Comparison of home-based and therapist-supervised balance training on gait variables of freezers

Abstract

Parkinson's disease (PD) often manifests as dysfunctional mobility, with freezing of gait being one of the most prominent signs. Individuals who freeze (freezers) often have a greater loss of independence compared to their non-freezing counter parts. Exercise interventions have shown some benefit in reducing freezing of gait frequency and severity. However, research still need to establish what type of exercise and exercise delivery is most effective for freezers. Therefore, this study aimed to evaluate and compare the efficacy of home-based to therapist-supervised balance training on freezing of gait and gait parameters. Based on a sample of convenience, 40 participants with mild-to-moderate Parkinson's disease (Hoehn & Yahr stages I–III) were allocated to a therapist-supervised ( n = 24, age 65.4 ± 8.3 years) or home-based group ( n = 16, age 64.9 ± 7.1 years). Within each group 50% of individuals reported experiencing freezing. Both groups followed 8 weeks of balance training; the therapist-supervised (TS) group attended classes, and the home-based (HB) group followed DVDs at home. Outcome measures included the instrumented Timed-Up-and-Go and the Activity-specific Balance confidence (ABC) scale. The freezers differed significantly from the non-freezers in both TS and HB groups at pre-test for gait variables ( P < 0.03), including stride length, stride velocity and cadence, as well as self-perceived balance confidence ( P < 0.05). The freezers in the TS group improved their gait variables over time and showed a strong tendency to improve ABC scores ( P = 0.061) over time. The improvements in gait of the TS freezers shows that balance training with a therapist could be an essential tool to improve the independence and confidence of freezers. This study reiterates the differences between freezers and non-freezers, and shows the complexities a therapist should keep in mind when working with a heterogeneous group, such as PD individuals.