Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover.

Mariano Serrao,Carmela Conte,Giorgia Chini,Elisabetta Sinibaldi,Giovanni Sellitto,Michelangelo Bartolo,Giuseppe Monari,Alberto Ranavolo,Stefano Filippo Castiglia,Francesco Pierelli,Dario Gimma,Marina Priori

doi:10.3389/fneur.2019.00902

Abstract

Introduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity.Design: Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period.Participants: Forty individuals with idiopathic PD in Hoehn and Yahr stages 1–4.Intervention: Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B).Primary outcome measures: Spatiotemporal gait parameters, joint kinematics, and trunk kinematics.Secondary outcome measures: UPDRS-III scale scores.Results: The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously.Conclusions: The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03346265.

Highlights

The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles
The present findings showed that a rehabilitative approach based on PMR plus visual cues (VC) for rehabilitation of gait function in people with Parkinson’s disease (PD) appears to be more beneficial when compared to conventional physiotherapy executed according to European guidelines
These findings can be summarized as follows: (i) both treatments improved gait function and motor function severity; (ii) patients who received PMR with VC presented with better results in gait performance, gait balance, and trunk control than those who received conventional physiotherapy; and (iii) only 37.5% of patients crossed over between the groups, there still were some differences in the primary outcomes

Summary

Introduction

The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. We propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. Several studies have shown improvement in electromyographic and spatiotemporal parameters of gait in PD patients undergoing gait training with auditory, visual, and tactile cues [22,23,24,25,26,27]

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