for balance disturbance in PD Background . Exercise may decrease the risk of Parkinson ’s disease ( PD ) in humans and reduce PD symptoms in animal models . The beneficial effects have been linked to increased levels of neurotrophic factors . Objective . We examined whether intensive rehabilitation treatment reduces motor disability in patients in the early stages of PD and increases brain-derived neurotrophic factor ( BDNF ) serum levels . Methods . Thirty participants in the early stages of PD treated with rasagiline  were r and omly assigned to 3 hours of rehabilitation treatment that included aerobic exercise for 28 days ( Group 1 ) or to not therapy ( control ; Group 2 ) . BDNF serum levels were assessed at time T0 ( baseline , before treatment ) , T1 ( 10 days ) , T2 ( 20 days ) , and T3 ( 28 days ) . At T0 and T3 , we assessed the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) III in both groups , as well as the UPDRS II and total , Berg Balance Scale , and 6-minute walking test only in Group 1 . Results . BDNF levels significantly increased at T1 in Group 1 , an increase that was maintained throughout the treatment period . At T3 compared to T0 , UPDRS III scores significantly improved in Group 1 along with scores for UPDRS II , total , Berg Balance Scale , and 6-minute walking test . Conclusions . Intensive rehabilitation treatment increases the BDNF levels and improves PD signs in patients in the early stages of the disease . These results are in line with studies on animal models of PD and healthy subjects OBJECTIVE To examine the effects of repetitive volitional and compensatory step training with preparatory signals on the limits of stability , postural and gait skills , and spatiotemporal gait characteristics in patients with Parkinson 's disease with no falls during the previous 12 months . DESIGN R and omized clinical trial with assessor blinded to group assignment . SUBJECTS Twenty-eight patients with Parkinson 's disease with no falls during the previous 12 months . METHODS Eligible patients were r and omly assigned to an experimental group , which undertook repetitive step training with preparatory visual cues , or a control group , which undertook lower limb strength training for 4 weeks . Outcome measures included limits of stability test , postural and gait sub-scores from Unified Parkinson 's Disease Rating Scale motor score ( UPDRS-PG ) , and spatiotemporal gait characteristics . All tests were conducted before and after training at patients ' peak medication cycle . RESULTS The experimental group showed significant improvements in reaction time , movement velocity , and endpoint excursion of limits of stability , as well as UPDRS-PG score and stride length ( p < 0.05 ) , compared with the control group . Both groups significantly increased gait velocity ( p < 0.05 ) . CONCLUSION Repetitive step training with preparatory cues can enhance limits of stability , postural and gait skills and spatiotemporal gait characteristics in patients with Parkinson 's disease with no falls during the previous 12 months Objectives : To examine the effects of Tai Chi on balance and functional mobility in people with Parkinson ’s disease , and determine whether fall incidence could be reduced by the Tai Chi exercise . Design : Single blinded r and omized control trial with 6 months ’ follow-up . Setting : A hospital and general community . Participants : Patients ( n=76 ) diagnosed with idiopathic Parkinson ’s disease , over 40 years old , able to walk independently and fell at least one time during the past 12 months . Interventions : The Tai Chi group ( n=37 ) received 24-form Yang style Tai Chi exercise for 60 minutes each time , three times a week and lasted for 12 weeks . The control group ( n=39 ) received no intervention . Main outcome measures : Berg Balance Scale ( BBS ) , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) III , Timed Up&Go ( TUG ) and occurrences of falls . Results : The Tai Chi group improved more than the control group on the BBS ( p<0.05 ) , but there was no difference on UPDRS III scores and Timed Up&Go ( p>0.05 ) . During the 6-month follow-up , only 8 ( 21.6 % ) out of 37 patients in the Tai Chi group had experience of falls comparing to 19 ( 48.7 % ) out of 39 patients in the control group ( p<0.05 ) . The average times of falls were 0.30±0.62 in the Tai Chi group compared with 0.64±0.74 in the control group ( p<0.05 ) . Conclusions : Our findings suggested that Tai Chi exercise could improve the balance and decrease the fall risks in patients with Parkinson ’s disease OBJECTIVES To investigate the effect of Nintendo Wii ™ -based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinson 's disease . DESIGN Parallel , prospect i ve , single-blind , r and omised clinical trial . SETTING Brazilian Parkinson Association . PARTICIPANTS Thirty-two patients with Parkinson 's disease ( Hoehn and Yahr stages 1 and 2 ) . INTERVENTIONS Fourteen training sessions consisting of 30 minutes of stretching , strengthening and axial mobility exercises , plus 30 minutes of balance training . The control group performed balance exercises without feedback or cognitive stimulation , and the experimental group performed 10 Wii Fit ™ games . MAIN OUTCOME MEASURE Section II of the Unified Parkinson 's Disease Rating Scale ( UPDRS-II ) . R AND OMISATION Participants were r and omised into a control group ( n=16 ) and an experimental group ( n=16 ) through blinded drawing of names . STATISTICAL ANALYSIS Repeated- measures analysis of variance ( RM-ANOVA ) . RESULTS Both groups showed improvement in the UPDRS-II with assessment effect ( RM-ANOVA P<0.001 , observed power=0.999 ) . There was no difference between the control group and the experimental group before training { 8.9 [ st and ard deviation ( SD ) 2.9 ] vs 10.1 ( SD 3.8 ) } , after training [ 7.6 ( SD 2.9 ) vs 8.1 ( SD 3.5 ) ] or 60 days after training [ 8.1 ( SD 3.2 ) vs 8.3 ( SD 3.6 ) ] . The mean difference of the whole group between before training and after training was -0.9 ( SD 2.3 , 95 % confidence interval -1.7 to -0.6 ) . CONCLUSION Patients with Parkinson 's disease showed improved performance in activities of daily living after 14 sessions of balance training , with no additional advantages associated with the Wii-based motor and cognitive training . Registered on http://www . clinical trials.gov ( identifier : NCT01580787 ) Background . Freezing of gait ( FOG ) is a disabling impairment for people with Parkinson ’s disease ( PD ) and may not respond to medications . The effectiveness of physical therapy for FOG is debatable . Action observation strategies to overcome FOG may enhance physical training . Objective . To assess whether action observation , combined with practicing the observed actions , may reduce FOG episodes . Methods . Twenty patients with PD entered a single-blind trial and were r and omly assigned to the experimental ( Action ) or control ( L and scape ) groups . Those in the Action group watched video clips showing specific movements and strategies to circumvent FOG episodes , whereas those in the L and scape group watched video clips of static pictures showing different l and scapes . All patients underwent identical physical therapy training , 3 sessions a week for 4 weeks . Results . The FOG Question naire score and the number of FOG episodes were significantly reduced in both groups after the training period . At follow-up examination ( 4 weeks after the end of the intervention ) , a significant reduction in the number of FOG episodes was observed only in the Action group . Motor performance ( walking and balance ) and quality -of-life assessment s were significantly improved in both groups at the end of training and at follow-up . Conclusions . Our results suggest that action observation has a positive additional effect on recovery of walking ability in PD patients with FOG . Further studies on the combination of observation and imitation to supplement a physical training program may result in an innovative rehabilitative approach for FOG BACKGROUND Treadmill training ( with or without robotic assistance ) has been reported to improve balance skills in patients with Parkinson 's disease ( PD ) . However , its effectiveness on postural instability has been evaluated mainly in patients with mild to moderate PD ( Hoehn & Yahr stage ≤3 ) . Patients with more severe disease may benefit from robot-assisted gait training performed by the Gait-Trainer GT1 , as a harness supports them with their feet placed on motor-driven footplates . The aim of this study was to determine whether robot-assisted gait training could have a positive influence on postural stability in patients with PD at Hoehn & Yahr stage 3 - 4 . METHODS Thirty-four patients with PD at Hoehn & Yahr stage 3 - 4 were r and omly assigned into two groups . All patients received twelve , 40-min treatment sessions , three days/week , for four consecutive weeks . The Robotic Training group ( n = 17 ) underwent robot-assisted gait training , while the Physical Therapy group ( n = 17 ) underwent a training program not specifically aim ed at improving postural stability . Patients were evaluated before , immediately after and 1-month post-treatment . Primary outcomes were : Berg Balance scale ; Nutt 's rating . RESULTS A significant improvement was found after treatment on the Berg Balance Scale and the Nutt 's rating in favor of the Robotic Training group ( Berg : 43.44 ± 2.73 ; Nutt : 1.38 ± 0.50 ) compared to the Physical Therapy group ( Berg : 37.27 ± 5.68 ; Nutt : 2.07 ± 0.59 ) . All improvements were maintained at the 1-month follow-up evaluation . CONCLUSIONS Robot-assisted gait training may improve postural instability in patients with PD at Hoehn & Yahr stage 3 - 4
target: Conclusion ] Different methods , such as scales , tests , and equipment , are used for the evaluation of balance in patients with Parkinson 's disease .
background: [ Purpose ] The present literature review was conducted on the use of different measures for the evaluation of balance in patients with Parkinson 's disease .