Better balance with somatosensory exercises : a Parkinson perspective

BACKGROUND: People with Parkinson’s Disease (PD) experience increasing activity limitations in walking, carrying objects, turning around, and dressing. Subtle and often unconscious balance decline may have occurred already at an early stage, even when first diagnosed. At present, no medical treatment can ease the progressive balance impairment. Instead, physical training has become a means to remain physically active and mobile for as long as possible.

AIM: The overall aim of this thesis was to evaluate if our hypotheses, the training approach of ‘Somatosensory Focused Balance Training without Cues’, can be effective in supporting people with PD at an early stage (early PD) to maintain their balance ability, so that they can remain physically active, move and walk independently, for as long as possible.

METHODS: At first, the BDL Balance Scale, a clinical balance assessment, was validated for use in people with early PD. Thereafter, to investigate the effect of ‘Somatosensory Focused Balance Training without Cues’, people with early PD (n=28) were randomised into two training groups and tested by a blinded assessor before and after the intervention. The training was evaluated with clinical outcomes, laboratory movement outcomes and the result was compared to healthy age-matched controls (n=18). Furthermore, to acquire knowledge of how people with early PD perceived the intervention, an interview study using content analysis was performed.

RESULTS: The BDL Balance Scale was found to be valid for use in early PD. It correlated to similar scales and could detect a difference between early PD and healthy controls. The training approach improved balance in the studies population, measured with clinical and movement laboratory outcomes, as well as by participant perceptions. The interviews provided important information on how the group contributed to greater motivation for training and offered a platform for making new friends.

CONCLUSION: The ‘Somatosensory Focused Balance Training without Cues’ improves balance in early PD. Notably, the training context is particularly important considering that it can increase the motivation and compliance to the training. In order to understand the underlying mechanisms for the improved balance, further research is needed.

List of scientific papers

I. Claesson IM, Grooten WJA, Lökk J, Ståhle A. Assessing postural balance in early Parkinson’s Disease – validity of the BDL balance scale. Physiother Theory Pract. 2017; 33: 490–6.
https://doi.org/10.1080/09593985.2017.1318424

II. Claesson IM, Ståhle A, Lökk J, Grooten WJA. Somatosensory Focused Balance Training without cues can improve balance and gait in early Parkinson’s disease – a randomised pilot study. European Journal of Physiotherapy. 2017.
https://doi.org/10.1080/21679169.2017.1363284

III. Claesson IM, Sobel J, Grooten WJA. Improved Dynamic Balance in early Parkinson’s Disease – Movement Analysis using the Alternate Step Test. [Submitted]

IV. Claesson IM, Ståhle A, Johansson S. The Group is the Glue – perceptions of group exercise among people with early Parkinson’s disease. [Submitted]