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Effect of externally cued training on dynamic stability control during sit-to-stand in patients with Parkinson disease
Bhatt T, Yang F, Mak MKY, Hui-Chan CW-Y, Pai Y-C
Physical Therapy 2013 Apr;93(4):492-503
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Previous studies have shown that people with Parkinson's disease (PwPD) have difficulty performing the sit-to-stand task, due to mobility and stability-related impairments. Despite its importance, limited literature exists on quantification of dynamic stability control in PwPD during this task. OBJECTIVE: To examine (1) differences in the control of dynamic stability between PwPD and healthy controls, and (2) the extent to which externally-cued training can improve such control during sit-to-stand in PwPD. DESIGN: Quasi-experimental controlled trial. METHODS: Performance of 21 PwPD was compared with 12 community-dwelling older adults. PwPD were randomly assigned to a non-training control group or a group receiving audio-visual-cued training for speeding up sit-to-stand performance, 3 times/week for 4 weeks. Outcome measures recorded at baseline and after 4 weeks included the center-of-mass position, its velocity, and the stability against either backward or forward balance loss (backward and forward stability) at seat-off and movement termination. RESULTS: Compared to healthy controls, PwPD had a greater backward stability resulting from a more anterior center-of-mass position at seat-off and lower velocity (p < 0.05). This feature, combined with a decreased forward stability at movement termination, increased their risk of forward balance loss at movement termination. Post-training, the PwPD achieved greater backward stability (p < 0.05) by increasing their forward center-of-mass velocity at seat-off; while achieving a posterior shift in center-of-mass position to reduce their likelihood of forward balance loss at movement termination. CONCLUSIONS: PwPD increase their postural stability against backward balance loss during task initiation at the expense of possible forward balance loss at task termination. Task-specific training with preparatory audio-visual cues improves their overall dynamic stability against both forward and back balance loss.

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