BALANCE IMPROVEMENT IN PATIENTS WITH PARKINSON'S DISEASE AFTER MOTOR AND COGNITIVE TRAINING

JOSÉ EDUARDO POMPEU- Physical Therapist

- Phd Student: Neuroscience and Behavior - São Paulo

University (Brazil)- Professor:

Paulista and São Camilo Universities

Introduction

Parkinson's disease (PD): second more frequent degenerative

disease of nervous system that causes: Rest tremor Bradykinesia Rigidity POSTURAL INSTABILITY (PI)

(Albin, Young et al., 1995; Mcauley, 2003;)

Introduction

Postural instability is the most refractory symptoms

Falls: PD x Elderly

FALLS FRACTURE FEAR

IMMOBILISM

(Pickering, Grimbergen et al., 2007; Hely, Reid et al., 2008)

Introduction

Patients with PD: use cortically mediated strategies to compensate the impaired automatic balance control.

increase the body sway in dual task conditions (DT).

(O'shea, Morris et al., 2002; Rochester, Hetherington et al., 2004; Rochester, Nieuwboer et al., 2008; Yu e Mak, 2008; Speciali,

Oliveira et al., 2009 )

Introduction

↓ FALLS RISK

BALANCE DISORDERS(PD)

NEW TREATMENT STRATEGIES

Introduction

What is the best strategy to improve the balance of patients with PD?1.Training in single task with attention focused on balance?

2.Training in multi task cognitive motor condition?

Introduction

Thus, a training program was devised to improve balance in PD patients in which automatic balance responses were stimulated under conditions of high cognitive demand.

Purpose

To compare the effectiveness of motor and cognitive training versus motor training alone for improving balance and functional performance in PD patients.

Method

Randomized Clinical Trial Approved by a local ethical

committee Local:

Brasil Parkinson Association São Paulo University

Method

Inclusion Criteria Exclusion Criteria

Idiopathic PD diagnosed by a neurologist

GDS-15 < 6 (Almeida e Almeida, 1999)

MEMS > 23 I – II stages – H & Y Aged between 65 – 85

years old Both genders

Didn’t agree with consent term

Associated neurological and orthopedic diseases

Clinics Fluctuations

n=20

CG (n=10)

Before training assessment

14 sessions- 30’ Global exercises

- 30’ Motor Training

After training assessment

Follow up - 60 days

EG (n=10)

Before training assessment

14 sessions- 30’ Global exercises- 30’ Cognitive Motor

Training

After training assessment

Follow up - 60 days

Method

Balance Assessment Balance Berg Scale (BBS) Dynamic Gait Index (DGI) Postural Stress Test (PST) Unipedal Stance Test (UST)

Statistical Analysis: ANOVA/Pos hoc test Tukey (p<0,05)

Results

Assessment and Group Effects (ANOVA; p<0,05)

BBS DGI UST

CONCLUSION

MCT was found to be superior to MT for: improving compensatory and

anticipatory balance responses in PD patients

led to improved balance during gait greater confidence with regard to

susceptibility to falls.

Implication

Postural stability in PD patients can be improved by stimulating automatic balance control through training which combines both motor and cognitive tasks.

Thank you!

José Eduardo Pompeuj.e.pompeu@usp.br+55 11 9298-7750