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Balance Issues Are Inevitable with Parkinson’s Disease

balance

Years ago, Harrison Ford played the role of Henry Turner, the main character in the movie “Regarding Henry.”

Henry’s entire world shifts when he is shot in the head during a robbery at the convenience store where he was buying cigarettes. The nearly fatal injury puts him into cardiac arrest and he ends up with brain damage, specifically retrograde amnesia.

It takes several months for Henry to recover. When he is finally released from the hospital, he is not the man he used to be — an arrogant playboy who steps on others to get what he wants. The Henry from before was unfaithful to his wife, and his daughter was afraid of him. Henry post-injury is almost childlike, and upon learning who he was before the accident, tries to right some of his wrongs.

In the first few days home, Henry is sitting at the table with his daughter eating breakfast when she accidentally spills her milk on the kitchen table. Fear seizes her as she awaits Henry’s reaction. He sees the fear in her eyes, and to put her at ease, says, “It’s OK. I do that all the time.” He then tips over his glass of milk as well.

A few months ago, I read about a woman who had Parkinson’s disease (PD). She, like so many of us, was frequently dropping things, including her meals, which made her feel humiliated and embarrassed. Unfortunately, that’s what PD does. It gives you plenty of opportunities to be humiliated and embarrassed, always when you least expect it. But what we need to do is learn to go easy on ourselves. It’s not like we are doing these things on purpose.

The fact is that we all spill things, Parkinson’s or not. We all lose our balance and drop things or fall to the ground. Having PD just makes the opportunities more probable. We need to recognize that spills and falls are going to happen sooner or later, and we should try to be ready for it.

Here’s what you will need:

  • A cane or a walker
  • A helmet
  • Knee pads
  • Body armor
  • Elbow pads
  • Shin guards
  • Safety goggles
  • Leather gloves
  • Steel-toe boots
  • Brawny paper towels for those tough spills
  • Medic alert device to alert people that you have fallen and can’t get up
  • A sense of humor

A dog to lick up those spills wouldn’t be bad, either. Just decide that you are going to turn that 5-second rule into 20 — as we all know, things take just a little bit longer to do with PD!

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Frustrated and Angry? It’s Not People, It’s Parkinson’s

angry

I get angry if he does and frustrated when he doesn’t. “He” is my husband.

I am getting rather self-conscious about going out in public. Sometimes, I feel like people who don’t know me perceive me as being a little drunk because I’m off balance when I walk. 

Other times, I feel people view me as ignorant because I’m unable to finish some of my sentences or I lose my train of thought. That’s where he — my husband — comes into play. When we are out in public, I sometimes get angry when he finishes my sentences for me, and at other times, I get frustrated when he doesn’t.

He can’t read my mind, so he won’t always know when I want him to step up and help me out or when I want him to let me communicate on my own. 

The other day, someone asked me an important question. I got so flustered over my response that I stewed over it for two days.

When I saw the person again, my husband was there. I posed the question to him so she could get a clearer, more logical answer. Then I stewed over whether I should have done that. Just as I had anticipated, however, he answered it with knowledge, wisdom, logic, and clarity. I find that harder to do at times with this scatterbrained kind of disease, and it makes me want to cry.

I have never considered myself a genius, but I have never thought I was stupid, either — until now.

I feel that’s how others perceive me, probably because I tend to view myself that way nowadays.

For example, when I am out for a walk with my neighbor and I am sharing something with her, poof! Just like that, the thought is gone. Or my words feel jumbled and sticky. Or I trip over the silliest things, like my own two feet, and I end up breaking my toe.  

Yes, that was a recent occurrence. 

In my own home. 

In front of all my grandchildren. 

It’s frustrating, and I do grieve the things I’ve lost to this disease — not just speech and balance, but all the things that were mine to use and refine and are now gone or on their way out.  

With all that said, I try to treasure what is still here and make the most of it because I know it could be much, much worse. I also know that if I want to finish my own sentences and feel I am not always given that opportunity, I should actually be grateful there is someone who cares enough to not leave me standing and looking foolish. All I have to do is look at him with “Help” written in my expression, and he comes to my rescue. My hero.

I get angry and frustrated sometimes. I have to remember that Parkinson’s is the cause, not people.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Imbalance in Dopamine and Acetylcholine Levels May Drive Disease Progression, Study Finds

neurotransmitters

Therapies against motor loss and progression in Parkinson’s’ disease (PD) may need to tackle the imbalance between two neurotransmitters, dopamine and acetylcholine, instead of focusing on dopamine alone, an early study suggests.

The study, “Dopamine Deficiency Reduces Striatal Cholinergic Interneuron Function in Models of Parkinson’s Disease,” was published in the journal Neuron.

Motor and cognitive functions depends on the coordinated interaction in the brain of two neurotransmitters — substances produced in response to nerve signals that act as chemical messengers — called dopamine and acetylcholine.

In Parkinson’s, the degeneration of motor neurons that produce dopamine in a brain region called the striatum results in difficulties with voluntary movement control.

Therapies that increase dopamine or activate dopamine receptors, such as levodopa, are currently used to restore motor skills. However, these treatments are not fully effective and their benefits wear off over time.

Researchers have thought that a decline in dopamine levels would increase acetylcholine production. Higher levels of acetylcholine are suggested to cause the dyskinesia — uncontrolled, involuntary movements — observed in Parkinson’s patients under long-term dopamine therapy.

Researchers at Yale University questioned points in these assumptions. They investigated how dopamine affects acetylcholine by looking at a specific type of nerve cell, called striatal interneurons, that is the main source of acetylcholine in the striatum.

To test the effects of dopamine loss, the team used a mouse model genetically modified to mimic Parkinson’s that has a progressive decline in dopamine levels. When motor symptoms appear in these mice, it is estimated that about 30% of dopamine is already lost, increasing to 60–80% at their death.

This progressive dopamine loss, the researchers saw, was matched in the animals by an initial and smaller decrease in the production of acetylcholine by striatal interneurons, creating an imbalance.

“While the concentrations of both dopamine and acetylcholine decline, the balance between these two neurotransmitters shifts to favor acetylcholine,” the researchers wrote.

Subsequent release of dopamine from remaining axon terminals push an increase of acetylcholine, worsening the imbalance between both neurotransmitters.

Under dopamine depleted conditions, proper motor function is dependent on adequate levels of both acetylcholine and dopamine, the study concluded.

Its findings suggest that progressive dopamine deficiency reduces the activity of striatal cholinergic interneurons, resulting in progressive motor difficulties.

Future treatments aiming to slow Parkinson’s progression should include those targeting the balance between acetylcholine and dopamine.

“Our findings suggest that targeted cholinergic therapy [those that mimic the action of acetylcholine] has a place in the management PD and highlight the need for additional experiments that will offer therapeutic options distinct from disease prevention,” the researchers wrote.

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Torso Exercises Helped Reduce Severity of Forward Stoop in Parkinson’s Patients

torso exercises

Torso-specific exercises can help improve posture and balance by significantly reducing the severity of forward stoop in patients with Parkinson’s disease.

The study with that finding, “Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson’s disease: A single-blinded, randomized controlled trial,” was published in the journal Parkinsonism and Related Disorders.

Forward bending of the spine, known as disease-related forward trunk flexion (FTF), is a common complication observed in patients with Parkinson’s disease. FTF can result in permanent postural imbalance, pain, frequent falls, and irreversible deformities. Early detection and rehabilitation efforts through focused physical therapy can help in reducing pain and delay motor symptoms progression. However, information is limited on FTF rehabilitative efforts in Parkinson’s patients.

In a controlled trial (NCT03741959), researchers assessed the impact of a four-week trunk-specific rehabilitation program in correcting the posture of  37 Parkinson’s patients with FTF. Patients were assigned randomly to the experimental group (19 patients) or the control group (18 patients).

The exercise regimen for the experimental group consisted of three routines. First was a 20-minute session of self-correction exercises in three levels of difficulty to be performed in front of a mirror (visual feedback), while measuring the muscle activity using electromyogram (proprioceptive feedback), or without any feedback. The second routine included 20 minutes of trunk stability exercise and improving muscle strength and coordination. The third set of exercises included functional tasks that were meant to trigger behavior changes to unconsciously correct posture and movement to aid daily activities.

In the four-week program, the exercise regimen was performed in 60-minute sessions for five days a week.

The control group performed 20 minutes of joint movements, exercise for muscle strength, and stretching, followed by gait training and balance exercises.

All the exercise routines were performed under the guidance of a trained physical therapist, and each treatment session consisted of 10 exercises with repetitions based on the patient’s capacity.

In the four-week program, the exercise regimen was 60-minute sessions five days a week.

Patients who underwent the four-week program showed a significant decrease in the degree of forward bend compared to the control group, indicating a positive effect from the trunk-specific exercises. The exercise regimen helped them straighten up by a mean of 9.73 degrees by the end of the program, and 8.84 degrees at the one-month follow-up. In contrast, the control group exercises corrected posture by a mean of only 1.62 degrees and 0.95 degrees at the same time intervals.

“The main findings of the present study are that the four-week trunk-specific exercise program reduced the degrees of FTF in patients with Parkinson’s disease more than the conventional treatment, and the training effects were maintained at one-month post-treatment,” researchers wrote.

Further assessments showed that both groups exhibited significant improvement in patients’ ability to perform daily activities, as determined by the Unified Parkinson’s Disease Rating Scale III (score range 0-132, with higher scores representing worsened symptoms), compared to before the intervention.

Also, significant reduction in pain was reported in both the groups at one month of follow-up. However, there was no statistical difference between the two groups, researchers noted.

The team also assessed the impact of the exercise in improving static balance (ability to balance while standing still) and dynamic balance (ability to balance while moving or switching positions). No difference was noted in both groups immediately after completion of the four-week program. But, at the one-month follow-up, the static and dynamic balance was significantly improved in the experimental group compared with the control group.

In addition, patients in the experimental group reported a marked overall decrease in the number of falls per month at the one-month follow-up, as well as an overall improvement in their health-related quality of life at the one-month follow-up; the control group experienced a decline.

“The four-week trunk-specific rehabilitation training decreased the forward trunk flexion severity and increased postural control in patients with Parkinson’s disease,” researchers stated.

More studies are warranted to further validate these preliminary findings and explore more extensively the potential of torso-specific exercises for Parkinson’s patients, they added.

 

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Ballet Not Seen to Greatly Improve Gait or Balance in Small Study in Parkinson’s Patients

Ballet practice may not improve balance and gait in people with Parkinson’s disease — at least not over the long term, a small study in patients engaged in dance for at least a year suggests, possibly contradicting earlier research reporting evidence of such benefits.

But the work did find probable social and psychological gains, noting a “high levels of adherence” among the Parkinson’s group, indicating motivation “to continue attending.”

Researchers for this study, “Effects of a ballet-based dance intervention on gait variability and balance confidence of people with Parkinson’s,” published in the journal Arts & Health, suggesting that more research needs to be done to understand whether and how dance therapy can be effective.

Dance can be beneficial for many, and especially people with neurodegenerative diseases. It is a form of physical movement that is often easier to “stick with” than just exercising, and offers social contact that rewards a person’s mental health and psychological well-being. Some previous studies specifically indicated that dance may improve motor skills in people with Parkinson’s.

The U.K. team here wondered whether ballet — a dance form that requires many balancing movements, like stabilizing weight on one leg while moving the other  — would be of benefit for Parkinson’s patients.

They recruited 19 patients already enrolled in weekly “dance for Parkinson’s” classes. Participants had to have been dancing for at least three months, although most had already been participating for over a year.

Another 13 patients who refrained from ballet classes for the study’s duration served as a control group.

Over the course of a year, people in both groups were examined for changes in gait and balance. To analyze gait, a sensor was placed on a participant’s lower back when they walked across the room, allowing for measurements of stability as they walked.

For balance, the Activities-specific Balance Confidence Scale was given to participants. This questionnaire is a measurement of confidence in balance, not balance itself, since it’s asking participants questions about their perceptions of their own balance.

No significant difference in all of the above measures was seen between the two groups over the study’s year. This contradicted pro-benefit findings of previous research, and the investigators offer two likely explanations for this disparity.

“First,” they write in their study, “gait variability as an indication of dynamic stability has not been assessed in previous dance for Parkinson’s research.” Further, measures of gait variability used in this study might “not be comparable” to “commonly used clinical rating scales” that look more at “static balance tasks,” and reliance on their  different variables may make all the difference.

“Secondly,” the researchers said, “previous studies evidencing changes to balance, gait, and functional mobility have often included a class frequency of two to three dance classes per week,” while participants in this study had one class per week.

They also suggested that a study limitation was the fact that its patient group had been taking the weekly classes for about a year prior to the study’s start. Regular long-term dance classes made it “possible that a ceiling effect may have occurred whereby any resulting change in gait variability as a result of the ballet-based sessions was no longer visible,” the researchers concluded.

“It is possible that the ballet-based sessions had a positive affect on gait variability for the participants; however, the measurements were not able to capture this early change at the beginning of their dance programme.”

 

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Hydrotherapy Improves Balance, Mobility in Parkinson’s Patients, Study Reports

hydrotherapy

Hydrotherapy may provide significant balance and mobility benefits in patients with Parkinson’s disease compared to medication and land-based exercises, according to a review study.

The research, “The Effects of Hydrotherapy on Balance, Functional Mobility, Motor Status, and Quality of Life in Patients with Parkinson Disease: A Systematic Review and Meta-analysis,” was published in the journal PM&R.

Impairments such as muscle rigidity and tremor affect the balance and mobility of people with Parkinson’s. Combined with fear of falling, it promotes a sedentary lifestyle and reduces quality of life.

Water-based exercise is often prescribed to these patients, providing a safe environment that reduces the risk of falling. Prior studies have reported that hydrotherapy improves motor symptoms. However, the evidence about  hydrotherapy as a treatment strategy in Parkinson’s is scarce.

To address this gap, researchers conducted a systematic review of the available scientific literature and a meta-analysis — a type of statistical analysis that combines the results of various studies.

The scientists focused on hydrotherapy’s effectiveness on patients’ balance, mobility, quality of life and motor function.

For this purpose, the investigators searched seven online databases as well as unpublished or ongoing clinical trials from inception through December 2017. Nineteen studies were identified, of which eight were randomized controlled trials (RCTs). Overall, the studies had 484 participants, with a mean age ranging from 54 to 78 years and an average disease duration ranging from three to 10 years.

The studies had different designs, which included comparisons of hydrotherapy with land-based exercises or medications, combinations of hydrotherapy with land-based therapy, and assessments of low-intensity and muscular resistance water-based exercises.

Hydrotherapy could include balance training, stretching, strengthening, trunk mobility, and gait exercises. The sessions ranged from 40 to 60 minutes, one to five days per week, for three to 20 weeks, for a total of eight to 60 sessions. Water temperature was set between 28ºC (82ºF) and 34ºC (93ºF) in the 12 studies that reported this parameter.

All but two studies with available information on levodopa usage evaluated patients’ in the “on” phase, which refers to the period when this medication is effective and has not yet worn off.

The meta-analysis on balance and mobility included five RCTs, which had a total of 133 patients. The results showed that hydrotherapy with or without land-based exercises significantly improved both balance and mobility compared to land-based therapy or usual care with medication alone.

Three other studies not included in the meta-analysis due to lacking a control group also found significant benefits with hydrotherapy in balance. One RCT not included in the statistical comparison did not report differences with hydrotherapy and land-based therapy, while another showed that aquatic obstacles training is more beneficial for balance than traditional water-based exercises.

In turn, two RCTs not included in the respective analysis failed to show mobility improvements with hydrotherapy.

As for quality of life, an analysis of three RCTs with 76 patients showed no benefits with hydrotherapy compared to land-based treatment, which the researchers attributed to the small number of studies included. This also was observed in one RCT not included in the meta-analysis. In contrast, five other studies, including two non-randomized trials, found significant improvements with water-based treatment.

Results of a meta-analysis of five RCTs with 140 patients also did not reveal improvements in motor function in comparison to land-based exercise. This can be explained by patients having types of motor complications not expected to improve with hydrotherapy, the team said.

Of note, two other RCTs and a non-randomized trial also did not find different results with hydrotherapy compared to other approaches in motor function.

Overall, the scientists wrote, “hydrotherapy, combined or not with other therapies, may improve balance and functional mobility of patients with [Parkinson’s] when compared to land-based therapy alone or usual care.”

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Freedom of Movement May Be Misinterpreted as Balance Instability, Parkinson’s Study Suggests

balance instability

Antiparkinsonian medicines may allow patients with mild to moderate Parkinson’s disease to experience freedom of movement, which could be confused with balance issues if measured by traditional postural stability testing, researchers suggest.

Their findings were published in the study, “The influence of dopaminergic medication on balance automaticity in Parkinson’s disease,” in the journal Gait & Posture.

Dopaminergic medications can help control Parkinson’s motor symptoms, but as the disease progresses, patients typically need to gradually increase the treatment dose for maximum benefit. Even after increasing the dose, they might sometimes experience a reappearance or worsening of symptoms (off periods) due to the diminishing effects of the therapy.

It is known that Parkinson’s patients have difficulty performing learned motor skills automatically, a phenomenon referred to as decreased motor automaticity. Automaticity is the ability to perform movements without having to pay attention to the details of the movement, particularly for actions that require low levels of precision or for movements that are frequently made.

Studies also report that the ability to perform two or more tasks at the same time, called dual-tasking, is impaired in Parkinson’s disease.

“Dual-tasking involves performing a primary motor task (e.g., standing) and a secondary task (e.g., conversing) simultaneously and is the primary means of assessing the automaticity of a given motor task,” the researchers wrote.

In theory, if a primary task is automatic, performing another task simultaneously should not interfere with the first one.

Although dopaminergic medication seems to improve dynamic balance (the ability to maintain postural stability while in motion), there is still little evidence on how it influences standing balance (the ability to maintain the body in a fixed posture).

University of Houston researchers set out to evaluate how dopaminergic medication influenced long-duration standing balance with the eyes open or closed while dual-tasking in Parkinson’s disease.

They recruited 16 Parkinson’s patients with mild to moderate disease (four women and 12 men, with a mean age of 67.1 years) for the study.

Before dual-task testing, the participants underwent a minimum 12-hour overnight medication withdrawal, so that researchers could assess patients’ status in an off state.

Single- and dual-task tests were conducted. For dual-task testing, patients had to stand in silence (primary task), both with their eyes open and then with them closed, while listening on headphones to a pre-recorded unfamiliar speech and mentally counting the number of times a specific word occurred (secondary task). This is known as phoneme monitoring. They also had to listen to the details of the story so that they could answer a few questions about it at the end of the testing session.

Under the protocol, participants were asked to perform the following tasks in random order: 1) phoneme monitoring while seated comfortably in a quiet room, 2) single-task standing eyes open, 3) single-task standing eyes closed, 4) dual-task standing eyes open, and 5) dual-task standing eyes closed.

“After the [off] trials were completed, the subjects took their dopaminergic medication as prescribed for their first/morning dose and waited until they achieved a stable ‘on’ feeling (minimum of 45 [minutes]) before commencing the on-medication testing,” the researchers said.

Every trial session was performed once for three minutes, and participants were given at least a minute between sessions to sit down and rest.

Data on motor variables of interest were obtained by the NeuroCom Balance Master, a system that uses a fixed force plate to measure the vertical forces exerted through the patient’s feet to measure the center of gravity position and postural control.

Results revealed that antiparkinsonian medicines significantly increased center of pressure movement. The center of pressure is a point, inside or outside the body, where the resulting vector of all forces (including gravity) acting on the body is considered to act.

Patients’ performance in the secondary task was reduced after they took the medications.

Additionally, having the eyes closed or open significantly increased the patients’ back and forth plus lateral sway velocities and the integrated time to boundary.

In biomechanics, time to boundary estimates the time required for the center of pressure to reach the boundary of the base of support if it were to continue its instantaneous trajectory and velocity. Higher integrated time indicates poorer balance.

Postural sway was also increased during the on state. Scientists often interpret increases in sway velocity and integrated time to boundary as indications of impaired balance; however, the researchers suggest that their findings could indicate an increase in freedom of movement rather than compromised stability.

Importantly, medication did not improve balance automaticity.

“The data did not support a medication-induced improvement in automaticity, as measured by significant medication by task interactions. An alternate interpretation for medication-induced balance changes in PD [Parkinson’s disease] includes an increase in maneuverability without sacrificing stability after taking dopaminergic medication,” the researchers concluded.

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Treadmill Incline Training Improves Walking Speed of Parkinson’s Patients, Study Finds

treadmill incline training

Eight weeks of training on a treadmill with continuously varying surface inclines improved gait disturbances, particularly walking speed, in Parkinson’s disease patients, researchers report.

Their finding were published in the study, “Exploring gait adaptations to perturbed and conventional treadmill training in Parkinson’s disease: Time-course, sustainability, and transfer,” in the journal Human Movement Science.

As the disease progresses, Parkinson’s patients experience an increase in gait difficulties and balance problems, lowering their mobility and quality of life.

In addition, studies have shown that Parkinson’s patients take shorter and slower steps, and have high stride-to-stride variability.

Because some gait disturbances are drug-resistant, nonpharmacological treatment options are needed to improve these patients’ quality of life.

“Improved stride length and stride-to-stride variability have been demonstrated following several weeks of treadmill practice for both, overground and treadmill walking, respectively,” the authors wrote.

Researchers had recently demonstrated that eight weeks of treadmill therapy with additional postural perturbations (i.e., varying surface inclines) improved overground gait speed and dynamic balance control in Parkinson’s patients.

Now the same team at Friedrich-Alexander University Erlangen-Nürnberg has analyzed spatiotemporal gait adaptations to treadmill training — with and without an incline — both on and off the machine.

They used data from a randomized controlled Phase 1 trial (NCT01856244) aimed at investigating the effectiveness of a sensorimotor treadmill intervention to improve walking and balance abilities in people in the early stages of Parkinson’s disease.

Sensorimotor treadmill training was conducted on a special machine that challenged the participants through small oscillations, simulating walking on natural, uneven surfaces. This intervention was compared with conventional treadmill training without surface perturbations.

Thirty-eight Parkinson’s patients were randomly assigned to 40 minutes of treadmill training two times per week for eight weeks. Of these patients, 18 performed treadmill training with continuously varying surface inclines, while the other 20 walked on the treadmill without surface perturbations.

Patients were assessed every week during training protocol (prior to the training sessions), within one week after the intervention, and at a three-month follow-up.

Gait variability significantly decreased in both training groups. Nonetheless, longer stride length and time, stance time, and swing time were significantly improved only in the treadmill incline training group.

For reference, one gait cycle consists of two phases: stance, or the period of time that the foot is on the ground, and swing, meaning the period of time that the foot is off the ground moving forward.

Researchers then investigated the sustainability of gait changes over three months.

At the three-month follow-up, there were significant changes between the groups in stance and swing time, which were due to a much higher variability in the conventional treadmill training group. Statistical comparisons within the groups revealed no significant changes in the treadmill incline training group.

Additional statistical analysis also showed decreased step length asymmetry in the conventional treadmill training group.

The team then assessed the extent of transfer effects to overground gait in both training regimes.

“When considering the entire sample, significant changes in overground gait parameters at [week 8] were observed only for stance- and swing time, with a significantly decreased stance time … and a corresponding increase in swing time,” they wrote. However, these findings were statistically significant only in the treadmill incline training regime.

“[Parkinson’s disease] patients demonstrated marked gait adaptations to the eight-week treadmill intervention, which were partially retained after three months follow-up,” they noted.

Treadmill training with small oscillations seemed to reduce gait disturbances, but the transfer of such changes to overground walking was limited in most evaluated variables.

Further research is still necessary to corroborate these findings.

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Vitamin D May Improve Balance in Younger Parkinson’s Patients, Pilot Study Suggests

Short-term supplementation of vitamin D in high doses may improve balance in people with Parkinson’s disease younger than 66, according to results of a Phase 2 pilot study.
The study, “A randomized, controlled pilot study of the effects of vitamin D supplementation on balance in Parkinson’s disease: Does age matter?” was published in Plos One.
Parkinson’s patients are at a high risk of falling mainly due to problems with balance — one of the primary symptoms of the disease. It is estimated that 70 percent of Parkinson’s patients fall at least once a year.
Falls are associated with substantial injury, disability, hospitalization, and reduced quality of life in Parkinson’s patients and in older people in general. However, no pharmaceutical or surgical intervention is currently known to significantly improve balance.
As a result, there is an unmet need to discover or develop therapeutic approaches to improve balance in Parkinson’s patients.
At the same time, individuals with Parkinson’s, particularly those with advanced disease, have lower levels of vitamin D, which is involved not only in bone health, but also in brain function.
Previous studies have shown that vitamin D supplementation reduces fall rates and improves balance in older people. While it has been suggested that higher doses of vitamin D are more effective than lower ones, more recent evidence suggests that higher doses in older populations may have the opposite effect, being associated with more frequent falls and fractures.
A randomized, double-blinded, placebo-controlled Phase 2 pilot study (NCT01119131) evaluated the safety and effectiveness of high-dose vitamin D supplementation on balance, gait, falls, strength, and cognition in Parkinson’s patients. Disease severity and quality of life were also assessed.
Researchers analyzed the data of 51 patients, at a mean age of 66.57 years, who were randomized to receive either a high dose of vitamin D (27 patients) or a placebo (24 patients), in addition to 1,000 mg of calcium, daily for four months.
Balance function was measured using the Sensory Organization Test (SOT), an objective test to measure impairments in postural stability or balance, which has been found to be the most suitable for assessing balance in relation to vitamin D levels.
Results showed that vitamin D supplementation doubled patients’ vitamin D blood levels after four months of treatment, while patients who received placebo showed no substantial changes in their levels.
Patients receiving the high dose of the supplement showed no significant improvements in balance, compared with those in the placebo group. In addition, no significant changes were found for gait, strength, cognition, disease severity, or quality of life between the two groups of patients.
However, when researchers divided the patients who received vitamin D into two age groups — those 66 or younger, and those 67 and older — the supplement was found to significantly improve the balance of patients in the younger group, compared with the older age group. No significant therapeutic effect of the supplement was found for any of the other measures.
High-dose vitamin D supplementation appeared to be safe, with no serious adverse events reported.
These findings highlight the possibility of an “age-dependent role for vitamin

Source: Parkinson's News Today

Parkinson’s Patients with Tendency to Fall Control Balance Differently than Non-Fallers, Study Suggests

Parkinson's fall risk

Parkinson’s disease patients who have a tendency to fall use different strategies to control their balance than those who do not fall, according to a recent study.

The study, “Fallers with Parkinson’s disease exhibit restrictive trunk control during walking,” was published in Gait and Posture.

Due to Parkinson’s-related motor imbalance, falls are a common consequence of the disease, and the risk of falling increases as patients get older and as the disease progresses.

Parkinson’s patients are twice as likely to fall than older adults living independently, and are also nine times more likely to have recurrent falls.

Observational studies suggest these patients underestimate the amount of work necessary for their muscles to produce a certain movement. They compensate for this lack of motor and perceptual ability by adopting distinct postural strategies to keep their balance during both static and dynamic movements.

Static measures of posture control can distinguish Parkinson’s patients from healthy older adults, but not Parkinson’s fallers from non-fallers.

“A better understanding of the relationship between falls and static and dynamic movements may provide further insight into falls-risk assessment in this clinical population,” the researchers said.

To study this, researchers at the University of Ottawa in Canada conducted a study that recruited 25 Parkinson’s patients and 17 healthy older adults used as controls.

They analyzed postural differences between Parkinson’s fallers and non-fallers, based on the self-reported occurrence of falls in the previous three months, and between healthy controls.

Motor disability was measured using the Unified Parkinson’s Disease Rating Scale III, cognitive impairment by the Montreal Cognitive Assessment, and freezing of gait by the Freezing of Gait questionnaire.

Participants were given static and dynamic motor tasks, consisting of one quiet standing condition and one walking condition (walking 15 meters while looking straight ahead).

Both tasks were presented twice and lasted for 30 seconds. Testing was performed while patients were optimally medicated with dopaminergic therapies.

The standing test was sensitive enough to distinguish between Parkinson’s patients and healthy controls, but not between fallers and non-fallers with Parkinson’s disease. However, static tasks were less sensitive in differentiating between fallers and non-fallers with Parkinson’s disease and healthy older adults than dynamic tasks.

Fallers had difficulty controlling their upper body (torso) when walking, compared with non-fallers and the control group. This was also true for individuals with Parkinson’s disease versus older healthy adults.

Importantly, falling was associated with static and dynamic postural control in Parkinson’s patients, with fallers and non-fallers adopting different postural strategies to regulate balance.

“Overall, this study provides useful information for falls-risk assessments as well as for developing fall prevention program specific to fallers and non-fallers with PD,” the researchers concluded.

The post Parkinson’s Patients with Tendency to Fall Control Balance Differently than Non-Fallers, Study Suggests appeared first on Parkinson’s News Today.

Source: Parkinson's News Today