Masters Degrees (Exercise, Sport and Lifestyle Medicine)

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Browsing Masters Degrees (Exercise, Sport and Lifestyle Medicine) by Author "Atterbury, Elizabeth Maria"

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    Home-based balance training for dynamic balance in independent-living individuals with Parkinson’s disease
    (Stellenbosch : Stellenbosch University, 2016-03) Atterbury, Elizabeth Maria; Welman, Karen Estelle; Stellenbosch University. Faculty of Education. Dept. of Sport Science
    ENGLISH ABSTRACT : Background: Individuals with Parkinson‘s disease (PD), are presented with a variety of motor and nonmotor symptoms which progressively affect their independence. As a result surgical and pharmacological interventions are often ineffective, especially for postural instability. Poor locomotion and balance dysfunction in PD ultimately leads to disability, which includes the loss of their ability to perform automated movements in a controlled manner (Floriano et al., 2015, Rinalduzzi et al., 2015). Accordingly dynamic balance and gait are considered to be one of the most relevant rehabilitation outcomes, and non-pharmacological interventions like exercise should be explored. Home-based balance exercises might be a viable mode of exercise delivery for PD individuals. However research on PD exercise interventions rarely indicate best practices to deliver exercises (King et al., 2015). Aim: The aim of this study was to compare an eight-week home-based balance programme with an equivalent therapist-supervised programme on dynamic balance, functional gait, and self-perceived measures of fall risk and balance confidence, disease severity, and motivation regarding the exercise interventions in individuals with mild to moderate PD. Methods: Forty participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7 years) were divided into a Therapist-supervised group (n=24) and Home-based group (n=16). Groups received eight weeks of balance training that including somatosensory cues, three times a week for an hour, either with an exercise therapist or via a DVD. Outcome measures were dynamic balance (FGA), gait and mobility (ITUG), dual-tasking gait and mobility (CTUG), freezing of gait (FoGQ), self-perceived balance confidence (ABC), self-perceived fall risk (FES-I), disease severity (MDS-UPDRS II & III) and intrinsic motivation (IMI). Results: Treatment effects were observed for the Home-based group with MDS-UPDRS total, subscore II and III (p < 0.01), and for the Therapist-supervised group for cadence (p = 0.047). Both groups improved (p < 0.05) in FGA (>9%, medium effect sze), stride length (>4%, small to medium effect size) and FoGQ (>16%, small effect size). Over the 8 weeks the Therapist-supervised group furthermore improved cadence and balance confidence (p < 0.05) with small effect size, stride and turn velocity (p < 0.05) with medium effect size, and turn-to-sit duration (p < 0.0001) with a huge effect size. The Home-based group improved by 23% in MDS-UPDRS III (p < 0.001), but gait deteriorated with dual-tasking. No significant differences observed for FES-I (p > 0.05). The therapist supervised group perceived the intervention to be 17% more enjoyable/interesting than Home-based (IMI; p = 0.002). Conclusion: An eight-week balance training programme with somatosensory cues at home may improve dynamic balance, stride length and freezing of gait. However greater improvements are achieved when exercising under supervision of a trained exercise therapist. Therapist-supervised training showed superior improvement in dynamic balance, gait, dual-tasking, balance confidence and motivation.