Vestibular-oriented balance training can aid posture, reduce risk of falls
Exercises for body's sensory system show benefits for Parkinson's patients
Vestibular-oriented balance training during the middle stages of Parkinson’s disease can improve postural control and reduce the risk of falls in people with mild to moderate disease, a new study found.
Unlike standard balance training, which typically focuses on stretches and strengthening practices, vestibular-based exercises are designed to enhance the vestibular system — the sensory system that provides information about body position and a sense of balance.
In the small study, which involved 40 middle-stage Parkinson’s patients in Egypt, the individuals receiving such training showed “significant sustained improvements” in an assessment of gait, or manner of walking, over time, the researchers noted. Balance also was significantly improved in the study group “in all test conditions,” according to the researchers.
“The findings provide valuable information for healthcare professionals and clinicians involved in the rehabilitation and treatment of patients with [Parkinson’s disease], forming the development of evidence-based interventions and rehabilitation programs,” the researchers wrote.
The study, “Effect of Vestibular-Oriented Balance Training on Postural Control and Risk of Fall in Patients With Parkinson’s Disease,” was published in the journal Neurology Research International by a team of scientists from Egypt and the U.S.
Benefits of standard balance training seen only with mild disease
In Parkinson’s, the loss of nerve cells that produce dopamine, a signaling molecule that helps control movement, leads to motor symptoms such as tremors, rigidity, and stiffness. These symptoms can also contribute to balance issues, increasing the risk of falls.
The neurodegeneration that underlies Parkinson’s can also affect the vestibular system, the sensory system that provides information about body position. When this system is damaged, a person’s balance, ability to control eye movements when the head is moving, and sense of spatial orientation are all affected. This adds to the risk of falls.
Conventional balance training for Parkinson’s patients typically consists of traditional flexibility, strength, and balance training, including stretches, strengthening exercises using resistance bands in all directions, and rocking from the heels to the toes with and without support.
However, the impact of standard balance training on the risk of falls in Parkinson’s remains inconclusive. Multiple studies show no effect, while others show some benefits — but solely among those with mild disease.
Vestibular-focused training is an alternative approach to balance training that’s designed to improve the workings of this system. It may include interventions to promote hip strategies for balance, step training for fall prevention, and techniques to improve the use of vestibular inputs, such as following a moving target with the eyes while standing still.
However, according to the team, “more research is needed to identify and establish the essential elements of balance training that can provide more informed guidelines for practice.”
To learn more, the researchers — from Cairo University in Giza and the University of St. Augustine for Health Sciences in Austin, Texas — conducted a study that evaluated the benefits of vestibular-oriented balance training during the middle stage of Parkinson’s.
The adults in the study, who ranged in age from 67 to 84, were all in the middle stages of Parkinson’s and were on stable therapy. Each was randomly assigned to vestibular-oriented balance training or standard balance training — the latter formed the control group — for eight weeks, or nearly two months. Assessments were conducted at the study’s start, or baseline, before the interventions began, and then at the end of the eight weeks and again at 12 weeks, or a month after the program ended.
Falls among study group dropped 30% by week 8, were sustained
To promote hip balance, the vestibular-oriented interventions had patients use an elastic band to resist hip movements while standing on a foam pad, and also take side and forward steps with an ankle weight. For fall prevention, interventions involved forward and side lunges, and tapping the forefoot on an eight-inch step placed on the front and to both sides. Vestibular input exercises included standing still with both eyes tracking a moving target, followed by head turns to the right and left and up and down, and then with eyes closed.
During the eight-week testing period, more patients in the experimental group reported fewer falls than those in the control group. In this period, about 45% of the patients in the experimental group reported at least one fall, compared with 65% of those in the control group. However, these differences were not considered to be statistically significant.
By week eight, at the end of the training period, the number of falls dropped by 30% in patients in the experimental group — a significant reduction compared with the 5% drop seen in those in the control group.
The Functional Gait Assessment, or FGA, was used to gauge postural stability and the ability to perform multiple motor tasks during walking. While FGA scores were similar at baseline, they were significantly higher (better) at both eight and 12 weeks with vestibular-focused training compared with standard training.
From baseline, patients in the experimental group showed significant sustained improvements in FGA scores over time, while those in the control group had significantly improved at week eight, but didn’t show further improvements at week 12.
The study suggests that vestibular-oriented balance training could be an effective intervention to improve postural control and decrease the risk of falls in individuals with mild to moderate [Parkinson’s disease]. … [Also, the findings] would suggest that physical therapists may consider intervening earlier in the disease process with balance interventions intended to reduce falls.
The modified Clinical Test of Sensory Interaction on Balance (mCTSIB) assessed an individual’s ability to maintain balance under various sensory conditions. Among them were having one’s eyes open or closed while standing on a stable (rigid) or compliant (soft) surface.
Like FGA scores, the mCTSIB scores significantly improved for patients in the experimental group under all sensory conditions compared with the control group at eight and 12 weeks. Over time, the study group improved significantly in all test conditions, while the control group showed significant improvements solely on stable surfaces with eyes open or closed, without lasting effects at week 12.
These findings, the researchers wrote, “would suggest that physical therapists may consider intervening earlier in the disease process with balance interventions intended to reduce falls” among people with Parkinson’s.
“Vestibular-focused balance training holds promise for preventing falls, particularly under conditions of compromised visual and [sensory] inputs,” the team wrote. “The study suggests that vestibular-oriented balance training could be an effective intervention to improve postural control and decrease the risk of falls in individuals with mild to moderate [Parkinson’s disease].”
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