Does Movement Velocity Respond to Training in Individuals with Advanced Parkinsonʼs Disease?

Abstract

2087 Parkinson's disease (PD) is a progressive neurological disease characterized by tremor, rigidity, bradykinesia, and postural instability. The bradykinesia (slow movement) and postural instability (loss of righting reflexes) become worse as the disease advances. PURPOSE: Conduct a pilot study of a gait and step training program designed to improve slow movement and postural instability. METHODS: Ten men with PD (age 70.6 +/−7.4 years; Hoehn & Yahr Disability Scale 3 or 4)) reporting frequent falls or demonstrating loss of postural righting responses, were randomly assigned to either a training or control group. Subjects had an average score on the Unified Parkinson's Disease Rating Scale of 33.8 +/− 13, and all were taking anti-parkinsonian medications. The training group received gait and step training 1 hour/day, 3 X/week for 8 weeks. Gait training consisted of walking at a speed faster than fastest overground walking speed on a treadmill in a safety harness to provide safety from falling in 4 directions (forward, backward, and sideways right and left). For step training, the subject stood on the treadmill (forward, backward, or sideways) supported in the safety harness while the treadmill was suddenly turned on and off. The speed of the treadmill was incresed as training progressed. Subjects were tested for forward (FMV) and backward movement velocity (BMV) on a Pro Balance Master. Analysis of variance with 2 factors (time and group) was used for the analysis. Effect sizes were also calculated. RESULTS: The training group demonstrated an increase of movement velocity of 1.16 deg/sec compared to 0.46 deg/sec in the control group for FMV, but both groups increased slightly for BMV (.2 deg/sec training and .23 deg/sec control). There were no significant differences for time or between groups. The effect size for FMV was large (1.32) compared to a small effect size of .12 for BMV. CONCLUSIONS: No other physical intervention has shown improvement in balance in advanced stages of the disease. Individuals with Parkinson's disease demonstrate considerable variability in these, and other, balance measures. This small pilot suggests that our training can produce a relatively large effect size for FMV after just 8 weeks of training. A larger sample size is needed to demonstrate the efficacy of this intervention in relation to movement velocity. Supported by HVAMC Parkinson's Disease, Research, Education & Clinical Center.