Can sensory attention focused exercise facilitate the utilization of proprioception for improved balance control in PD?

Impaired sensory processing in Parkinson's disease (PD) has been argued to contribute to balance deficits. Exercises aimed at improving sensory feedback and body awareness have the potential to ameliorate balance deficits in PD. Recently, PD SAFEx™, a sensory and attention focused rehabilitation program, has been shown to improve motor deficits in PD, although balance control has never been evaluated. The objective of this study was to measure the effects of PD SAFEx™ on balance control in PD. Twenty-one participants with mild to moderate idiopathic PD completed 12 weeks of PD SAFEx™ training (three times/week) in a group setting. Prior to training, participants completed a pre-assessment evaluating balance in accordance with an objective, computerized test of balance (modified clinical test of sensory integration and balance (m-CTSIB) and postural stability testing (PST)) protocols. The m-CTSIB was our primary outcome measure, which allowed assessment of balance in both eyes open and closed conditions, thus enabling evaluation of specific sensory contributions to balance improvement. At post-test, a significant interaction between time of assessment and vision condition (p=.014) demonstrated that all participants significantly improved balance control, specifically when eyes were closed. Balance control did not change from pre to post with eyes open. These results provide evidence that PD SAFEx™ is effective at improving the ability to utilize proprioceptive information, resulting in improved balance control in the absence of vision. Enhancing the ability to utilize proprioception for individuals with PD is an important intermediary to improving balance deficits.