Effects of Protective Step Training on Proactive and Reactive Motor Adaptations in Parkinson's Disease Patients

Understanding the mechanism of compensation and neuroplasticity to unexpected step perturbation training during walking and static stance can have positive implications on the treatment of PD by helping to design effective training paradigms that remediate fall risk. Current rehabilitation therapies are inadequate at reducing falls in people with Parkinson's disease (PD). While pharmacologic and surgical treatments have proved largely ineffective in treating postural instability and gait dysfunction in people with PD, studies have demonstrated that therapy specifically focusing on posture, gait, and balance may significantly improve these factors and reduce falls. The primary goal of this study was to assess the effectiveness of a novel and promising intervention therapy (protective step training - i.e., PST - balance disturbance/perturbation during treadmill walking) to improve balance as measured by the reaction time and reduce falls in people with PD. A secondary goal was to understand the effects of PST on proactive and reactive feedback responses during stance and gait tasks. Multi-baseline, repeated measures analyses were performed on the multitude of proactive and reactive performance measures to assess the effects of PST on gait and postural stability parameters.

Inclusion criteria

• able to ambulate without assistance
• had no known neurologic, cardiovascular, or orthopedic deficit - (Mini-Mental Status Examination <25), and had a Hoehn & Yahr (H&Y) score between II-III.

Exclusion criteria

• exhibited functionally disabling dyskinesia
• has dystonia, orthostatic hypotension,
• had neurosurgical intervention (deep brain stimulation)
• has and any significant musculoskeletal or metabolic disorders.