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Poster 2 The Effect of Virtual Reality-based Balance Training in Multiple Sclerosis
Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2013;94:12e6
Neurodegenerative Disorders Poster 1 Effects of Transcranial Direct Current Stimulation (tDCS) Plus Physical Therapy on Gait in Parkinson Pattarapol Yotnuengnit (Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University), Krisna Piravej Objective: To study the effect of transcranial direct current stimulation (tDCS) combined with physical therapy on walking ability in patients with Parkinson’s disease (PD), a preliminary study Design: Experimental double-blinded randomized controlled trial. Setting: Outpatient Rehabilitation Clinic, King Chulalongkorn Memorial Hospital, Thailand Participants: PD patients (NZ32, age 40-80 y) with Modified Hoehn & Yahr stages 2 & 3 Interventions: The 1st group (G1) was treated with anodal tDCS 2 mA stimulated on lower extremity motor cortex, the 2nd group (G2) with same anodal tDCS and physical therapy and the 3rd group (G3) was given sham tDCS and underwent physical therapy. All protocols were scheduled over 6 sessions in 2 weeks. Main Outcome Measure(s): Gait speed (m/s), step length (cm) and cadence (step/min) were assessed by gait & motion analysis at baseline, 2nd, 4th and 8th week post-treatment. Results: At all follow-up visits (2nd, 4th and 8th week), all groups showed significant improvements (P<0.05) in gait speed and step length but not cadence. For gait speed, G1 showed 18.7%, 18.0%, 19.1%, (PZ 0.008, 0.009 & 0.017) G2 showed 20.6%, 26.2%, 23.7% and G3 showed 11.0%, 20.9%, 23.5% improvement, respectively. For step length, G1 showed 16.4%, 16.8%, 13.8% G2 showed 21.3%, 18.3%, 12.8% and G3 showed 6.9%, 8.9% & 14.1% improvement, respectively. When compared among groups, G2 showed the highest percent of improvement in gait speed and step length at 2nd and 4th week, but not significant. Conclusions: Anodal tDCS or physical therapy showed significant improvement in gait ability in PD patients. Combined treatment may have an additive effect. Key Words: Parkinson, transcranial Direct Current Stimulation (tDCS), Physical therapy, Gait speed, Step length, Cadence Disclosure: Pattarapol Yotnuengnit has nothing to disclose. Poster 2 The Effect of Virtual Reality-based Balance Training in Multiple Sclerosis Arash Babaei-Ghazani (Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences), Bina Eftekhar Sadat, Mahnaz Talebi, Fariba Eslamian Objective: To investigate the short term effects of 12 week balance training on postural stability in persons with Multiple Sclerosis (MS). Design: A randomized controlled trial. Setting: Rehabilitation education and research hospital.
Participants: Thirty MS patients (22 female, 8 male) were assigned randomly to training (nZ15) or control group (nZ15). No participant withdrew. Interventions: Participants stood over a dual force platform (Biodex Balance System) and performed visually guided weight-shifting movements. The task required subjects to gradually transfer weight between sides during a 12-week training period (2 training sessions per week), and the control group maintained their usual lifestyle. Main Outcome Measure(s): Berg Balance scale (BBS), Postural Stability test, Falling Risk, Timed up and go test (TUG) and Modified Ashworth Scale. All outcomes were measured before and after intervention. Results: After 24 training sessions the mean BBS, Postural stability, Falling risk and TUG improvements were 0.200.4, 0.440.51, 1.481.10 and 0.660.72 in the training group and 0.260.7, 0.080.4, 0.261.16 and 0.201.08 in the control group (PZ0.018, PZ0.007, PZ 0.004, PZ0.21 respectively). Conclusions: This study demonstrated that this type of 12 weeks balance training could improve the outcomes in terms of BBS, fall risk and postural stability in MS population in short term. Long term follow ups before recommending this kind of balance training are needed. Key Words: Fall Risk test, Postural Stability, Balance training, Multiple Sclerosis Disclosure: Arash Babaei-Ghazani has nothing to disclose; Bina Eftekhar Sadat has nothing to disclose. Poster 3 Group Exercise Improves Gait and Balance in Parkinson’s Disease but Gains are Lost Over Time Melanie J. Lomaglio (University of St. Augustine for Health Sciences), Kerry C. Mallini Objective: To examine changes in gait, balance, and quality of life in individuals with Parkinson’s Disease (PD) after participating in 8 weeks of supervised group exercise. Design: Before-after trial with an 8 week follow-up. Setting: Community wellness center. Participants: Eleven community dwelling volunteers with PD (Hoehn and Yahr stages I - III). Interventions: Participants exercised for up to 60 minutes, 2 times a week, for 8 weeks. Sessions focused on repetitive functional activities and whole body movements to improve flexibility, strength, gait, and balance. All sessions ended with progressive treadmill walking with a target of 2.0 miles per hour and 26 minutes. Main Outcome Measure(s): Functional gait was measured with the Timed Up and Go test, at both comfortable and fast walking speeds (TUGc and TUGf respectively), and the Two-Minute Walk Test (2MWT). Balance and balance confidence were measured with the Five Times Sit to Stand test (5xSTS) and the Activity Specific Balance Confidence Scale (ABC). Quality of life was measured by the Nottingham Health Profile (NHP). Results: A comparison of the measures taken before and after the intervention revealed improvements on the TUGc, TUGf, 2MWT, 5xSTS, and the ABC (P Z 0.001 - 0.037). At the 8 week follow up assessment all of
0003-9993/13/$36 - see front matter ª 2013 by the American Congress of Rehabiliation Medicine
Neurodegenerative Disorders Poster 1 Effects of Transcranial Direct Current Stimulation (tDCS) Plus Physical Therapy on Gait in Parkinson Pattarapol Yotnuengnit (Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University), Krisna Piravej Objective: To study the effect of transcranial direct current stimulation (tDCS) combined with physical therapy on walking ability in patients with Parkinson’s disease (PD), a preliminary study Design: Experimental double-blinded randomized controlled trial. Setting: Outpatient Rehabilitation Clinic, King Chulalongkorn Memorial Hospital, Thailand Participants: PD patients (NZ32, age 40-80 y) with Modified Hoehn & Yahr stages 2 & 3 Interventions: The 1st group (G1) was treated with anodal tDCS 2 mA stimulated on lower extremity motor cortex, the 2nd group (G2) with same anodal tDCS and physical therapy and the 3rd group (G3) was given sham tDCS and underwent physical therapy. All protocols were scheduled over 6 sessions in 2 weeks. Main Outcome Measure(s): Gait speed (m/s), step length (cm) and cadence (step/min) were assessed by gait & motion analysis at baseline, 2nd, 4th and 8th week post-treatment. Results: At all follow-up visits (2nd, 4th and 8th week), all groups showed significant improvements (P<0.05) in gait speed and step length but not cadence. For gait speed, G1 showed 18.7%, 18.0%, 19.1%, (PZ 0.008, 0.009 & 0.017) G2 showed 20.6%, 26.2%, 23.7% and G3 showed 11.0%, 20.9%, 23.5% improvement, respectively. For step length, G1 showed 16.4%, 16.8%, 13.8% G2 showed 21.3%, 18.3%, 12.8% and G3 showed 6.9%, 8.9% & 14.1% improvement, respectively. When compared among groups, G2 showed the highest percent of improvement in gait speed and step length at 2nd and 4th week, but not significant. Conclusions: Anodal tDCS or physical therapy showed significant improvement in gait ability in PD patients. Combined treatment may have an additive effect. Key Words: Parkinson, transcranial Direct Current Stimulation (tDCS), Physical therapy, Gait speed, Step length, Cadence Disclosure: Pattarapol Yotnuengnit has nothing to disclose. Poster 2 The Effect of Virtual Reality-based Balance Training in Multiple Sclerosis Arash Babaei-Ghazani (Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences), Bina Eftekhar Sadat, Mahnaz Talebi, Fariba Eslamian Objective: To investigate the short term effects of 12 week balance training on postural stability in persons with Multiple Sclerosis (MS). Design: A randomized controlled trial. Setting: Rehabilitation education and research hospital.
Participants: Thirty MS patients (22 female, 8 male) were assigned randomly to training (nZ15) or control group (nZ15). No participant withdrew. Interventions: Participants stood over a dual force platform (Biodex Balance System) and performed visually guided weight-shifting movements. The task required subjects to gradually transfer weight between sides during a 12-week training period (2 training sessions per week), and the control group maintained their usual lifestyle. Main Outcome Measure(s): Berg Balance scale (BBS), Postural Stability test, Falling Risk, Timed up and go test (TUG) and Modified Ashworth Scale. All outcomes were measured before and after intervention. Results: After 24 training sessions the mean BBS, Postural stability, Falling risk and TUG improvements were 0.200.4, 0.440.51, 1.481.10 and 0.660.72 in the training group and 0.260.7, 0.080.4, 0.261.16 and 0.201.08 in the control group (PZ0.018, PZ0.007, PZ 0.004, PZ0.21 respectively). Conclusions: This study demonstrated that this type of 12 weeks balance training could improve the outcomes in terms of BBS, fall risk and postural stability in MS population in short term. Long term follow ups before recommending this kind of balance training are needed. Key Words: Fall Risk test, Postural Stability, Balance training, Multiple Sclerosis Disclosure: Arash Babaei-Ghazani has nothing to disclose; Bina Eftekhar Sadat has nothing to disclose. Poster 3 Group Exercise Improves Gait and Balance in Parkinson’s Disease but Gains are Lost Over Time Melanie J. Lomaglio (University of St. Augustine for Health Sciences), Kerry C. Mallini Objective: To examine changes in gait, balance, and quality of life in individuals with Parkinson’s Disease (PD) after participating in 8 weeks of supervised group exercise. Design: Before-after trial with an 8 week follow-up. Setting: Community wellness center. Participants: Eleven community dwelling volunteers with PD (Hoehn and Yahr stages I - III). Interventions: Participants exercised for up to 60 minutes, 2 times a week, for 8 weeks. Sessions focused on repetitive functional activities and whole body movements to improve flexibility, strength, gait, and balance. All sessions ended with progressive treadmill walking with a target of 2.0 miles per hour and 26 minutes. Main Outcome Measure(s): Functional gait was measured with the Timed Up and Go test, at both comfortable and fast walking speeds (TUGc and TUGf respectively), and the Two-Minute Walk Test (2MWT). Balance and balance confidence were measured with the Five Times Sit to Stand test (5xSTS) and the Activity Specific Balance Confidence Scale (ABC). Quality of life was measured by the Nottingham Health Profile (NHP). Results: A comparison of the measures taken before and after the intervention revealed improvements on the TUGc, TUGf, 2MWT, 5xSTS, and the ABC (P Z 0.001 - 0.037). At the 8 week follow up assessment all of
0003-9993/13/$36 - see front matter ª 2013 by the American Congress of Rehabiliation Medicine