Randomized controlled trial protocol: balance training with rhythmical cues to improve and maintain balance control in Parkinson's disease.
BACKGROUND
Postural instability is a particularly incapacitating disorder, whose loss of motor independence by Parkinson´s Disease (PD) patients marks a significant stage of disease onset. Evidence suggests that deficits in automatic motor control, sensory integration and attention are associated with the lack of balance in PD. Physiotherapy together with medication play an important role in the treatment of this state, although no consensus has been reached on the best treatment modality. The aim of this randomized controlled trial protocol is to evaluate the effects of balance training with rhythmical (BRT), which is a motor program to improve balance associated with rhythmical auditory cues (RACs). This study is ongoing in the stage 1.


METHODS
A total of 150 PD patients at H&Y stages II-III and asymptomatic for depression and dementia are enrolled in a single-blind randomized study. Randomization is achieved via a computer-generated random-sequence table. All patients should also present a fall history. They will be assigned into one of three groups, and their balance and gait will be assessed before and after 10 training sessions, and after 4 and 30 weeks subsequent to the end of the training. The BRT group will receive a motor program to improve balance associated with RACs, the MT group will perform motor training with the same aims as those in the BRT group but without RACs, and the control group (CG) will be trained only in orientations. The exercise program specific to balance is of 5 weeks' duration with two sessions per week, 45 min each, and consists of general physiotherapy exercises. Each session will be divided into five warm-up minutes-30 min for the main part and 10 min for the cool down. The training progresses and intensifies each week depending on the individual's performance. The subjects should be able to execute 10 repetitions of the exercise sequences correctly to progress to the next movement.


CONCLUSIONS
This randomized study protocol will evaluate the effects of a motor program designed to improve balance associated with RACs, and will also assess whether balance training leads to activation of balance reactions at the appropriate time. We hypothesize that if this motor program is maintained long-term, it will prevent falls.


BACKGROUND
Clinicaltrials.gov NCT02488265 ; Ethics Committee of the University of São Paulo Faculty of Medicine Clinics Hospital 1.102.464.
Department of Physicaltherapy, University of São Paulo, Av Dr Enéias de Aguiar, 255 - 05403.000, São Paulo, São Paulo, Brazi. taminec@yahoo.com.br.|PHYSICAL, Rua Cubatão 929 conj, 142 - 04013-043, São Paulo, São Paulo, Brazil. taminec@yahoo.com.br.
Tamine Teixeira da Costa
TT
Capato
PHYSICAL, Rua Cubatão 929 conj, 142 - 04013-043, São Paulo, São Paulo, Brazil. physicalreabilitacaofuncional@yahoo.com.br.
Juliana
J
Tornai
PHYSICAL, Rua Cubatão 929 conj, 142 - 04013-043, São Paulo, São Paulo, Brazil. physicalreabilitacaofuncional@yahoo.com.br.
Patrícia
P
Ávila
Department of Neurology, University of São Paulo, Av Dr Enéias de Aguiar, 255 - 05403.000, São Paulo, São Paulo, Brazil. egbertob@8415.com.br.
Egberto Reis
ER
Barbosa
Department of Physicaltherapy, University of São Paulo, Av Dr Enéias de Aguiar, 255 - 05403.000, São Paulo, São Paulo, Brazi. elisapp@usp.br.
Maria Elisa Pimentel
ME
Piemonte
D000058:Accidental Falls / Q000517:prevention & control; D003463:Cues; D005081:Exercise Therapy; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D016037:Single-Blind Method