Objective: To assess the effect of balance training on dual-tasking gait, and to investigate if a home-based programme is comparable to a therapist-supervised programme.

Background: Parkinson’s disease often manifests as a loss of automaticity, and as a result gait dysfunction occurs. Difficulties with gait are aggravated when paired with a secondary cognitive task, leading to possible unsafe ambulation. Dual-tasking is an essential part of independent-living and thus important to understand what effect it has on gait, and if possible improvements in dynamic balance can influence it. Therefore this study sets out to explore the effect of balance training, at home or with a therapist, on dual-tasking gait.

Methods: This experimental study included 39 participants with mild to moderate Parkinson’s disease (H&Y I–III), divided into a Therapist-supervised group (n=23, age 65.4±8.3yrs) and a Home-based group (n=16, age 64.9±7.1yrs), based on a sample of convenience. Both groups followed 8 weeks of balance training, with the Therapist-supervised group attended classes with an exercise therapist, and the Home-based group followed a series of guided DVDs at home with their caregiver. Primary outcome measures included mobility and gait parameters, assessed with the modified instrumented Timed-up-and-Go (ITUG), and dual-tasking ability, assessed with the instrumented cognitive Timed-up-and-Go (CTUG), from which dual-task interference was calculated. Secondary outcome measures included perceived fear of falling, assessed with the International Fall Efficacy Scale (FES-I), and disease severity, assessed with Unified Parkinson’s disease Rating Scale (UPDRS).

Results: The Home-based group showed a significant decrease in UPDRS III scores (p<0.001) after the intervention, and also showed significantly increased dual-task interference for duration, stride velocity, cadence and time in double support (p<0.005). The Therapist-supervised group maintained their disease severity and dual-task interference after the intervention (p>0.05).

Conclusions: The dual-task interference showed that, unlike the Therapist-supervised group, the Home-based group was unable to maintain their gait performance when a secondary task was applied. This study has revealed that eight weeks of balance training with a therapist is more likely to maintain and improve gait during dual-tasking than without the presence of a therapist performed at home.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/eight-weeks-of-home-based-balance-training-not-as-effective-as-therapist-based-during-dual-tasks/