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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(09): 935-943
DOI: 10.1055/s-0042-1755325
Original Article

Are static posturography-assisted biofeedback exercises effective in Parkinson's disease?

Os exercícios com biorretroalimentação assistidos por posturografia estática são eficazes na doença de Parkinson?
Elif Yakşi 
1   Abant Izzet Baysal University, Medical Faculty, Department of Physical Medicina and Rehabilitation, Bolu, Turkey.
,
Mustafa Fatih Yaşar 
1   Abant Izzet Baysal University, Medical Faculty, Department of Physical Medicina and Rehabilitation, Bolu, Turkey.
,
Canan Akünal Türel 
2   Abant Izzet Baysal University, Medical Faculty, Department of Neurology, Bolu, Turkey.
,
Muhammed Balcı 
1   Abant Izzet Baysal University, Medical Faculty, Department of Physical Medicina and Rehabilitation, Bolu, Turkey.
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Abstract

Background Parkinson disease (PD) is a progressive condition that causes disorders in movement and balance.

Objective To evaluate the effectiveness of static posturography-assisted biofeedback exercises in PD-related balance disorder.

Methods We screened 83 patients, 48 of whom were enrolled, and 41 completed the study. The sample was randomized into two groups, one submitted to static posturography-assisted biofeedback exercises and the other, to a conventional exercise program. The patients in the biofeedback group (n = 20) performed biofeedback exercises in addition to conventional balance exercises. Those in the conventional exercise group (n = 21) performed classic balance exercises. Both groups were treated for 20 minutes per session 3 times a week for 6 weeks. The patients were evaluated using the Hoehn and Yahr Scale, the Movement Disorder Society–Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Berg Balance Scale (BBS), the Tinetti Gait and Balance Assessment (TGBA), the Timed Up and Go Test (TUG), the Tandem Stance Test (TST), a Turkish version of the Stanford Health Assessment Questionnaire (HAQ), and the Beck Depression Inventory (BDI) before and at the end of the treatment.

Results No statistically significant differences were observed between the two groups in terms of the MDS-UPDRS, BBS, TGBA, TST, TUG, HAQ, or BDI measurements before and after the treatment (p > 0.05).

Conclusions Improved balance parameters were observed following balance training in the patients with PD, although static posturography-assisted biofeedback exercises appeared to provide no additional benefit. However, larger, randomized controlled trials are needed to investigate their effectiveness.

Resumo

Antecedentes A doença de Parkinson (DP) é uma doença degenerativa que causa alterações no movimento e no equilíbrio.

Objetivo Avaliar a eficácia dos exercícios com biorretroalimentação assistidos por posturografia estática na alterações do equilíbrio derivadas da DP.

Métodos Selecionamos 83 pacientes, 48 dos quais foram incluídos, e 41 completaram o estudo. A amostra foi randomizada e dividida em dois grupos, um submetido a exercícios com biorretroalimentação assistidos por posturografia estática, e outro submetido a um programa de exercícios convencional. Os pacientes do grupo de biorretroalimentação (n = 20) fizeram exercícios com biorretroalimentação e exercícios convencionais de equilíbrio. E o grupo dos exercícios convencionais (n = 21), fez exercícios clássicos de equilíbrio. Ambos os grupos receberam tratamento durante 20 minutos por sessão, 3 vezes por semana, por 6 semanas. Os pacientes foram avaliados antes e depois do tratamento pela Escala de Hoehn e Yahr, Escala Unificada de Avaliação da Doença de Parkinson (EUADP) da Movement Disorder Society (MDS), a Escala de Equilíbrio Berg (EEB), Avaliação de Equilíbrio e Marcha Tinetti (AEMT), o Teste Timed Up and Go (TUG), o Teste de Apoio Tandem (TAT), a versão em turco do Questionário de Avaliação de Saúde (QAS) de Stanford, e o Inventário de Depressão de Beck (IDB).

Resultados Não se observaram diferenças estatisticamente significativas entre os dois grupos quanto às medições do EUADP, EEB, AEMT, TAT, TUG, QAS ou IDB realizadas antes e depois do tratamento (p > 0.05).

Conclusões Verificou-se uma melhoria dos parâmetros de equilíbrio após os exercícios de equilíbrio nos pacientes com DP, apesar de não ter sido detectado sem nenhum benefício adicional aparente dos exercícios com retroalimentação assistidos por posturografia estática. Contudo, é necessário efetuar ensaios maiores, randomizados e controlados para estudar a sua eficácia.

Keywords

Biofeedback, Psychology - Exercise - Parkinson Disease - Postural Balance

Palavras-chave

Biorretroalimentação Psicológica - Exercícios - Doença de Parkinson - Equilíbrio Postural

Authors' Contributions

EY, CAT, MFY: conceptualization, methodology, writing - original draft; MB, EY: formal analyses and investigation; CAT, EY, MB: data curation, writing - review and editing; EY, MFY, MB: supervision, visualization.




Publication History

Received: 31 August 2021

Accepted: 19 December 2021

Article published online:
09 November 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 DeMaagd G, Philip A. Parkinson's disease and its management: part 1: disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. P&T 2015; 40 (08) 504-532
    Google Scholar
  • 2 Shulman JM, De Jager PL, Feany MB. Parkinson's disease: genetics and pathogenesis. Annu Rev Pathol 2011; 6: 193-222
    CrossrefPubMedGoogle Scholar
  • 3 Yalıman A, Şen Eİ. Parkinson Hastalığı ve Rehabilitasyonu. Turk J Phys Med Rehabil 2011; 57 (01) 38-44
    Google Scholar
  • 4 Chaudhuri KR, Healy DG, Schapira AH. National Institute for Clinical Excellence. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet Neurol 2006; 5 (03) 235-245
    CrossrefPubMedGoogle Scholar
  • 5 Boonstra TA, van der Kooij H, Munneke M, Bloem BR. Gait disorders and balance disturbances in Parkinson's disease: clinical update and pathophysiology. Curr Opin Neurol 2008; 21 (04) 461-471
    CrossrefPubMedGoogle Scholar
  • 6 Allen NE, Sherrington C, Paul SS, Canning CG. Balance and falls in Parkinson's disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 2011; 26 (09) 1605-1615
    CrossrefPubMedGoogle Scholar
  • 7 Bloem BR, Beckley DJ, van Dijk JG, Zwinderman AH, Remler MP, Roos RA. Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson's disease. Mov Disord 1996; 11 (05) 509-521
    CrossrefPubMedGoogle Scholar
  • 8 Bello O, Sánchez JA, Lopez-Alonso V. et al. The effects of treadmill or overground walking training program on gait in Parkinson's disease. Gait Posture 2013; 38 (04) 590-595
    CrossrefPubMedGoogle Scholar
  • 9 Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil 2013; 10: 60
    CrossrefPubMedGoogle Scholar
  • 10 Huffman JL, Norton LE, Adkin AL, Allum JH. Directional effects of biofeedback on trunk sway during stance tasks in healthy young adults. Gait Posture 2010; 32 (01) 62-66
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 Maciaszek J. Effects of Posturographic Platform Biofeedback Training on the Static and Dynamic Balance of Older Stroke Patients. J Stroke Cerebrovasc Dis 2018; 27 (07) 1969-1974
    CrossrefPubMedGoogle Scholar
  • 13 Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17 (05) 427-442
    CrossrefPubMedGoogle Scholar
  • 14 Akbostancı M, Balaban H, Atbaşoğlu C. Birleşik Parkinson Hastalığı Değerleme Ölçeği Motor Muayene Bölümü ve Anormal İstemsiz Hareketler Ölçeği'nin değerlendiriciler arası güvenilirlik çalışması. Parkinson Hastalığı ve Hareket Bozuklukları Dergisi 2000; 3 (02) 7-13
    Google Scholar
  • 15 Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34 (02) 119-126
    CrossrefPubMedGoogle Scholar
  • 16 Sahin F, Yilmaz F, Ozmaden A, Kotevolu N, Sahin T, Kuran B. Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther 2008; 31 (01) 32-37
    CrossrefPubMedGoogle Scholar
  • 17 Wall JC, Bell C, Campbell S, Davis J. The Timed Get-up-and-Go test revisited: measurement of the component tasks. J Rehabil Res Dev 2000; 37 (01) 109-113
    PubMedGoogle Scholar
  • 18 Jonsson E, Seiger A, Hirschfeld H. Postural steadiness and weight distribution during tandem stance in healthy young and elderly adults. Clin Biomech (Bristol, Avon) 2005; 20 (02) 202-208
    CrossrefPubMedGoogle Scholar
  • 19 Küçükdeveci AA, Sahin H, Ataman S, Griffiths B, Tennant A. Issues in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum 2004; 51 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 20 Hisli N. Beck Depresyon Envanterinin gecerligi. [A study on the validity of Beck Depression Inventory] J Psychol 1988; 6: 118-122
    Google Scholar
  • 21 Yang WC, Wang HK, Wu RM, Lo CS, Lin KH. Home-based virtual reality balance training and conventional balance training in Parkinson's disease: A randomized controlled trial. J Formos Med Assoc 2016; 115 (09) 734-743
    CrossrefPubMedGoogle Scholar
  • 22 Hung JW, Yu MY, Chang KC, Lee HC, Hsieh YW, Chen PC. Feasibility of using tetrax biofeedback video games for balance training in patients with chronic hemiplegic stroke. PM R 2016; 8 (10) 962-970
    CrossrefPubMedGoogle Scholar
  • 23 Moss D, Sella G, Andrasik F. et al. Current applications of biofeedback to physical medicine and rehabilitation. Eura Medicophys 2003; 39 (04) 165-170
    Google Scholar
  • 24 Walker C, Brouwer BJ, Culham EG. Use of visual feedback in retraining balance following acute stroke. Phys Ther 2000; 80 (09) 886-895
    CrossrefPubMedGoogle Scholar
  • 25 Barclay-Goddard R, Stevenson T, Poluha W, Moffatt ME, Taback SP. Force platform feedback for standing balance training after stroke. Cochrane Database Syst Rev 2004; 2004 (04) CD004129
    PubMedGoogle Scholar
  • 26 Balci NÇ, Tonga E, Gülşen M. The Effect of Balance Training by Tetraks Interactive Balance System on Balance and Fall Risk in Parkinson's Patients: A Report of Four Cases. Noro Psikiyatri Arsivi 2013; 50 (03) 283-287
    PubMedGoogle Scholar
  • 27 Mirelman A, Herman T, Nicolai S. et al. Audio-biofeedback training for posture and balance in patients with Parkinson's disease. J Neuroeng Rehabil 2011; 8: 35
    CrossrefPubMedGoogle Scholar
  • 28 Pompeu JE, Mendes FA, Silva KG. et al. Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial. Physiotherapy 2012; 98 (03) 196-204
    CrossrefPubMedGoogle Scholar
  • 29 Yen CY, Lin KH, Hu MH, Wu RM, Lu TW, Lin CH. Effects of virtual reality-augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial. Phys Ther 2011; 91 (06) 862-874
    CrossrefPubMedGoogle Scholar