Parkinson Disease
Conditions
Keywords
multimodal, real-time feedback, automaticity, gait, balance
Brief summary
People with Parkinson Disease (PWPD) have significant problems with velocity, safety and dual tasking during walking that may be secondary to poor automaticity. Sensory functions, especially visual dependence and proprioceptive integration are critical for efficient walking and are often impaired. This home program compares the use of multimodal sensory feedback during stepping and balance exercises in PWPD to a group without the sensory feedback performing the same basic exercises.
Detailed description
Parkinson disease impairs motor and sensory functions. Automaticity of gait is lost increasing the use of higher center control of walking, leading to cognitive fatigue, slower movement and motor errors. People with Parkinson disease (PWPD) improve motor performance when external sensory cues, which bypass the faulty basal ganglia, are used during interventions. Enhancing proprioceptive, visual and vestibular cues that are critical for walking has the potential to improve gait and decrease cognitive fatigue by restoring automaticity. This is a single-blinded randomized controlled study with repeated measures to evaluate the effects of a home exercise program with or without the addition of multi-modal sensory feedback (MMSF) in real-time on automaticity of gait and balance. PWPDs are randomly assigned to one of 2 home exercise groups. There are two 6 week exercise sessions with a 6 week of no exercises inter-spaced between them. The exercises promote rapid and large movement in stepping activities, balance using self-perturbation through single, leg swings and standing on a compliant surface for sensory re-weighting. People in the experimental group perform the program with real-time with MMSF. Participants are to progress exercises in speed and distance as well as performing with eyes closed to improve proprioceptive processing and automaticity.
Interventions
BEHAVIORALexercise+multi-modal sensory feedback (MMSF)
home program of 3 stepping exercises and 3 balance exercises with progression of speed, step distance and reduced vision. Real-time sensory feedback during ex. using ankle, wrist wts., laser on chest and mat with footpads and clickers (auditory feedback during stepping)
BEHAVIORALExercise only
3 stepping and 3 balance exercises which are to progress in speed and distance of movement as well as progress to eyes closed while performing.
Sponsors
Regis University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
blinded to subject group assignment
Intervention model description
Single blind randomized trial with 2 groups
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Medical diagnosis of Parkinson Disease * A score of 26 or higher on the Mini-Mental Status Exam * Able to stand from sitting and take 5 steps without assistance * People who have been on the same dosages of medication for PD for 3 weeks or longer
Exclusion criteria
* Participating in an exercise program for less than 3 months * Plans to change a current exercise program during the study * Changes in medications that affect PD or its sequelea
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in temporalspatial components of Gait | baseline before exercise training, 6 weeks, 12 weeks and 18 weeks after initiation of exercise | temporal and spacial components of gait measured with Gaitrite Mat |
| changes in balance | baseline before exercise training, 6 weeks, 12 weeks and 18 weeks after initiation of exercise | single leg stance time, time standing on foam eyes closed, Mini-BESTest |
| Change in cognitive attention needed for gait | Baseline, 6 weeks, 12 weeks and 18 weeks after initiation of exercise | 3 meter walk test performed at comfortable gait speed once and repeated while subtracting 3s from 100 to assess cognitive attention needed for walking tasks (automaticity) |
| Change in perceived difficulty during gait and ADLs, | Baseline, 6 weeks, 12 weeks and 18 weeks after initiation of exercise | Parkinson Disease Questionnaire (PDQ-39) |
Countries
United States
Outcome results
None listed