Objective: To study the effectiveness of Multimodal Motor Skill Balance Training (MBT) with rhythmical auditory cues to improve balance control and reduce falls in PD.

Background: External cues are often applied in Parkinson’s Disease (PD) to improve gait. However, it is not clear what the effect of external cueing on balance control in PD is.

Methods: We performed a Randomized Controlled Trial in patients with PD in H&Y stage II–III. Patients were randomized in to one of three groups: (1) MBT with rhythmical auditory cues by a metronome (MBTR), (2) MBT without rhythmical cues (MBT), and (3) no intervention control group (CG). Training was performed for 5 weeks, two times a week using a personalized protocol.1 Our primary outcome was the Mini-Best score. Treatment effects were estimated with a linear mixed model, adjusted for baseline. We used the Falls Efficacy Scale (FES-I) and a weekly falling questionnaire as secondary outcomes. Assessments were performed by a single, blinded assessor at baseline and after 5, 9 and 35 weeks follow-up [1].

Results: We included 133 patients with a mean age of 70 years (SD 13). Groups were comparable at baseline. Compared to the CG group, at 5 weeks follow-up, both the MBTR and the MBT group had improved on the Mini-Best Test (estimated mean difference MBTR-CG 6.7 (SE 0.7), P<0.001; MBT-CG 3.0 (SE 0.7), P<0.001). The MBTR group showed a significantly larger improvement than the MBT group (MBTR-MBT 3.7 (SE 0.6), P<0.001). The improvements were retained at 9 weeks follow-up (MBTR-CG 6.2 (SE 0.7), P<0.001; MBTR-CG 2.0 (SE 0.7), P 0.004). Only the MBTR group maintained its improvement at 35 weeks (MBTR-CG 5.0 (SE 0.7), P<0.001). Less falls and injuries were reported after the study in comparison to baseline by all groups. Moreover, we found no severe injuries in the MBTR group and a reduced fear of falling in the MBTR and MBT groups after 9 weeks. Again, only the MBTR group maintained the results at 35 weeks. The control group showed an increased fear of falling after 5, 9 and 35 weeks.

Conclusions: Both MBTR and MBT are effective in improving balance and reduce falls. The MTBR is more effective and lead to sustained improvements up to 35 weeks.

References: [1] Capato TTC, Tornai J, Ávila P, Barbosa ER, Piemonte ME. Randomized controlled trial protocol: balance training with rhythmical cues to improve and maintain balance control in Parkinson’s disease. BMC Neurol. 2015 Sep 7;15:162.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-multimodal-motor-skill-balance-training-with-rhythmical-cues-to-improve-and-maintain-balance-control-in-parkinsons-disease/