title: Audio-biofeedback training for posture and balance in patients with Parkinson's disease.
abstract: BACKGROUND
  Patients with Parkinson's disease (PD) suffer from dysrhythmic and disturbed gait, impaired balance, and decreased postural responses. These alterations lead to falls, especially as the disease progresses. Based on the observation that postural control improved in patients with vestibular dysfunction after audio-biofeedback training, we tested the feasibility and effects of this training modality in patients with PD.
  
  
  METHODS
  Seven patients with PD were included in a pilot study comprised of a six weeks intervention program. The training was individualized to each patient's needs and was delivered using an audio-biofeedback (ABF) system with headphones. The training was focused on improving posture, sit-to-stand abilities, and dynamic balance in various positions. Non-parametric statistics were used to evaluate training effects.
  
  
  RESULTS
  The ABF system was well accepted by all participants with no adverse events reported. Patients declared high satisfaction with the training. A significant improvement of balance, as assessed by the Berg Balance Scale, was observed (improvement of 3% p = 0.032), and a trend in the Timed up and go test (improvement of 11%; p = 0.07) was also seen. In addition, the training appeared to have a positive influence on psychosocial aspects of the disease as assessed by the Parkinson's disease quality of life questionnaire (PDQ-39) and the level of depression as assessed by the Geriatric Depression Scale.
  
  
  CONCLUSIONS
  This is, to our knowledge, the first report demonstrating that audio-biofeedback training for patients with PD is feasible and is associated with improvements of balance and several psychosocial aspects.
authors.affiliation: Laboratory for Gait and Neurodynamics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. anatmi@tasmc.health.gov.il
authors.forename: Anat
authors.initials: A
authors.lastname: Mirelman
authors.forename: Talia
authors.initials: T
authors.lastname: Herman
authors.forename: Simone
authors.initials: S
authors.lastname: Nicolai
authors.forename: Agnes
authors.initials: A
authors.lastname: Zijlstra
authors.forename: Wiebren
authors.initials: W
authors.lastname: Zijlstra
authors.forename: Clemens
authors.initials: C
authors.lastname: Becker
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Chiari
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Hausdorff
mesh_terms: D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods*; D056228:Feedback, Sensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000534:rehabilitation*; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology*; D011788:Quality of Life