Exercise programs improve mobility and balance in people with Parkinson's disease. A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance, balance and quality of life in patients with Parkinson’s disease Taiji for Individuals with Parkinson Disease and their Support Partners: Program Evaluation A novel conceptual framework for balance training in Parkinson’s disease-study protocol for a randomised controlled trial Effects of dance on movement control in Parkinson's disease: a comparison of Argentine tango and American ballroom. Diagnosis of Fall Risk in Parkinson Disease: An Analysis of Individual and Collective Clinical Balance Test Interpretation Home-based virtual reality balance training and conventional balance training in Parkinson's disease: A randomized controlled trial. Exercise and Motor Training in People with Parkinson's Disease: A Systematic Review of Participant Characteristics, Intervention Delivery, Retention Rates, Adherence, and Adverse Events in Clinical Trials Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson’s disease: a single-blinded randomized controlled trial Neurofeedback and physical balance in Parkinson's patients. Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson’s disease Amantadine in Parkinson's disease. In-patient multidisciplinary rehabilitation for Parkinson's disease: A randomized controlled trial. Effects of Virtual Reality–Augmented Balance Training on Sensory Organization and Attentional Demand for Postural Control in People With Parkinson Disease: A Randomized Controlled Trial Effects of vibratory orthosis on balance in idiopathic Parkinson's disease A randomized controlled trial of movement strategies compared with exercise for people with Parkinson's disease. Balance versus resistance training on postural control in patients with Parkinson's disease: a randomized controlled trial. Clinical and posturographic correlates of falling in Parkinson's disease. 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 Water-based vs. non-water-based physiotherapy for rehabilitation of postural deformities in Parkinson’s disease: a randomized controlled pilot study Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism Progressive resistance training improves gait initiation in individuals with Parkinson's disease.
Compromised balance and loss of mobility are among the major consequences of Parkinson 's disease ( PD ) . The literature documents numerous effective interventions for improving balance and mobility . The purpose of this study was to verify the effectiveness of two exercise programs on balance and mobility in people with idiopathic PD . Thirty-four participants , with idiopathic PD that ranged from Stage I to Stage III on the Hoehn & Yahr ( H&Y ) scale , were assigned to two groups . Group 1 ( n = 21 ; 67+/-9 years old ) was engaged in an intensive exercise program ( aerobic capacity , flexibility , strength , motor coordination and balance ) for 6 months : 72 sessions , 3 times a week , 60 minutes per session ; while Group 2 ( n = 13 ; 69+/-8 years old ) participated in an adaptive program ( flexibility , strength , motor coordination and balance ) for 6 months : 24 sessions , once a week , 60 minutes per session . Balance and basic functional mobility were assessed in pre- and post-tests by means of the Berg Balance Scale and the Timed Up and Go Test . Before and after the interventions , groups were similar in clinical conditions ( H&Y , UPDRS , and Mini-Mental ) . A MANOVA 2 ( programs ) by 2 ( moments ) revealed that both groups were affected by the exercise intervention . Univariate analyses showed that participants improved their mobility and balance from pre- to post-test . There were no differences between groups in either mobility or balance results . Both the intensive and adaptive exercise programs improved balance and mobility in patients with PD Purpose : To establish the effect of a 6-week programme of cycle ergometry training on exercise tolerance , balance , activities of daily living ( ADL ) and quality of life in individuals with Parkinson ’s disease ( PD ) . Method : Twenty-three subjects were recruited from the Parkinson ’s data base of the neurology service in a large urban teaching hospital . Quasi-experimental study of interrupted time-series design was conducted with subjects acting as their own control . Assessment s were carried out at baseline , week 7 following the control phase , and week 14 following the intervention phase . Intervention consisted of 30-min cycle ergometry training once weekly . Outcome measures included Six Minute Walk Test , Physiological Cost Index , Berg Balance Scale , Timed Up and Go Test ( TUAG ) , ADL and mobility sections of the Unified Parkinson ’s disease Rating Scale ( UPDRS ) and the Parkinson ’s disease question naire ( PDQ ) . Results : Statistically significant improvements were noted for the Berg Balance Scale ( p = 0.003 ) , TUAG ( p = 0.019 ) and ADL ( p = 0.006 ) and mobility ( p = 0.021 ) sections of the UPDRS . A trend towards improvement was found for exercise tolerance . No significant effect on quality of life was found . Conclusion : A 6-week programme of cycle ergometry training did not significantly influence exercise tolerance in this sample , but improved balance , functional abililty and PD-related disability were noted . Implication s for Rehabilitation Individuals with Parkinson ’s disease demonstrate lower levels of exercise tolerance than healthy controls . Individuals with Parkinson ’s disease could participate in 30 min of cycle ergometry training , with no rest periods required . Cycle ergometry training has a positive effect on balance , function and PD-related disability Background and Purpose Exercise is advocated in the management of Parkinson disease ( PD ) , however , little is known regarding the potential benefits of complementary mind/body exercise for this clinical population . The purpose of this pilot program evaluation was to gain insight into participant and instructor perceptions of the perceived benefits and potential utility of a taiji exercise program . Program Evaluation Program participants ( N= 15 ) included 8 individuals with PD and 7 support partners with no history of PD .  Group taiji instruction was offered in 45-minute weekly sessions , for 12 weeks at a community facility . Postprogram evaluation included administration of a survey question naire , thematic analysis of a focus group discussion , instructor reflections , and review of attendance records . Results Benefits were perceived by participants in physical , psychological , and social domains . Thirteen of the survey respondents , including 6 of the 8 respondents with PD reported perceiving a physical benefit attributed to taiji practice . Improved balance was reported most frequently . Instructor observations and participant testimony suggest movement capability for individuals with Parkinsons may also be improved by performing taiji . Conclusion This preliminary research provides support for further Taiji Buddy program examination and application Background There is increasing scientific knowledge about the interaction between physiological ( musculoskeletal , neuromuscular , cognitive and sensory ) systems and their influence on balance and walking impairments in Parkinson ’s disease . We have developed a new conceptual framework for balance training , emphasising specific components of balance control related to Parkinson ’s disease symptoms by using highly challenging , progressive and varying training conditions . The primary aim of this proposed r and omised controlled trial will be to investigate the short-term and long-term effects of a 10-week balance training regime in elderly with Parkinson ’s disease . Methods / Design Eighty participants with mild to moderate idiopathic Parkinson ’s disease will be recruited and r and omly allocated to an intervention group receiving balance training or a control group whose participants will continue to receive their usual care . The intervention will consist of a 10-week group training regime ( 1-hour training , three times per week ) , which will be led by two physiotherapists to ensure training progression and safety . The conceptual framework will be applied by addressing specific balance components ( sensory integration , anticipatory postural adjustments , motor agility , stability limits ) through varying training conditions and structured progression . Assessment will be conducted through a multi-dimensional battery of outcomes , prior to and immediately after the 10-week intervention , and at 9 and 15 months ’ follow-up after entering the study . Primary outcome measures will be balance performance ( assessed using the Mini Balance Evaluation Systems Test ) , change in gait velocity ( m/s ) between single and dual task walking , and fear of falling ( evaluated using the Fall Efficacy Scale International ) . Discussion This study has the potential to provide new insight and knowledge of the effects of specific , varied and challenging balance training on a wide health spectrum in elderly with PD . If found to be effective , this pragmatic approach with translation of theory into practice , can be implemented in existing outpatient care . Trial registration OBJECTIVE The basal ganglia may be selectively activated during rhythmic , metered movement such as tango dancing , which may improve motor control in individuals with Parkinson 's disease . Other partner dances may be more suitable and preferable for those with Parkinson 's disease . The purpose of this study was to compare the effects of tango , waltz/foxtrot and no intervention on functional motor control in individuals with Parkinson 's disease . DESIGN This study employed a r and omized , between- notsubject , prospect i ve , repeated measures design . SUBJECTS/ PATIENTS Fifty-eight people with mild-moderate Parkinson 's disease participated . METHODS Participants were r and omly assigned to tango , waltz/foxtrot or no intervention ( control ) groups . Those in the dance groups attended 1-h classes twice a week , completing 20 lessons in 13 weeks . Balance , functional mobility , forward and backward walking were evaluated before and after the intervention . RESULTS Both dance groups improved more than the control group , which did not improve . The tango and waltz/foxtrot groups improved significantly on the Berg Balance Scale , 6-minute walk distance , and backward stride length . The tango group improved as much or more than those in the waltz/foxtrot group on several measures . CONCLUSION Tango may target deficits associated with Parkinson 's disease more than waltz/foxtrot , but both dances may benefit balance and locomotion Background and Purpose : Parkinson disease ( PD ) results in an increased frequency of falls relative to the frequency in neurologically healthy people . The purpose of this study was to compare the accuracy of PD fall risk diagnosis based on one test with that based on the collective interpretation of multiple tests . Participants : Seventy people with PD ( mean age=73.91 years ) participated in this study . Method : Clinical balance tests were conducted during the initial examinations of people with PD .  Validity indices were calculated for individual tests and compared with validity indices calculated for a combination of multiple tests . Results : Thirty-six participants reported a fall history . Analysis of individual tests revealed broad variations in validity indices , whereas the collective interpretation of multiple tests improved sensitivity and negative likelihood ratios . Discussion and Conclusion : Collective interpretation of clinical balance tests result ed in fewer false-negative results and more substantial adjustments to the posttest probability of being a “ faller ” than the interpretation of one test alone . These results should be confirmed in a prospect i ve examination of fall risk in PD BACKGROUND / PURPOSE Virtual reality has the advantage to provide rich sensory feedbacks for training balance function . This study tested if the home-based virtual reality balance training is more effective than the conventional home balance training in improving balance , walking , and quality of life in patients with Parkinson 's disease ( PD ) . METHODS Twenty-three patients with idiopathic PD were recruited and underwent twelve 50-minute training sessions during the 6-week training period . The experimental group ( n = 11 ) was trained with a custom-made virtual reality balance training system , and the control group ( n = 12 ) was trained by a licensed physical therapist . Outcomes were measured at Week 0 ( pretest ) , Week 6 ( posttest ) , and Week 8 ( follow-up ) . The primary outcome was the Berg Balance Scale . The secondary outcomes included the Dynamic Gait Index , timed Up- and -Go test , Parkinson 's Disease Question naire , and the motor score of the Unified Parkinson 's Disease Rating Scale . RESULTS The experimental and control groups were comparable at pretest . After training , both groups performed better in the Berg Balance Scale , Dynamic Gait Index , timed Up- and -Go test , and Parkinson 's Disease Question naire at posttest and follow-up than at pretest . However , no significant differences were found between these two groups at posttest and follow-up . CONCLUSION This study did not find any difference between the effects of the home-based virtual reality balance training and conventional home balance training . The two training options were equally effective in improving balance , walking , and quality of life among community-dwelling patients with PD There is research evidence that exercise and motor training are beneficial for people with Parkinson 's disease ( PD ) , and clinicians seek to implement optimal programs . This paper summarizes important factors about the nature and reporting of r and omized controlled trials of exercise and /or motor training for people with PD which are likely to influence the translation of research into clinical practice . Search es identified 53 relevant trials with 90 interventions conducted for an average duration of 8.3 ( SD 4.2 ) weeks . Most interventions were fully supervised ( 74 % ) and conducted at a facility ( 79 % ) . Retention rates were high with 69 % of interventions retaining ≥85 % of their participants ; however adherence was infrequently reported , and 72 % of trials did not report adverse events . Overall , the labor-intensive nature of most interventions tested in these trials and the sparse reporting of adherence and adverse events are likely to pose difficulties for therapists attempting to balance benefits and costs when selecting protocol s that translate to sustainable clinical practice for people with PD Background The present study examined the effects of a balance-based exergaming intervention using the Kinect sensor on postural stability and balance in people with Parkinson ’s disease ( PD ) . Methods We conducted a subject-blinded , r and omized controlled study . Twenty people with PD ( Hoehn and Yahr stages I through III ) were recruited and r and omly assigned to either a balance-based exergaming group ( N = 10 ) or a balance training group ( N = 10 ) for an 8-week balance training period . Postural stability was assessed using the limits of stability ( LOS ) and one-leg stance ( OLS ) tests . Balance was assessed using the Berg Balance Scale ( BBS ) and the timed up and go ( TUG ) test . Participants were assessed pre- and post-training . Results After training , participants in the balance-based exergaming group showed significant improvements in LOS performance , and in the eyes-closed condition of the OLS test . Both training programs led to improvements in BBS and TUG performance . Furthermore , balance-based exergaming training result ed in significantly better performance in directional control in the LOS test ( 78.9 ± 7.65 % ) compared with conventional balance training ( 70.6 ± 9.37 % ) . Conclusions Balance-based exergaming training result ed in a greater improvement in postural stability compared with conventional balance training . Our results support the therapeutic use of exergaming aided by the Kinect sensor in people with PD.Trial registration Clinical Trials.gov . 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 : Impaired postural stability places individuals with Parkinson ’s at an increased risk for falls . Given the high incidence of fall-related injuries within this population , ongoing assessment of postural stability is important . Objective : To evaluate the validity of the Nintendo Wii ® balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson ’s . Subjects : Twenty individuals with Parkinson ’s participated . Intervention : Subjects completed testing on two balance tasks with eyes open and closed on a Wii ® balance board and biomechanical force platform . Main Measures : Bl and –Altman plots and a two-way , r and om-effects , single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data . Results : Concurrent validity was demonstrated to be excellent across balance tasks ( intraclass correlation coefficients = 0.96 , 0.98 , 0.92 , 0.94 ) . Conclusions : This study suggests that the Wii ® balance board is a valid tool for the quantification of postural stability among individuals with Parkinson ’s Background Although levodopa is the most common drug prescribed to relieve the symptoms of Parkinson 's disease it is associated with motor and psychiatric side-effects . Consequently , interest has turned to alternative drugs with improved side-effect profiles to replace or augment levodopa . Amantadine , originally used as an antiviral drug , has been shown to improve the symptoms of Parkinson 's disease . Objectives To compare the efficacy and safety of amantadine therapy ( monotherapy or adjuvant therapy ) versus placebo in treating people with Parkinson 's disease . Search methods Electronic search es of The Cochrane Controlled Trials Register ( The Cochrane Library Issue 3 , 2001 ) , MEDLINE ( 1966 - 2001 ) , EMBASE ( 1974 - 2001 ) , SCI SEARCH ( 1974 - 2001 ) , BIOSIS ( 1993 - 2001 ) , GEROLIT ( 1979 - 2001 ) , OLD MEDLINE ( 1957 - 1965 ) , LILACS ( 1982 - 2001 ) , MedCarib ( 17th Century - 2001 ) , PASCAL ( 1973 - 2001 ) , JICST-EPLUS ( 1985 - 2001 ) , RUSSMED ( 1973 - 2001 ) , DISSERTATION ABSTRACT S ( 2000 - 2001 ) , SIGLE ( 1980 - 2001 ) , ISI-ISTP ( 1990 - 2001 ) , Aslib Index to Theses ( 2001 ) , Clinical trials.gov ( 2001 ) , metaRegister of Controlled Trials ( 2001 ) , NIDRR ( 2001 ) and NRR ( 2001 ) were conducted . Grey literature was h and search ed and the reference lists of identified studies and review s examined . The manufacturers of amantadine were contacted . Selection criteria R and omised controlled trials comparing amantadine with placebo in the treatment of patients with a clinical diagnosis of idiopathic Parkinson 's disease . Data collection and analysis Data was abstract ed independently by NC and KD onto st and ardised forms and disagreements were resolved by discussion . Main results Six r and omised controlled trials were found comparing  amantadine monotherapy or adjuvant therapy with placebo  in the treatment of idiopathic Parkinson 's disease . Five examined amantadine as adjuvant therapy with optimal levels of levodopa or anticholinergics and one examined amantadine as an adjuvant  therapy with minimum tolerated levels of anticholinergics or as a monotherapy .  Five were double-blind cross-over studies and one was a double-blind parallel group study . In total they examined 215 patients . The parallel group study allowed the r and omisation codes to be broken and allowed patients in the placebo group to then receive amantadine . This could have led to bias . One study did not present the results of the placebo arm of the trial , hence we could not determine the difference between the two treatment groups . Two cross-over studies presented the results of the combined data from both treatment and placebo arms . The risk of carry-over effect into the second arm meant that these results could not be analysed . The final two studies presented at least some of their data from the end of the first arm of the trials . However only means were given , without st and ard deviations , so we could not determine the statistical significance of any difference between the amantadine and placebo groups . Although the authors did report on the side-effects from amantadine ( such as livido recticularis , dry mouth and blurred vision ) , they state that none of them were severe . Authors ' conclusions A considerable amount of evidence on the effectiveness of amantadine has accrued from non-controlled trials , often in patients with Parkinsonian conditions other than idiopathic Parkinson 's disease . However , rigorous analysis of the six r and omised controlled trials of amantadine reveals insufficient evidence of its efficacy and safety in the treatment of idiopathic Parkinson 's disease PURPOSE This study was undertaken to evaluate the effects of an inpatient 2-month multidisciplinary rehabilitative program of task-oriented exercises , cognitive-behavioral training , and occupational therapy on motor impairment , activities of daily living , and quality of life ( QoL ) in subjects with long- duration Parkinson 's disease ( PD ) . METHODS Subjects were r and omly selected for an experimental ( multidisciplinary rehabilitative care ) and a control group ( general physiotherapy ) and were assessed before treatment , after 8 weeks ( post-treatment ) , and 12 months after the end of treatment . Medications were not adjusted during training . Outcome measures were the Movement Disorder Society Unified Parkinson 's Disease Rating Scale , Part III ( primary outcome ) , the Berg Balance Scale , the Functional Independence Measure , and the 39-Parkinson 's Disease Question naire . A linear mixed model for repeated measures was used for each outcome . RESULTS Seventy subjects with PD ( 46 females ; mean age , 74 ± 7 years ; mean disease duration , 15 ± 3 years , modified Hoehn & Yahr stage , 2.5 - 4 ) were r and omized , 64 completed the study ( experimental = 32 ; control = 32 ) . A significant effect of time , group , and time by group interaction were noted for all outcomes . The primary outcome showed a between-group difference in favor of the experimental group of 25 points after training , which was maintained at follow-up . After training , the Berg Balance Scale score of the experimental group was greater than 43.5 , a value previously identified as a cutoff between fallers and nonfallers for subjects with PD . CONCLUSION Our findings suggest that multidisciplinary rehabilitative care is useful in changing the course of motor impairment , balance , activities of daily living , and QoL. The effects lasted for at least 1 y after the intervention Background There is a lack of studies related to virtual reality (VR)–augmented balance training on postural control in people with Parkinson disease ( PD ) . Objective The purpose s of this study were : ( 1 ) to examine the effects of VR-augmented balance training on the sensory integration of postural control under varying attentional dem and s and ( 2 ) to compare the results with those of a conventional balance training ( CB ) group and an untrained control group . Design A longitudinal , r and omized controlled trial was used . Setting The intervention was conducted in the clinic , and the assessment was performed in a research laboratory . Patients Forty-two people with PD ( Hoehn and Yahr stages II – III ) were recruited . Intervention The VR and CB groups received a 6-week balance training program . Measurements The sensory organization tests ( SOTs ) of computerized posturography with single- and dual-task conditions were conducted prior to training , after training , and at follow-up . Equilibrium scores , sensory ratios , and verbal reaction times ( VRTs ) were recorded . Results There were no significant differences in equilibrium scores or VRTs between the VR and CB groups . However , the equilibrium scores in SOT-6 ( ie , unreliable vision and somatosensation ) of the VR group increased significantly more than that of the control group after training . The equilibrium scores in SOT-5 ( ie , unreliable somatosensation with eyes closed ) of the CB group also increased significantly more than that of the control group after training . Limitations The functional significance of the improvements in equilibrium scores in the SOTs was not known , and the sample size was small . Conclusions Both VR and CB training improved sensory integration for postural control in people with PD , especially when they were deprived of sensory redundancy . However , the attentional dem and for postural control was not changed after either VR or CB training Purpose . It was hypothesised that lumbar vibration stimulation applied by a vibratory orthosis improves balance in people with Parkinson 's disease ( PD ) . Methods . The overall stability index and the percent of elapsed time in different zones and quadrants on the platform of Biodex balance system were evaluated . General conditions of eyes-open and eyes-close , each with two situations of motors On and motors Off of vibratory orthosis were considered . Results . Balance in  PD patients improved in eyes-open condition rather than eyes-close . The balance also improved in eyes-open condition with motors On rather than that in motors Off . In eyes-close condition , balance was lesser in motors On than that in motors Off situation . The results also suggest that in PD patients , body trajectories on the platform of Biodex balance system follow a r and om-like chaotic behaviour . Conclusions . A new orthosis in rehabilitation of PD patients was introduced to enhance balance and decrease risk of fall . It promotes new ideas for rehabilitation of similar neurological diseases . The possibility of enhancing balance in PD patients in a short-term setting was evaluated . Results showed balance enhancement in PD patients in eyes-open condition . However , in eyes-close condition , we are not sure of its effectiveness This r and omized controlled clinical trial was conducted to compare the effects of movement rehabilitation strategies and exercise therapy in hospitalized patients with idiopathic Parkinson 's disease . Participants were r and omly assigned to a group that received movement strategy training or musculoskeletal exercises during 2 consecutive weeks of hospitalization . The primary outcome was disability as measured by the Unified Parkinson 's Disease Rating Scale , UPDRS ( motor and ADL components ) . Secondary outcomes were balance , walking speed , endurance , and quality of life . Assessment s were carried out by blinded testers at baseline , after the 2 weeks of treatment and 3 months after discharge . The movement strategy group showed improvements on several outcome measures from admission to discharge , including the UPDRS , 10 m walk , 2 minute walk , balance , and PDQ39 . However , from discharge to follow up there was significant regression in performance on the 2 minute walk and PDQ39 . For the exercise group , quality of life improved significantly during inpatient hospitalization and this was retained at follow-up . Inpatient rehabilitation produces short term reductions in disability and improvements in quality of life in people with Parkinson 's disease BACKGROUND Evidence s have shown that physiotherapy programs may improve the balance of individuals with Parkinson 's disease ( PD ) , although it is not clear which specific exercise program is better . AIM The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients . DESIGN R and omized controlled trial . SETTING The study was conducted in a physiotherapy outpatient clinic of a university hospital . POPULATION A total of 40 PD participants were r and omly divided into two groups : balance training ( BT ) and resistance training ( RT ) . METHODS The BT group focused on balance training , functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk , both supervised by trained physiotherapists . Therapy sessions were held twice a week ( at 60 minutes ) , totaling 24 sessions . The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test ( BESTest ) scale to determine the effects of the intervention on postural control . RESULTS Significant improvement of postural control ( pre vs. post 15.1 vs. 9.6 cm2 ) was only reported in favor of BT group ( d=1.17 ) for one-legged st and condition on force platform . The st and ardized mean difference between groups was significantly ( P<0.02 ) , with 36 % of improvement for BT vs. 0.07 % for RT on this condition . Significant improvement ( P<0.05 ) was also observed in favor of BT ( in mean 3.2 % ) for balance gains in some BESTest scores , when compared to RT group ( -0.98 % ) . CONCLUSIONS Postural control in Parkinson 's disease is improved when training by a directional and specific balance program than a resistance training program . CLINICAL REHABILITATION IMPACT Balance training is superior to resistance training in regard to improving postural control of individuals with PD . Gold st and ard instruments ( high in cost and difficult to access ) were used to assess balance , as well as scales with clinical applicability ( low cost , easily acceptable , applicable and valid ) , which can guide the management of physiotherapists both in their decision-making and in clinical practice Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson 's disease ( IPD ) .  Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling . The purpose of this study was to determine the efficacy of clinical tests , balance scales , and  stable-platform posturography  in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort . Forty-eight PD subjects ( Hoehn & Yahr stage 1 - 3 ) and 17 age-matched controls had the following assessment s : Activities-specific Balance Confidence scale , Berg Balance Scale , Unified Parkinson 's Disease Rating Scale ( UPDRS ) ( motor ) , pull-test , timed up- and -go , static posturography , and dynamic posturography to assess multidirectional leaning balance . Of the clinical assessment s , all but the pull-test were closely correlated with a history of falling .  Static posturography  discriminated between PD fallers and controls but not between PD fallers and non-fallers , whereas  dynamic posturography ( reaction time , velocity , and target hit-time ) also discriminated between fallers and non-fallers . Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospect i ve assessment of falls risk in PD patients . A further prospect i ve study is now required to assess their predictive value . © 2013 Movement Disorder Society 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 Objective : To compare the efficacy of two physiotherapy protocol s ( water-based vs. non-water-based ) on postural deformities of patients with Parkinson ’s disease . Design : A single blind , r and omized controlled pilot study . Setting : Inpatient ( Rehabilitative Department ) . Participants : A total of 30 patients with idiopathic Parkinson ’s disease . Interventions : Participants were r and omly assigned to one of two eight-week treatment groups : Water-based ( n = 15 ) or non-water-based physiotherapy exercises ( n = 15 ) . Outcome measures : Changes in the degree of cervical and dorsal flexion and in the angle of lateral inclination of the trunk ( evaluated by means of a posturographic system ) were used as primary outcomes . Unified Parkinson Disease Rating Scale section III , Time Up and Go Test , Berg Balance Scale , Activities-specific Balance Confidence , Falls Efficacy Scale and the Parkinson ’s disease quality of life question naire ( 39 items ) were the secondary outcomes . All outcomes were assessed at baseline , at the end of training and eight weeks after treatment . Patients were always tested at the time of their optimal antiparkinsonian medication ( ‘ on ’ phase ) . Results : After the treatment , only Parkinson ’s disease subjects r and omized to water-based treatment showed a significant improvement of trunk posture with a significant reduction of cervical flexion ( water-based group : −65.2 ° ; non-water-based group : + 1.7 ° ) and dorsal flexion ( water-based group : −22.5 ° ; non-water-based group : −6.5 ° ) and lateral inclination of the trunk ( water-based group : −2.3 ° ; non-water-based group : + 0.3 ° ) . Both groups presented significant improvements in the secondary clinical outcomes without between-group differences . Conclusion : Our results show that water-based physiotherapy was effective for improving postural deformities in patients with Parkinson ’s disease Background and Purpose : Distinguishing between a clinical ly significant change and change due to measurement error can be difficult . The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale ( BBS ) , forward and backward functional reach , the  Romberg Test and the Sharpened Romberg Test ( SRT ) with eyes open and closed , the Activities-specific Balance Confidence ( ABC ) Scale , the  Six-Minute Walk Test ( 6MWT ) , comfortable and fast gait speed , the  Timed “ Up & Go ” Test ( TUG ) , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , and the Unified Parkinson Disease Rating Scale ( UPDRS ) in people with parkinsonism . Subjects : Thirty-seven community-dwelling adults with parkinsonism ( mean age=71 years ) participated . The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale ; however , the scores ranged from 1 to 4 . Methods : Subjects were tested twice by the same raters , with 1 week between tests . Test-retest reliability was calculated using intraclass correlation coefficients ( ICCs ) . Minimal detectable change was calculated using a 95 % confidence interval ( MDC95 ) . Results : The ICCs for test-retest reliability were above .90 for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and comfortable and fast gait speeds . The MDC95 values for those functional tests were : BBS=5/56 , ABC Scale=13 % , SRT with eyes closed=19 seconds , 6MWT=82 m , comfortable gait speed=0.18 m/s , and fast gait speed=0.25 m/s . The ICCs for test-retest reliability of SF-36 scores were above .80 , with the exception of the social functioning subscale . The MDC95 values for the SF-36 ranged between 19 % and 45 % . The MDC95 values for the UPDRS Activities of Daily Living section , Motor Examination section , and total scores were 4/52 , 11/108 , and 13/176 , respectively . Discussion and Conclusion : Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinical ly significant . High test-retest reliability of scores for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and gait speed make them trustworthy functional assessment s in people with parkinsonism . The SF-36 and UPDRS provide quality -of-life and disease severity rating values in the ongoing assessment of people with parkinsonism 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
Conclusion ] Different methods , such as scales , tests , and equipment , are used for the evaluation of balance in patients with Parkinson 's disease .
[ Purpose ] The present literature review was conducted on the use of different measures for the evaluation of balance in patients with Parkinson 's disease .