Objective: To study the effectiveness of balance training with and without rhythmical auditory cues in people with advanced stages of PD (H&Y4).

Background: Non-pharmacological interventions are important elements in the clinical management in Parkinson’s disease (PD). A recent trial found positive effects of multimodal balance training in PD (mild to moderate-stages), with greater and more sustained effects when rhythmical auditory stimuli were added. High-quality evidence of physiotherapy in PD advanced-stages is sparse. It is yet unclear whether multimodal balance training is effective in people with PD advanced-stages.

Method: We performed an exploratory prospective, single-blind, randomized clinical trial. Were screened 76 people with PD and H&Y4-stage (while ON medication); 35 patients were assigned randomly into two groups: (1) multimodal balance training with rhythmical auditory stimuli (RAS-supported group n=17) and (2) multimodal balance training without rhythmical auditory cues (Regular group n=18). Training was performed for 5 weeks, two times/week. Primary outcome was the Mini-BESTest score immediately after the training period. Secondary outcomes were gait measured by Timed Up and Go test and motor aspects measured by MDS-UPDRS 3. Assessments were performed by a single, blinded assessor at baseline, immediately post-intervention, and after one and 6-months follow-up.

Results: Immediately post-intervention both groups improved significantly on Mini-Best scores (RAS-supported group 5.6 points and Regular group 3.8 points), with no significant differences between both intervention modalities. In both groups, results were retained at one-month follow-up. At 6-months follow-up, however, the effects were only retained in the RAS-supported group (P=0.005). For both intervention groups, no improvements were found on secondary gait outcome measures. Only RAS-supported group improved on the MDS-UPDRS part 3 immediately post-intervention.

Conclusion: Both RAS-supported and regular groups improve balance in PD patients in H&Y4-stage. Effects appear to sustain longer in the RAS-supported group.

References: Capato, T.T.C., et al., Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson’s Disease: A Randomized Clinical Trial. J Parkinsons Dis, 2020. 10(1): p. 333-346

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-multimodal-balance-training-supported-by-rhythmical-auditory-stimuli-in-people-with-advanced-stages-of-parkinsons-disease-a-randomized-clinical-trial/