//Therapist-supervised compared to home-based balance training encourages a ‘posture first’ strategy during turn-to-sit transitions in individuals with Parkinson's disease

Abstract

Individuals with Parkinson's disease (IwPD) tend to turn slower and with more steps than age-match healthy individuals. This poor postural control during complex transitional movements, like turning or turn-to-sit, results in increased fall risk, as well as diminished quality of life and independence. Fall risk is furthermore aggravated when IwPD attempt to perform multiple tasks at the same time (i.e. termed dual-tasking). Previous research has shown that balance training effectively improves postural control in IwPD; however, whether a therapist-supervised or home-based balance-training program is more effective remains unclear. Consequently, this study endeavoured to compare the effect a therapist-supervised and home-based eight-week balance training program has on turning in IwPD. Twenty-nine men (65.7 ± 7.1years) diagnosed with PD (Hoehn&Yahr: II–III) were randomized into a therapist-supervised ( n = 15) or home-based ( n = 14) group. Both groups followed an eight-week balance-training program (3 × week for 45–50 minutes) under the supervision of a therapist or on their own with a DVD. Turn-to-Sit, Turning Velocity (TV) and Duration (TD) were assessed with a 7 m Timed-Up-and-Go test and the APDM mobility Lab ® , during single- and dual-task conditions, over the interventions. Percentage dual-task cost (% DTC) was also determined. No differences were found between the groups for TV and TD over time ( P > 0.05). Therapist-supervised group completed the Turn-to-Sit faster over the intervention and compare to the home-based group during single- and dual-task conditions ( P < 0.05). The % DTC was poorer in the home-based compared to therapist-supervised group post-intervention ( P = 0.04). Findings suggest that when IwPD are supervised by a therapist that they learn to prioritize postural control during the turn-to-sit transitions (i.e. ‘posture first’ strategy) as well as switch more effectively from one motor program to another. While an unsupervised home-based balance program resulted in a ‘posture second’ strategy, in which participants’ attention was divided, which may contribute to an increase fall risk.