What is dynamic balance in PE?

The performance of automatic and repetitive movements of patients with Parkinson's is disturbed as a result of fundamental problems of internal control. That’s why cues are used to complete or replace this reduced internal control.
Cues can be generated internally or externally. Rhythmical recurring cues are given as a continuous rhythmical stimulus, which can serve as a control mechanism for walking. [15] [16]

Early phase - patients have no or little limitations. Goals of the therapeutic intervention are:

1. Prevention of inactivity
2. Prevention of fear to move/to fall
3. Preserving/ improving physical capacity

Mid phase - more severe symptoms; performance of activities become restricted, problems with balance and an increased risk of falls
Problems:

1. Transfers
2. Body posture
3. Reaching and grasping
4. Balance
5. Gait

A randomised controlled trial (RCT) found RESPOND; a telephone-based falls prevention program with a person-centered approach is found to be useful at reducing the rate of falls and fractures compared with usual care, but not fall injuries or hospitalisations[17].

Late phase - patients are confined to a wheelchair or bed. The treatment goal in this phase is to preserve vital functions and to prevent complications, such as pressure sores and contractures.

Elderly[edit | edit source]

Balance training can also be used in the elderly. Falls of elderly, due to poor balance, has important clinical and economical costs and intervention. For this reason, it is interesting to search for possibilities to reduce these costs, such as the use of balance training.[18]

In 2011 weak evidence has been found for the effectiveness of several exercises in improving clinical balance outcomes in elderly:

• Gait
• Balance
• Co-ordination and functional tasks
• Strengthening exercise
• But evidence for the effect of computerized balance programs or vibration plates is insufficient.[19]

To keep the therapy adherence up it is best to look for an approach with a ‘fun factor’. Some examples:

• Music-based multitask exercise program - basic exercises consisted of walking in time to the music and responding to changes in the music’s rhythmic patterns. Exercises involved a wide range of movements and challenged the balance control system mainly by requiring multidirectional weight shifting, walk-and-turn sequences, and exaggerated upper body movements when walking and standing. 
• Balance training using a virtual-reality system - in contrast to the review of 2011, in 2013 it was found an effective method to train the balance in older fallers. This method is intended to complete, not replace, other fall prevention programs. 
• Tai chi - tai chi has been proven to be an economic and effective way for training balance in older people. [20]
  To ameliorate balance in the elderly it isn’t enough to just follow a conventional exercise intervention (including muscle strengthening, stretching and aerobic exercises, and health education). Besides, this it is better to also include static, and dynamic balance exercises.
• Static balance exercises: squats, two-leg stance and one-leg stance.
• Dynamic exercises: jogging end to end, sideways walking or running with crossovers, forward walking or running in a zigzag line, backward walking, or running in zigzag line.[21]
• Use of Balance Boards.
• Core strength training: Nevertheless to improve balance core strength training is an important element. The benefit is this therapy can be both given in a group setting or in individual fall preventive interventions.

A randomized control trial in 72 prefrail adults (65 yrs and above) with mild-to-moderate fall risk found significant improvement in fall risk, proprioception, muscle strength, reaction time, postural sway and health-related quality of life with the Multi-system Physical Exercise (MPE) which consisted of proprioceptive, muscle strengthening, reaction time, and balance training exercises[22].

According to the systematic review, prevention-focused unimodal exercise programs that incorporate only strength training approach seems as effective as alternative unimodal (Tai-chi, stretching) or multimodal exercise programs(balance + tone training or balance + strength training) in tackling the risk of falls in older adults. Thus findings suggest that the implementation of supervised strength training might be a time-efficient exercise strategy to prevent falls in older adults. [23]

References[edit | edit source]

1. ↑ 1.0 1.1 1.2 Susan B O sullivan, Leslie G Portnry. Physical Rehabilitation :Sixth Edition. Philadelphia: FA Davis. 2014.
2. ↑ Peterka RJ. Sensorimotor integration in human postural control. J Neurophysiol 88: 1097–1118, 2002.
3. ↑ Cynthia Lions,Emmanuel Bui Quoc,Sylvette Wiener-Vacher,and Maria P. Bucci1:Postural control in strabismic children: importance of proprioceptive information:Front Physiol. 2014; 5: 156.
4. ↑ 4.0 4.1 Hwang S, Agada P, Kiemel T, Jeka JJ (2014) Dynamic Reweighting of Three Modalities for Sensor Fusion. PLoS ONE 9(1): e88132. doi:10.1371/journal.pone.0088132
5. ↑ Friedrich M, Grein HJ, Wicher C, Schuetze J, Mueller A, Lauenroth A, Hottenrott K, Schwesig R:Influence of pathologic and simulated visual dysfunctions on the postural system.:Exp Brain Res. 2008 Mar; 186(2):305-14.
6. ↑ Nicoleta Bugnariu and Joyce Fung;Aging and selective sensorimotor strategies in the regulation of upright balance:J Neuroengineering Rehabil. 2007; 4: 19
7. ↑ 7.0 7.1 Bannister R: Brain's Clinical Neurology, ed 3. New York, NY,Oxford University Press, Inc, 1969, pp 51-54, 102
8. ↑ GOLDIE PA, BACH TM, EVANS OM. Force platform measures for evaluating postural control: fckLRReliability and validity. Arch Phys Med Rehabil. 1989; 70:510-517
9. ↑ Saumur TM, Gregor S, Mochizuki G, Mansfield A, Mathur S. The effect of bed rest on balance control in healthy adults: A systematic scoping review. Journal of Musculoskeletal & Neuronal Interactions. 2020;20(1):101.
10. ↑ Sell TC. An examination, correlation, and comparison of static and dynamic measures of postural stability in healthy, physically active adults. Phys Ther Sport. 2012;13:80–86.
11. ↑ Mehrholz J, Friis R et al, Treadmill training for patients with Parkinson’s disease (Review), The Cochrane Collaboration, 2010 http://cdn.physioblasts.org/f/public/1282390662_223_FT5630_park.pdf
12. ↑ Deane KHO, Jones D, Physiotherapy for parkinson’s disease: a comparison of techniques, Cochrane Database of Systematic Reviews, 2001 http://www.ncbi.nlm.nih.gov/pubmed/11687029 fckLRlevel of evidence: 1
13. ↑ Tomlinson CL, Patel S, Physiotherapy versus placebo or no intervention in Parkinson’s disease, Cochrane Database Syst Rev. 2012 Jul 11 http://www.ncbi.nlm.nih.gov/pubmed/22786482 level of evidence: 1
14. ↑ Dr. Samyra Keus, Evidence-based guidelines for physiotherapy in Parkinson’s disease, ParkinsonNet, 16 May 2012 http://www.appde.eu/pdfs/Keus_ParkinsonNet_Physiotherapy%20Guidelines.pdf fckLRlevel of evidence: 2
15. ↑ S.H.J. Keus
H.J.M. Hendriks et al, KNGF: Ziekte van Parkinson Praktijkrichtlijn, jaargang 114, nummer 3, 2004 fckLRlevel of evidence: 2
16. ↑ 16.0 16.1 Anat Mirelman, Talia Herman et al, Audio-Biofeedback training for posture and balance in Patients with Parkinson’s disease, J Neuroeng Rehabil. 2011 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142211/ fckLRlevel of evidence: 2
17. ↑ Morris RL, Hill KD, Ackerman IN, Ayton D, Arendts G, Brand C, Cameron P, Etherton-Beer CD, Flicker L, Hill AM, Hunter P. A mixed methods process evaluation of a person-centred falls prevention program. BMC health services research. 2019 Dec 1;19(1):906.
18. ↑ Newell D. et al., Changes in gait and balance parameters in elderly subjects attending an 8-week supervised Pilates programme, J Bodyw Mov Ther, 2012fckLRLevel of evidence: 3
19. ↑ Howe T.E. et al., Exercise for improving balance in older people, Cochrane Database Syst Rev, 2011fckLRLevel of evidence: 1
20. ↑ Liu H. and Frank A., Tai chi as a balance improvement exercise for older adults: a systematic review, J Geriatr Phys Ther, 2010fckLRLevel of evidence: 1
21. ↑ Zheng J. et al., Strategic targeted exercise for preventing falls in elderly people, Journal of International Medical Research, 2013 Level of evidence: 2
22. ↑ Chittrakul J, Siviroj P, Sungkarat S, Sapbamrer R. Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults: a randomized controlled trial. International journal of environmental research and public health. 2020 Jan;17(9):3102.
23. ↑ Claudino JG, Afonso J, Sarvestan J, Lanza MB, Pennone J, Serrão JC, Espregueira-Mendes J, Vasconcelos AL, de Andrade MP, Rocha-Rodrigues S, Andrade R. Strength training to prevent falls in older adults: a systematic review with meta-analysis of randomized controlled trials. Journal of clinical medicine. 2021 Jan;10(14):3184.