Do Individualized Physical Therapy Interventions Improve Balance And Gait Initiation In Persons With Parkinson’S Disease?

Abstract

Resting tremor, bradykinesia, rigidity, and loss of postural reflexes are the cardinal signs of Parkinson’s disease (PD). Persons with PD frequently have balance impairments and postural instability which correlates with the increase in fractures and soft tissue injuries when compared to age-matched peers without PD. Persons with PD also frequently present with increased postural sway during quiet stance in addition to impaired weight shifting when transitioning between states of static and dynamic equilibrium such as during gait initiation and termination. Previous intervention studies lasting at least 12 weeks implemented a variety of methodologies such as strength training, aerobic training, tai chi, and dance therapy and produced long-term benefits. Previous studies are inconclusive whether a multi-faceted approach for physical therapy intervention based on preferences of the participants will affect balance and gait initiation in those persons with PD. PURPOSE: To investigate if 12 weeks of individualized and supervised physical therapy intervention improves balance and gait initiation in persons with PD. METHODS: Six adults diagnosed with mild to moderate PD (mean age= 68.8 years±10.3 years), Hoehn and Yahr Levels I-III (Level I, n=2) (Level II, n=3) (Level III, n=1) participated in a 12-week program. The interventions were tailored to address functional deficits and participants’ goals. Pre- (PRE) and post-testing (POST) included the Mini-BESTest, which measures 4 balance control systems. Gait initiation assessments were also performed as the participants voluntarily initiated gait from a quiet stance position on force plates. A paired sample t-test was used to compare PRE and POST. RESULTS: Four participants met or exceeded the minimal clinically important difference for the Mini-BESTest. The Mini-BESTest scores improved significantly (PRE, 18.5±5.8; POST, 24.7±3.5; p=0.021). There was no significant change in gait initiation parameters related to center of pressure movement. CONCLUSION: The 12-week individualized and supervised physical therapy program improved dynamic and static balance, but not gait initiation. The intervention was individualized towards the functional deficits and goals that were obtained in pre-testing. A limitation for this study was the small sample size.