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Research
Janet H Bultitude
University of Bath
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4648-6184
License:
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Background
Gait difficulties in Parkinson’s disease have been related to problems shifting center of gravity forward. We previously showed reduced forward stepping latencies for people with Parkinson’s disease after one session of adaptation to upward visual shifts, which produces downward motor after-effects and potentially shifts center of gravity forward. Here we tested if repeated prism adaptation improved gait and postural control in Parkinson’s disease through a parallel, double-blind, randomized, sham-controlled trial.
Methods
We recruited participants with idiopathic Parkinson’s disease aged 40 – 80 and meeting any one of three clinical criteria: 1) Hoehn and Yahr Stage II.5 – IV; 2) Scoring > 0 on the gait, freezing of gait, and/or postural stability items of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale; or 3) Timed Up and Go > 12 seconds. Sealed envelope style randomization allocated participants to two weeks of twice-daily prism adaptation or sham treatment. Participants, care givers, and those assessing the outcomes were blinded to group assignment. Primary outcomes were changes in postural control measured using the Berg Balance Scale; and the Limits of Stability, Sensory Organisation, and Motor Control tests from the Smart EquiTest system. Secondary outcomes included other physiotherapy and questionnaire measures. Outcomes were assessed at the Dartmouth Hitchcock Medical Center immediately before and after the treatment period, with further long-term postal follow-up over two months. Outcomes were analysed using Analyses of Variance with follow-up t-tests.
Results
Eighteen participants were allocated to undergo prism adaptation, of which sixteen were analysed. Thirteen participants were allocated to undergo sham treatment, and all were analysed. The prism adaptation group showed increased forward stepping velocity on the Limits of Stability test (Pre: M=2.33, SEM=0.24; post: M=2.88, SEM=0.26; t(15)=3.2, p=.005, d=.819). The sham group showed no such change (Pre: M=2.13, SEM=0.22; 1d post: M=2.24, SEM=0.22; t(13)=.636, p=.537, d=.176). However, there were no group differences for any other outcome measures, and no indications that prism adaptation produced functional improvements in posture, gait, or activities of daily living.
Conclusions
Prism adaptation does not improve gait or postural control in Parkinson’s disease.
Trial Registration
Registered prospectively at ClinicalTrials.gov, 5th March 2015, NCT02380859, https://clinicaltrials.gov/ct2/show/NCT02380859.
Keywords
Parkinson’s disease, prism adaptation, gait, rehabilitation, clinical trial, freezing of gait
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This preprint is under consideration at Trials. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Janet H Bultitude
University of Bath
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4648-6184
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 14 Jun, 2021
No community comments so far
Reviews received
Received 24 Jul, 2021
Reviewers invited
Invitations sent on 09 Jul, 2021
Editor assigned
On 09 Jul, 2021
Submission checks complete
On 12 Jun, 2021
First submitted
On 11 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Gait difficulties in Parkinson’s disease have been related to problems shifting center of gravity forward. We previously showed reduced forward stepping latencies for people with Parkinson’s disease after one session of adaptation to upward visual shifts, which produces downward motor after-effects and potentially shifts center of gravity forward. Here we tested if repeated prism adaptation improved gait and postural control in Parkinson’s disease through a parallel, double-blind, randomized, sham-controlled trial.
Methods
We recruited participants with idiopathic Parkinson’s disease aged 40 – 80 and meeting any one of three clinical criteria: 1) Hoehn and Yahr Stage II.5 – IV; 2) Scoring > 0 on the gait, freezing of gait, and/or postural stability items of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale; or 3) Timed Up and Go > 12 seconds. Sealed envelope style randomization allocated participants to two weeks of twice-daily prism adaptation or sham treatment. Participants, care givers, and those assessing the outcomes were blinded to group assignment. Primary outcomes were changes in postural control measured using the Berg Balance Scale; and the Limits of Stability, Sensory Organisation, and Motor Control tests from the Smart EquiTest system. Secondary outcomes included other physiotherapy and questionnaire measures. Outcomes were assessed at the Dartmouth Hitchcock Medical Center immediately before and after the treatment period, with further long-term postal follow-up over two months. Outcomes were analysed using Analyses of Variance with follow-up t-tests.
Results
Eighteen participants were allocated to undergo prism adaptation, of which sixteen were analysed. Thirteen participants were allocated to undergo sham treatment, and all were analysed. The prism adaptation group showed increased forward stepping velocity on the Limits of Stability test (Pre: M=2.33, SEM=0.24; post: M=2.88, SEM=0.26; t(15)=3.2, p=.005, d=.819). The sham group showed no such change (Pre: M=2.13, SEM=0.22; 1d post: M=2.24, SEM=0.22; t(13)=.636, p=.537, d=.176). However, there were no group differences for any other outcome measures, and no indications that prism adaptation produced functional improvements in posture, gait, or activities of daily living.
Conclusions
Prism adaptation does not improve gait or postural control in Parkinson’s disease.
Trial Registration
Registered prospectively at ClinicalTrials.gov, 5th March 2015, NCT02380859, https://clinicaltrials.gov/ct2/show/NCT02380859.
Figure 1
Figure 2
Figure 3
Figure 4
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