Somatosensory training for postural control in independent-living individuals with Parkinson’s disease

Gregory, Tania (2015-12)

Thesis (MSc)--Stellenbosch University, 2015.

Thesis

ENGLISH ABSTRACT: Introduction: Postural control (PC) impairments in Parkinson’s disease (PD) involve proprioceptive processing and integration deficits. Although deficits in proprioception have a negative effect on PC, the precise contribution to postural instability in PD remains unclear. The somatosensory system incorporates both the proprioceptive and haptic feedback systems, and by applying light touch postural sway (PS) can be improved in individuals with PD. The study therefore aimed to determine if an eight-week somatosensory training program (SSTP) would influence PC in individuals with mild to moderate PD. Study design: Time-series experimental study design. Methods: Thirty-seven participants with idiopathic PD (67 9 years; H&Y: 2 1; MDS-UPDRS III: 28 14) were divided into two groups i.e. somatosensory training group (EXP; n = 24) and placebo group (PBO; n = 13). Primary outcome measures included joint position sense (JPS), sensory integration (mCTSIB), Timed-Up-and-Go (TUG), fear of falling (FES-I) and PS. Secondary outcome measures were quality of life (PDQ-39 SI), part II, III and total score of Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and balance confidence (ABC). Participants were tested on medication, at baseline, pre- and post-intervention over a period of 16- weeks. JPS was tested at the ankle joint with the Active Movement Extent Discrimination Apparatus (AMEDA) at 10°, 11°, 12°, 13° and 14°. For the modified Clinical Test of Sensory Integration and Balance (mCTSIB) and PS with and without haptic feedback, the Instrumented Sway tri-axial accelerometer was used to assess overall PS during eight conditions i.e. eyes open (EO), eyes closed (EC), both off and on a foam pad (+F) as well as all four conditions with haptic feedback. Results: A statistically significant treatment effect was found in the EC+F (p = 0.0002), TUG (p = 0.0001), FES-I (p = 0.02), part III (p = 0.02), as well as in total score of MDS-UPDRS (p = 0.02) for the EXP group. The EXP group improved in JPS (p = 0.02), EC+F JERK (p = 0.002) and RMS (p = 0.01) as well as PDQ-39 SI (p = 0.03) after the intervention. The EXP group showed a significant improvement in the TUG before and after the Treatment phase (p < 0.05). The EXP group also showed a significant improvement for EC+F JERK (p = 0.002) and TUG (p = 0.01), with a strong tendency for better balance confidence (p = 0.07), compared to the PBO group. Both groups presented with reduced sway amplitude when receiving haptic feedback compared to no manual contact, regardless of the surface area (p < 0.01). However, no group differences were found during the Baseline and Treatment phase (p > 0.05). Conclusion: The positive findings of this study provide evidence that this SSTP could improve PC in PD individuals. However, haptic feedback cannot be altered by a SSTP, but it can improve PS in individuals with PD, regardless of the surface area.

AFRIKAANSE OPSOMMING: Inleiding: Posturale beheer (PB) beperkinge in Parkinson’s siekte (PS) betrek tekortkominge in proprioseptiewe prossessering en integrasie. Alhoewel tekortkominge in propriosepsie ’n negatiewe effek het op PB, is die presiese bydrae daarvan op posturale onstabiliteit onbekend. Ligte aanraking verbeter posturale wieg (PW) in individue met PS, maar meer navorsing oor effektiewe oefenprogram ontwikkeling om PB te verbeter word benodig. Die doel van hierdie studie was om vas te stel of ’n agt-weke somatosensoriese oefenprogram (SSOP) PB kan beïnvloed in individue met ligte tot matige PS. Studie ontwerp: Tyd-reeks eksperimentele studie ontwerp. Metodes: Sewe-en-dertig deelnemers met idiopatiese PS (67 9 jaar; H&Y: 2 1; MDS-UPDRS III: 28 14) was in twee groepe ingedeel naamlik, somatosensoriese oefengroep (EXP; n = 24) en placebo groep (PBO; n = 13). Primêre uitkoms maatreëls het gewrigsposisie (GP), sensoriese integrasie (mCTSIB), Staan-Op-en-Stap (SOS), vrees vir val (FES-I ) en PW ingesluit. Sekondêre uitkoms maatreëls was kwaliteit van lewe (PDQ-39 SI ), gedeelte II, III en totale telling van die Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) asook balans selfvertroue (ABC). Toetsing het plaasgevind terwyl die deelnemers op medikasie was vir basislyn, vooren na-intervensie oor ’n periode van 16-weke. Gewrigsposisie was getoets by die enkelgewrig deur die Active Movement Extent Discrimination Apparatus (AMEDA) by 10°, 11°, 12°, 13° and 14°. Vir die modified Clinical Test of Sensory Integration and Balance (mCTSIB) en PW met en sonder haptiese terugvoer, is die Instrumented Sway (ISway) tri-aksiale versneller gebruik om algehele PW (JERK, RMS en CF) te assesseer tydens agt verskillende kondisies naamlik, oë oop (OO), oë toe (OT), beide op die vloer en op ’n balansmaatjie (+BM), asook al vier kondisies met haptiese terugvoer. Resultate: ’n Statisties betekenisvolle behandeling effek was gevind in OT+BM (p = 0.0002), SOS (p = 0.0001), vrees vir val (p = 0.02), gedeelte III (p = 0.02) asook totale telling van MDS-UPDRS (p = 0.02) vir die EXP groep. Die EXP groep het verbeter in GP (p = 0.02), OT+BM JERK (p = 0.002) en RMS (p = 0.01) asook kwaliteit van lewe (p = 0.03) na die Behandelingsfase. Die EXP groep het statisties betekenisvol verbeter voor en na die Behandelingsfase in die SOS (p < 0.05). Addisioneel was daar ’n statisties betekenisvolle groepverskil na die intervensie vir OT+BM (p = 0.002), SOS (p = 0.01) asook ’n sterk tendens vir ’n groepverskil in balans selfvertroue (p = 0.07), waar die EXP groep verbeterde resultate aangedui het in vergelyking met die PBO groep. Beide groepe het minder posturale amplitude aangedui wanneer haptiese terugvoer tot beskikking was teenoor geen aanraking nie, ongeag van die vloer oppervlakte. Alhoewel, geen groep verskille is gevind tydens die Basislyn en Behandelingsfase nie. Gevolgtrekking: Die positiewe bevindinge van hierdie studie voorsien bewys dat die SSOP, PB in individue met PS kan verbeter. Haptiese terugvoer kan nie beïnvloed word deur ’n SSOP nie, maar dit kan PW verbeter in individue met PS, ongeag van die oppervlakte.

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