The effects of augmented visual feedback during balance training in Parkinson’s disease: study design of a randomized clinical trial

M.R.C. van den Heuvel, E.E.H. van Wegen, C.J.T. de Goede, I.A.L. Burgers-Pots, P.J. Beek, A. Daffertshofer, G. Kwakkel

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Background: Patients with Parkinson’s disease often suffer from reduced mobility due to impaired postural control.
Balance exercises form an integral part of rehabilitative therapy but the effectiveness of existing interventions is
limited. Recent technological advances allow for providing enhanced visual feedback in the context of computer
games, which provide an attractive alternative to conventional therapy. The objective of this randomized clinical
trial is to investigate whether a training program capitalizing on virtual-reality-based visual feedback is more
effective than an equally-dosed conventional training in improving standing balance performance in patients with
Parkinson’s disease.
Methods/design: Patients with idiopathic Parkinson’s disease will participate in a five-week balance training
program comprising ten treatment sessions of 60 minutes each. Participants will be randomly allocated to (1) an
experimental group that will receive balance training using augmented visual feedback, or (2) a control group that
will receive balance training in accordance with current physical therapy guidelines for Parkinson’s disease patients.
Training sessions consist of task-specific exercises that are organized as a series of workstations. Assessments will
take place before training, at six weeks, and at twelve weeks follow-up. The functional reach test will serve as the
primary outcome measure supplemented by comprehensive assessments of functional balance, posturography, and
Discussion: We hypothesize that balance training based on visual feedback will show greater improvements on
standing balance performance than conventional balance training. In addition, we expect that learning new control
strategies will be visible in the co-registered posturographic recordings but also through changes in functional
Trial registration: ISRCTN: ISRCTN47046299
Original languageEnglish
Article number137
Number of pages9
JournalBMC Neurology
Publication statusPublished - 2013

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