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Published in: Journal of NeuroEngineering and Rehabilitation 1/2011

Open Access 01-12-2011 | Research

Audio-Biofeedback training for posture and balance in Patients with Parkinson's disease

Authors: Anat Mirelman, Talia Herman, Simone Nicolai, Agnes Zijlstra, Wiebren Zijlstra, Clemens Becker, Lorenzo Chiari, Jeffrey M Hausdorff

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2011

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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.
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Literature
1.
go back to reference AGS Guidelines: Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 2001, 49: 664-672. 10.1046/j.1532-5415.2001.49115.xCrossRef AGS Guidelines: Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 2001, 49: 664-672. 10.1046/j.1532-5415.2001.49115.xCrossRef
2.
go back to reference Condron JE, Hill KD: Reliability and validity of a dual-task force platform assessment of balance performance: effect of age, balance impairment, and cognitive task. J Am Geriatr Soc 2002, 50: 157-162. 10.1046/j.1532-5415.2002.50022.xCrossRefPubMed Condron JE, Hill KD: Reliability and validity of a dual-task force platform assessment of balance performance: effect of age, balance impairment, and cognitive task. J Am Geriatr Soc 2002, 50: 157-162. 10.1046/j.1532-5415.2002.50022.xCrossRefPubMed
3.
go back to reference Camicioli R, Howieson D, Lehman S, Kaye J: Talking while walking: the effect of a dual task in aging and Alzheimer's disease. Neurology 1997, 48: 955-958.CrossRefPubMed Camicioli R, Howieson D, Lehman S, Kaye J: Talking while walking: the effect of a dual task in aging and Alzheimer's disease. Neurology 1997, 48: 955-958.CrossRefPubMed
4.
go back to reference Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL: Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 1990, 19: 136-141. 10.1093/ageing/19.2.136CrossRefPubMed Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL: Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 1990, 19: 136-141. 10.1093/ageing/19.2.136CrossRefPubMed
5.
go back to reference Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M, Vuori I: Fall-induced injuries and deaths among older adults. JAMA 1999, 281: 1895-1899. 10.1001/jama.281.20.1895CrossRefPubMed Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M, Vuori I: Fall-induced injuries and deaths among older adults. JAMA 1999, 281: 1895-1899. 10.1001/jama.281.20.1895CrossRefPubMed
6.
go back to reference Tinetti ME, Doucette J, Claus E, Marottoli R: Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995, 43: 1214-1221.CrossRefPubMed Tinetti ME, Doucette J, Claus E, Marottoli R: Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995, 43: 1214-1221.CrossRefPubMed
7.
go back to reference Fahn S, Elton R, Members of the UPDRS development committee: Unified Parkinson's disease rating scale. In Recent developments in Parkinson's disease. Edited by: Fahn S, Marsden CD, Calne D, Goldstein M. Florham Park, NJ: Macmillan Health Care Information; 1987:153-163. Fahn S, Elton R, Members of the UPDRS development committee: Unified Parkinson's disease rating scale. In Recent developments in Parkinson's disease. Edited by: Fahn S, Marsden CD, Calne D, Goldstein M. Florham Park, NJ: Macmillan Health Care Information; 1987:153-163.
8.
go back to reference Camicioli R, Oken BS, Sexton G, Kaye JA, Nutt JG: Verbal fluency task affects gait in Parkinson's disease with motor freezing. J Geriatr Psychiatry Neurol 1998, 11: 181-185.CrossRefPubMed Camicioli R, Oken BS, Sexton G, Kaye JA, Nutt JG: Verbal fluency task affects gait in Parkinson's disease with motor freezing. J Geriatr Psychiatry Neurol 1998, 11: 181-185.CrossRefPubMed
9.
go back to reference Hausdorff JM, Balash J, Giladi N: Effects of cognitive challenge on gait variability in patients with Parkinson's disease. J Geriatr Psychiatry Neurol 2003, 16: 53-58.CrossRefPubMed Hausdorff JM, Balash J, Giladi N: Effects of cognitive challenge on gait variability in patients with Parkinson's disease. J Geriatr Psychiatry Neurol 2003, 16: 53-58.CrossRefPubMed
10.
go back to reference Hely MA, Morris JG, Traficante R, Reid WG, O'Sullivan DJ, Williamson PM: The sydney multicentre study of Parkinson's disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry 1999, 67: 300-307. 10.1136/jnnp.67.3.300PubMedCentralCrossRefPubMed Hely MA, Morris JG, Traficante R, Reid WG, O'Sullivan DJ, Williamson PM: The sydney multicentre study of Parkinson's disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry 1999, 67: 300-307. 10.1136/jnnp.67.3.300PubMedCentralCrossRefPubMed
11.
go back to reference Kerr GK, Worringham CJ, Silburn P: Sensorimotor and clinical factors in the prediction of future falls in Parkinson disease. Gait Posture 2004. Proceedings of the IXth Congress of the International Society for Postural and Gait Research, Sydney, 23-28 March, 2003. Kerr GK, Worringham CJ, Silburn P: Sensorimotor and clinical factors in the prediction of future falls in Parkinson disease. Gait Posture 2004. Proceedings of the IXth Congress of the International Society for Postural and Gait Research, Sydney, 23-28 March, 2003.
12.
go back to reference Keus SH, Bloem BR, Hendriks EJ, Bredero-Cohen AB, Munneke M: Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Mov Disord 2007, 22: 451-460. 10.1002/mds.21244CrossRefPubMed Keus SH, Bloem BR, Hendriks EJ, Bredero-Cohen AB, Munneke M: Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Mov Disord 2007, 22: 451-460. 10.1002/mds.21244CrossRefPubMed
13.
go back to reference Keus SH, Bloem BR, van Hilten JJ, Ashburn A, Munneke M: Effectiveness of physiotherapy in Parkinson's disease: The feasibility of a randomised controlled trial. Parkinsonism Relat Disord 2007, 13: 115-121. 10.1016/j.parkreldis.2006.07.007CrossRefPubMed Keus SH, Bloem BR, van Hilten JJ, Ashburn A, Munneke M: Effectiveness of physiotherapy in Parkinson's disease: The feasibility of a randomised controlled trial. Parkinsonism Relat Disord 2007, 13: 115-121. 10.1016/j.parkreldis.2006.07.007CrossRefPubMed
14.
go back to reference Liu-Ambrose TY, Khan KM, Eng JJ, Gillies GL, Lord SR, McKay HA: The beneficial effects of group-based exercises on fall risk profile and physical activity persist 1 year postintervention in older women with low bone mass: follow-up after withdrawal of exercise. J Am Geriatr Soc 2005, 53: 1767-1773. 10.1111/j.1532-5415.2005.53525.xPubMedCentralCrossRefPubMed Liu-Ambrose TY, Khan KM, Eng JJ, Gillies GL, Lord SR, McKay HA: The beneficial effects of group-based exercises on fall risk profile and physical activity persist 1 year postintervention in older women with low bone mass: follow-up after withdrawal of exercise. J Am Geriatr Soc 2005, 53: 1767-1773. 10.1111/j.1532-5415.2005.53525.xPubMedCentralCrossRefPubMed
15.
go back to reference Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH: Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003, CD000340. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH: Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003, CD000340.
16.
go back to reference Campbell AJ, Robertson MC: Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing 2007, 36: 656-662. 10.1093/ageing/afm122CrossRefPubMed Campbell AJ, Robertson MC: Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing 2007, 36: 656-662. 10.1093/ageing/afm122CrossRefPubMed
17.
go back to reference Wong MS, Mak AF, Luk KD, Evans JH, Brown B: Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients. Prosthet Orthot Int 2001, 25: 60-70. 10.1080/03093640108726570CrossRefPubMed Wong MS, Mak AF, Luk KD, Evans JH, Brown B: Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients. Prosthet Orthot Int 2001, 25: 60-70. 10.1080/03093640108726570CrossRefPubMed
18.
go back to reference Wu G: Real-time feedback of body center of gravity for postural training of elderly patients with peripheral neuropathy. IEEE Trans Rehabil Eng 1997, 5: 399-402. 10.1109/86.650298CrossRefPubMed Wu G: Real-time feedback of body center of gravity for postural training of elderly patients with peripheral neuropathy. IEEE Trans Rehabil Eng 1997, 5: 399-402. 10.1109/86.650298CrossRefPubMed
19.
go back to reference Dozza M, Chiari L, Horak FB: Audio-biofeedback improves balance in patients with bilateral vestibular loss. Arch Phys Med Rehabil 2005, 86: 1401-1403. 10.1016/j.apmr.2004.12.036CrossRefPubMed Dozza M, Chiari L, Horak FB: Audio-biofeedback improves balance in patients with bilateral vestibular loss. Arch Phys Med Rehabil 2005, 86: 1401-1403. 10.1016/j.apmr.2004.12.036CrossRefPubMed
20.
go back to reference Dozza M, Chiari L, Chan B, Rocchi L, Horak FB, Cappello A: Influence of a portable audio-biofeedback device on structural properties of postural sway. J Neuroeng Rehabil 2005, 2: 13. 10.1186/1743-0003-2-13PubMedCentralCrossRefPubMed Dozza M, Chiari L, Chan B, Rocchi L, Horak FB, Cappello A: Influence of a portable audio-biofeedback device on structural properties of postural sway. J Neuroeng Rehabil 2005, 2: 13. 10.1186/1743-0003-2-13PubMedCentralCrossRefPubMed
21.
go back to reference Horak FB, Dozza M, Peterka R, Chiari L, Wall C III: Vibrotactile biofeedback improves tandem gait in patients with unilateral vestibular loss. Ann N Y Acad Sci 2009, 1164: 279-281. 10.1111/j.1749-6632.2008.03707.xPubMedCentralCrossRefPubMed Horak FB, Dozza M, Peterka R, Chiari L, Wall C III: Vibrotactile biofeedback improves tandem gait in patients with unilateral vestibular loss. Ann N Y Acad Sci 2009, 1164: 279-281. 10.1111/j.1749-6632.2008.03707.xPubMedCentralCrossRefPubMed
22.
go back to reference Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6CrossRefPubMed Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6CrossRefPubMed
24.
go back to reference Nicolai S, Mirelman A, Herman T, Zijlstra A, Mancini M, Becker C, Lindemann U, Berg D, Maetzler W: Improvement of balance after audio-biofeedback. A 6-week intervention study in patients with progressive supranuclear palsy. Z Gerontol Geriatr 2010, 43: 224-228. 10.1007/s00391-010-0125-6CrossRefPubMed Nicolai S, Mirelman A, Herman T, Zijlstra A, Mancini M, Becker C, Lindemann U, Berg D, Maetzler W: Improvement of balance after audio-biofeedback. A 6-week intervention study in patients with progressive supranuclear palsy. Z Gerontol Geriatr 2010, 43: 224-228. 10.1007/s00391-010-0125-6CrossRefPubMed
25.
go back to reference Winstein CJ: Knowledge of results and motor learning--implications for physical therapy. Phys Ther 1991, 71: 140-149.PubMed Winstein CJ: Knowledge of results and motor learning--implications for physical therapy. Phys Ther 1991, 71: 140-149.PubMed
26.
go back to reference Berg K, Wood-Dauphinee S, Williams JI: The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 1995, 27: 27-36.PubMed Berg K, Wood-Dauphinee S, Williams JI: The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 1995, 27: 27-36.PubMed
27.
go back to reference Podsiadlo D, Richardson S: The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39: 142-148.CrossRefPubMed Podsiadlo D, Richardson S: The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39: 142-148.CrossRefPubMed
28.
go back to reference Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49: M85-M94.CrossRefPubMed Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49: M85-M94.CrossRefPubMed
29.
go back to reference Peto V, Jenkinson C, Fitzpatrick R, Greenhall R: The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease. Qual Life Res 1995, 4: 241-248. 10.1007/BF02260863CrossRefPubMed Peto V, Jenkinson C, Fitzpatrick R, Greenhall R: The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease. Qual Life Res 1995, 4: 241-248. 10.1007/BF02260863CrossRefPubMed
30.
go back to reference Powell LE, Myers AM: The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 1995, 50A: M28-M34.CrossRefPubMed Powell LE, Myers AM: The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 1995, 50A: M28-M34.CrossRefPubMed
31.
go back to reference Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982, 17: 37-49. 10.1016/0022-3956(82)90033-4CrossRefPubMed Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982, 17: 37-49. 10.1016/0022-3956(82)90033-4CrossRefPubMed
32.
go back to reference Espay AJ, Baram Y, Dwivedi AK, Shukla R, Gartner M, Gaines L, Duker AP, Revilla FJ: At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease. J Rehabil Res Dev 2010, 47: 573-581. 10.1682/JRRD.2009.10.0165CrossRefPubMed Espay AJ, Baram Y, Dwivedi AK, Shukla R, Gartner M, Gaines L, Duker AP, Revilla FJ: At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease. J Rehabil Res Dev 2010, 47: 573-581. 10.1682/JRRD.2009.10.0165CrossRefPubMed
33.
go back to reference Lowenthal J, Gruedlinger L, Baltadjieva R, Herman T, Hausdorff JM, Giladi N: Effects of rhythmic auditory stimulation on gait dynamics in Parkinson's disease. Movement Disorders 2004, 19: S139. Lowenthal J, Gruedlinger L, Baltadjieva R, Herman T, Hausdorff JM, Giladi N: Effects of rhythmic auditory stimulation on gait dynamics in Parkinson's disease. Movement Disorders 2004, 19: S139.
34.
go back to reference Nieuwboer A, Kwakkel G, Rochester L, Jones D, van WE, Willems AM, Chavret F, Hetherington V, Baker K, Lim I: Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial. J Neurol Neurosurg Psychiatry 2007, 78: 134-140. 10.1136/jnnp.200X.097923PubMedCentralCrossRefPubMed Nieuwboer A, Kwakkel G, Rochester L, Jones D, van WE, Willems AM, Chavret F, Hetherington V, Baker K, Lim I: Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial. J Neurol Neurosurg Psychiatry 2007, 78: 134-140. 10.1136/jnnp.200X.097923PubMedCentralCrossRefPubMed
Metadata
Title
Audio-Biofeedback training for posture and balance in Patients with Parkinson's disease
Authors
Anat Mirelman
Talia Herman
Simone Nicolai
Agnes Zijlstra
Wiebren Zijlstra
Clemens Becker
Lorenzo Chiari
Jeffrey M Hausdorff
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2011
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-8-35

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