A novel conceptual framework for balance training in Parkinson’s disease-study protocol for a randomised controlled trial Effect of Balance Training on Postural Instability in Patients With Idiopathic Parkinson’s Disease Exercise programs improve mobility and balance in people with Parkinson's disease. Diagnosis of Fall Risk in Parkinson Disease: An Analysis of Individual and Collective Clinical Balance Test Interpretation Neurofeedback and physical balance in Parkinson's patients. Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Clinical and posturographic correlates of falling in Parkinson's disease. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease. An evaluation of the patient education programme for Parkinson's disease in clinical practice. The effect of deep brain stimulation randomized by site on balance in Parkinson's disease. The effects of a balance and strength training program on equilibrium in Parkinsonism: A preliminary study. A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance, balance and quality of life in patients with Parkinson’s disease In-patient multidisciplinary rehabilitation for Parkinson's disease: A randomized controlled trial. Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson’s Disease Balance versus resistance training on postural control in patients with Parkinson's disease: a randomized controlled trial. Effects of augmented visual feedback during balance training in Parkinson's disease: a pilot randomized clinical trial.
Background There is increasing scientific knowledge about the interaction between physiological ( musculoskeletal , neuromuscular , cognitive and sensory ) systems and their influence on balance and walking impairments in Parkinson ’s disease . We have developed a new conceptual framework for balance training , emphasising specific components of balance control related to Parkinson ’s disease symptoms by using highly challenging , progressive and varying training conditions . The primary aim of this proposed r and omised controlled trial will be to investigate the short-term and long-term effects of a 10-week balance training regime in elderly with Parkinson ’s disease . Methods / Design Eighty participants with mild to moderate idiopathic Parkinson ’s disease will be recruited and r and omly allocated to an intervention group receiving balance training or a control group whose participants will continue to receive their usual care . The intervention will consist of a 10-week group training regime ( 1-hour training , three times per week ) , which will be led by two physiotherapists to ensure training progression and safety . The conceptual framework will be applied by addressing specific balance components ( sensory integration , anticipatory postural adjustments , motor agility , stability limits ) through varying training conditions and structured progression . Assessment will be conducted through a multi-dimensional battery of outcomes , prior to and immediately after the 10-week intervention , and at 9 and 15 months ’ follow-up after entering the study . Primary outcome measures will be balance performance ( assessed using the Mini Balance Evaluation Systems Test ) , change in gait velocity ( m/s ) between single and dual task walking , and fear of falling ( evaluated using the Fall Efficacy Scale International ) . Discussion This study has the potential to provide new insight and knowledge of the effects of specific , varied and challenging balance training on a wide health spectrum in elderly with PD . If found to be effective , this pragmatic approach with translation of theory into practice , can be implemented in existing outpatient care . Trial registration Background . Postural instability ( PI ) is a disabling sign of Parkinson ’s disease ( PD ) not easily amenable to treatment with medication . Objective . To evaluate the effects of balance training on PI in patients with PD . Methods . A total of 64 patients with PI were r and omly assigned to the experimental group ( n = 33 ) for balance training or to the control group ( n = 31 ) for general physical exercises . Each patient received 21 treatment sessions of 50 minutes each . Patients were evaluated by a blinded rater before and after treatment as well as 1 month posttreatment using the Berg Balance Scale ( BBS ) , Activities-Specific Balance Confidence Scale ( ABC ) , postural transfer test , self-destabilization of the center of foot pressure test , number of falls , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , modified Hoehn and Yahr ( H&Y ) Staging Scale , and Geriatric Depression Scale ( GDS ) . Results .At the end of treatment , the experimental group showed significant improvements in all outcome measures , except for the UPDRS and the H&Y scale . Improvement was maintained at the 1-month follow-up in all outcome measures except for the GDS . No significant changes in performance were observed in the control group . Conclusions . A program of balance training can improve PI in patients with PD Compromised balance and loss of mobility are among the major consequences of Parkinson 's disease ( PD ) . The literature documents numerous effective interventions for improving balance and mobility . The purpose of this study was to verify the effectiveness of two exercise programs on balance and mobility in people with idiopathic PD . Thirty-four participants , with idiopathic PD that ranged from Stage I to Stage III on the Hoehn & Yahr ( H&Y ) scale , were assigned to two groups . Group 1 ( n = 21 ; 67+/-9 years old ) was engaged in an intensive exercise program ( aerobic capacity , flexibility , strength , motor coordination and balance ) for 6 months : 72 sessions , 3 times a week , 60 minutes per session ; while Group 2 ( n = 13 ; 69+/-8 years old ) participated in an adaptive program ( flexibility , strength , motor coordination and balance ) for 6 months : 24 sessions , once a week , 60 minutes per session . Balance and basic functional mobility were assessed in pre- and post-tests by means of the Berg Balance Scale and the Timed Up and Go Test . Before and after the interventions , groups were similar in clinical conditions ( H&Y , UPDRS , and Mini-Mental ) . A MANOVA 2 ( programs ) by 2 ( moments ) revealed that both groups were affected by the exercise intervention . Univariate analyses showed that participants improved their mobility and balance from pre- to post-test . There were no differences between groups in either mobility or balance results . Both the intensive and adaptive exercise programs improved balance and mobility in patients with PD Background and Purpose : Parkinson disease ( PD ) results in an increased frequency of falls relative to the frequency in neurologically healthy people . The purpose of this study was to compare the accuracy of PD fall risk diagnosis based on one test with that based on the collective interpretation of multiple tests . Participants : Seventy people with PD ( mean age=73.91 years ) participated in this study . Method : Clinical balance tests were conducted during the initial examinations of people with PD .  Validity indices were calculated for individual tests and compared with validity indices calculated for a combination of multiple tests . Results : Thirty-six participants reported a fall history . Analysis of individual tests revealed broad variations in validity indices , whereas the collective interpretation of multiple tests improved sensitivity and negative likelihood ratios . Discussion and Conclusion : Collective interpretation of clinical balance tests result ed in fewer false-negative results and more substantial adjustments to the posttest probability of being a “ faller ” than the interpretation of one test alone . These results should be confirmed in a prospect i ve examination of fall risk in PD The primary goal of the present research is to study the effect of a neurofeedback training ( NFT ) period on  balance problems associated with Parkinson 's disease . Sixteen patients were selected through purposive sampling and were r and omly divided into experimental and control groups . The research procedure included eight sessions . Prior to and after training , pre-tests and post-tests of static and dynamic balance were administered using " limit of stability " for the Biodex as well as the Berg scale . The results revealed that , after neurofeedback training , a statistically significant improvement in both static and dynamic balance in the experimental group was achieved . The means of the Biodex and Berg scores in the experimental group increased from 18.87 to 42.87 and 17.62 to 46.37 , respectively . The means of the Biodex and Berg scores in the control group in the pretest were 18.25 and 17.75 and increased to 20.00 and 20.50 , respectively . The results suggest that NFT can improve static and dynamic balance in PD patients OBJECTIVE To assess the criterion-related validity of the  Berg Balance Scale ( BBS ) in subjects with Parkinson 's disease ( PD ) . DESIGN Prospect i ve , correlational analysis between the BBS and accepted measures of PD motor and functional impairment . SETTING The federally funded PD research center , an interdisciplinary center of excellence for people with PD within a Veterans Affairs medical center . PARTICIPANTS Thirty-eight men ( average + /- st and ard deviation , 71.1+/-10.5 y ) with confirmed PD . Their initial diagnosis had been made on average 5.8+/-3.6 years earlier . All could st and or walk unassisted and had mild to moderate disability . Patients who could not ambulate without assistive devices were excluded . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Correlational analyses between the  BBS  and the Unified Parkinson 's Disease Rating Scale ( UPDRS ) motor scale , Modified Hoehn and Yahr Staging ( Hoehn and Yahr ) Scale , and the Modified Schwab and Engl and Capacity for Daily Living Scale ( S&E ADL Scale ) . RESULTS BBS score showed significant correlations with indicators of motor functioning , stage of disease , and daily living capacity . BBS score was inversely associated with the UPDRS motor score ( -.58 , P < .005 ) , Hoehn and Yahr Scale staging ( -.45 , P < .005 ) , and S&E ADL Scale rating ( .55 , P < .005 ) . In all 3 correlations , lower scores on the BBS ( indicating greater balance deficits ) correlated with higher UPDRS scores ( indicating greater motoric or functional impairment ) . CONCLUSIONS Results support the criterion-related validity of the BBS . Its utility in other balance conditions of older adults has been established . Rehabilitation interventions have been shown to improve the balance deficits associated with PD . Early referral and periodic re assessment is vital to achieving and maintaining improvements . Our research results agree with other published research in suggesting that the BBS may be used as a screening tool and ongoing assessment tool for patients with PD OBJECTIVE To assess immediate and near-term effects of 2 exercise training programs for persons with idiopathic Parkinson 's disease ( IPD ) . DESIGN R and omized control trial . SETTING Public health facility and medical center . PARTICIPANTS Fifteen persons with IPD . INTERVENTION Combined group ( balance and resistance training ) and balance group ( balance training only ) underwent 10 weeks of high-intensity resistance training ( knee extensors and flexors , ankle plantarflexion ) and /or balance training under altered visual and somatosensory sensory conditions , 3 times a week on nonconsecutive days . Groups were assessed before , immediately after training , and 4 weeks later . MAIN OUTCOME MEASURES Balance was assessed by computerized dynamic posturography  , which determined the subject 's response to reduced or altered visual and somatosensory orientation cues ( Sensory Orientation Test [ SOT ] ) . Muscle strength was assessed by measuring the amount of weight a participant could lift , by using a st and ardized weight- and -pulley system , during a 4-repetition-maximum test of knee extension , knee flexion , and ankle plantarflexion . RESULTS Both types of training improved SOT performance . This effect was larger in the combined group . Both groups could balance longer before falling , and this effect persisted for at least 4 weeks . Muscle strength increased marginally in the balance group and substantially in the combined group , and this effect persisted for at least 4 weeks . CONCLUSION Muscle strength and balance can be improved in persons with IPD by high-intensity resistance training and balance training Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson 's disease ( IPD ) .  Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling . The purpose of this study was to determine the efficacy of clinical tests , balance scales , and  stable-platform posturography  in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort . Forty-eight PD subjects ( Hoehn & Yahr stage 1 - 3 ) and 17 age-matched controls had the following assessment s : Activities-specific Balance Confidence scale , Berg Balance Scale , Unified Parkinson 's Disease Rating Scale ( UPDRS ) ( motor ) , pull-test , timed up- and -go , static posturography , and dynamic posturography to assess multidirectional leaning balance . Of the clinical assessment s , all but the pull-test were closely correlated with a history of falling .  Static posturography  discriminated between PD fallers and controls but not between PD fallers and non-fallers , whereas  dynamic posturography ( reaction time , velocity , and target hit-time ) also discriminated between fallers and non-fallers . Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospect i ve assessment of falls risk in PD patients . A further prospect i ve study is now required to assess their predictive value . © 2013 Movement Disorder Society OBJECTIVE To compare the effects of whole body vibration ( WBV ) and conventional physiotherapy ( PT ) on levodopa-resistant disturbances of balance and gait in idiopathic Parkinson 's disease ( PD ) . DESIGN R and omized controlled rater-blinded trial comparing 2 active interventions , final follow-up assessment 4 weeks after termination of active intervention . SETTING Specialized referral center , hospitalized care . PARTICIPANTS Patients with PD and dopa-resistant imbalance on stable dopamine replacement medication ( N=27 ) were r and omized ( intent-to-treat population ) to receive WBV  ( n=13 ) or  conventional PT ( controls , n=14 ) . Twenty-one patients ( per protocol population ) completed follow-up ( 14 men , 7 women ; mean age , 73.8 y ; age range , 62 - 84 y ; mean disease duration , 7.2 y ; mean dopa-equivalent dose , 768 mg/d ) . INTERVENTION Subjects were r and omized to receive 30 sessions ( two 15-min sessions a day , 5 days a week ) of either WBV on an oscillating platform or conventional balance training including exercises on a tilt board .  Twenty-one subjects ( 10 with WBV , 11 controls ) were available for follow-up 4 weeks after treatment termination . MAIN OUTCOME MEASURES The primary measure was Tinetti Balance Scale score . Secondary clinical ratings included st and -walk-sit test , walking velocity , Unified Parkinson 's Disease Rating Scale ( section III motor examination ) score , performance in the pull test , and dynamic posturography . RESULTS The Tinetti score improved from 9.3 to 12.8 points in the WBV group and from 8.3 to 11.7 in the controls . All secondary measures , except posturography , likewise improved at follow-up compared with baseline in both groups . Quantitative dynamic posturography only improved in patients with WBV ( 1937 - 1467 mm ) whereas there was no significant change in controls ( 1832 - 2030 mm ) . CONCLUSIONS Equilibrium and gait improved in patients with PD receiving conventional WBV or conventional PT in the setting of a comprehensive rehabilitation program . There was no conclusive evidence for superior efficacy of WBV compared with conventional balance training AIM The Patient Education Programme for Parkinson 's disease ( PEPP ) was assessed in a recent r and omised controlled trial ( RCT ) . In this study , a trend was identified towards significant improvement of patients ' quality of life ( Qol ) as well as a significant reduction of caregivers ' psychosocial burden and need for help . This study is aim ed at evaluating the effectiveness of the PEPP in clinical practice as compared with the RCT in an academic setting . The second aim is to assess its effectiveness in clinical practice at 6-month follow-up . METHODS Fifty-five patients and 50 caregivers from nine clinical setting s participated in the PEPP consisting of eight weekly sessions of 90 min .  Self-report question naires were used to assess patients ' Qol ( PDQ-39 ) and caregivers ' psychosocial burden and need for help ( BELA-A-k ) at baseline , directly after the programme and at 6-month follow-up . To compare the baseline data and short-term effects , data were used from an RCT study which included 64 Parkinson 's disease patients and 46 caregivers . RESULTS Compared with the RCT control group , significant effects , after Bonferoni adjustment , were found for patients ' Qol as well as for caregivers ' psychosocial burden and need for help . No significant changes were found between baseline scores compared with 6-month follow-up . Scores returned to baseline levels at 6-month follow-up . CONCLUSIONS Effects from the RCT study were replicated and the effect on patients ' Qol was now significant . However , at 6-month follow-up , scores returned to baseline levels , indicating the need for some form of a booster session BACKGROUND The effect of the surgical site of DBS on balance and gait in Parkinson 's Disease ( PD ) is uncertain . This is the first double-blind study of subjects r and omized to either the STN ( N = 14 ) or GPi ( N = 14 ) who were assessed on a range of clinical balance measures . METHODS Balance testing occurred before and 6 months postsurgery . A control PD group was tested over the same period without surgery ( N = 9 ) . All subjects were tested on and off medication and DBS subjects were also tested on and off DBS . The Postural Instability and Gait Disability items of the UPDRS and additional functional tests , which we call the Balance and Gait scale , were assessed . Activities of Balance Confidence and Activities of Daily Living question naires were also recorded . RESULTS Balance was not different between the best-treated states before and after DBS surgery for both sites . Switching DBS on improved balance scores , and scores further improved with medication , compared to the off state . The GPi group showed improved performance in the postsurgery off state and better ratings of balance confidence after surgery , compared to the STN group . CONCLUSIONS Clinical measures of balance function for both the STN and GPi sites showed that balance did not improve beyond the best medically treated state before surgery . Both clinical balance testing in the off/off state and self-reported balance confidence after surgery showed better performance in the GPi than the STN group The purpose of this study was to determine if a balance and strength training program could improve equilibrium and strength in persons with stage I-III Parkinsonism . Subjects were pre-tested on strength and balance ( EquiTest ) and r and omized into either a treatment or a control group . The treatment subjects participated in 10 weeks of lower limb strength training and balance exercises design ed to challenge a stable posture and increase limits of stability . Both groups were then posttested on balance , knee flexion , knee extension , and ankle inversion strength . Subjects who received strength and balance training demonstrated significantly improved equilibrium and modest gains in knee flexion and extension strength , while the control group showed no improvement in conditions of destabilizing balance environments and significant declines in strength . Results indicate that 10 weeks of balance and strength training lead to improved equilibrium by producing positive changes in two different control mechanisms . One , training altered the ability to control the motor system when vestibular cues had to be the primary source of reliable feedback ; and two , training helped subjects to override faulty proprioceptive feedback and utilize reliable visual or vestibular cues Purpose : To establish the effect of a 6-week programme of cycle ergometry training on exercise tolerance , balance , activities of daily living ( ADL ) and quality of life in individuals with Parkinson ’s disease ( PD ) . Method : Twenty-three subjects were recruited from the Parkinson ’s data base of the neurology service in a large urban teaching hospital . Quasi-experimental study of interrupted time-series design was conducted with subjects acting as their own control . Assessment s were carried out at baseline , week 7 following the control phase , and week 14 following the intervention phase . Intervention consisted of 30-min cycle ergometry training once weekly . Outcome measures included Six Minute Walk Test , Physiological Cost Index , Berg Balance Scale , Timed Up and Go Test ( TUAG ) , ADL and mobility sections of the Unified Parkinson ’s disease Rating Scale ( UPDRS ) and the Parkinson ’s disease question naire ( PDQ ) . Results : Statistically significant improvements were noted for the Berg Balance Scale ( p = 0.003 ) , TUAG ( p = 0.019 ) and ADL ( p = 0.006 ) and mobility ( p = 0.021 ) sections of the UPDRS . A trend towards improvement was found for exercise tolerance . No significant effect on quality of life was found . Conclusion : A 6-week programme of cycle ergometry training did not significantly influence exercise tolerance in this sample , but improved balance , functional abililty and PD-related disability were noted . Implication s for Rehabilitation Individuals with Parkinson ’s disease demonstrate lower levels of exercise tolerance than healthy controls . Individuals with Parkinson ’s disease could participate in 30 min of cycle ergometry training , with no rest periods required . Cycle ergometry training has a positive effect on balance , function and PD-related disability PURPOSE This study was undertaken to evaluate the effects of an inpatient 2-month multidisciplinary rehabilitative program of task-oriented exercises , cognitive-behavioral training , and occupational therapy on motor impairment , activities of daily living , and quality of life ( QoL ) in subjects with long- duration Parkinson 's disease ( PD ) . METHODS Subjects were r and omly selected for an experimental ( multidisciplinary rehabilitative care ) and a control group ( general physiotherapy ) and were assessed before treatment , after 8 weeks ( post-treatment ) , and 12 months after the end of treatment . Medications were not adjusted during training . Outcome measures were the Movement Disorder Society Unified Parkinson 's Disease Rating Scale , Part III ( primary outcome ) , the Berg Balance Scale , the Functional Independence Measure , and the 39-Parkinson 's Disease Question naire . A linear mixed model for repeated measures was used for each outcome . RESULTS Seventy subjects with PD ( 46 females ; mean age , 74 ± 7 years ; mean disease duration , 15 ± 3 years , modified Hoehn & Yahr stage , 2.5 - 4 ) were r and omized , 64 completed the study ( experimental = 32 ; control = 32 ) . A significant effect of time , group , and time by group interaction were noted for all outcomes . The primary outcome showed a between-group difference in favor of the experimental group of 25 points after training , which was maintained at follow-up . After training , the Berg Balance Scale score of the experimental group was greater than 43.5 , a value previously identified as a cutoff between fallers and nonfallers for subjects with PD . CONCLUSION Our findings suggest that multidisciplinary rehabilitative care is useful in changing the course of motor impairment , balance , activities of daily living , and QoL. The effects lasted for at least 1 y after the intervention Background . Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson ’s disease ( PD ) . However , there are inconsistent findings on the effects of balance and gait training on balance confidence . Objective . To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups . Methods . A total of 51 PD patients were r and omly assigned to a balance and gait training ( BAL ) group or to an active control ( CON ) group . The BAL group received balance and gait training with augmented feedback , whereas CON participants received lower-limb strength training for 12 weeks . Outcome measures included Activities-Specific Balance Confidence ( ABC ) Scale , limits-of-stability test , single-leg-stance test , and spatiotemporal gait characteristics . All tests were administered before intervention ( Pre ) , immediately after training ( Post ) , and at 3 months ( Post3 m ) and 12 months ( Post12 m ) after treatment completion . Results . The ABC score improved marginally at Post and significantly at Post3 m and Post12 m only in the BAL group ( P < .017 ) . Both participant groups increased their end point excursion at Post , but only the BAL group maintained the improvement at Post3 m . The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3 m and Post12 m ( P < .05 ) . For gait characteristics , both participant groups increased gait velocity , but only the BAL group increased stride length at Post , Post3 m , and Post12 m ( P < .017 ) . Conclusions . Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD BACKGROUND Evidence s have shown that physiotherapy programs may improve the balance of individuals with Parkinson 's disease ( PD ) , although it is not clear which specific exercise program is better . AIM The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients . DESIGN R and omized controlled trial . SETTING The study was conducted in a physiotherapy outpatient clinic of a university hospital . POPULATION A total of 40 PD participants were r and omly divided into two groups : balance training ( BT ) and resistance training ( RT ) . METHODS The BT group focused on balance training , functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk , both supervised by trained physiotherapists . Therapy sessions were held twice a week ( at 60 minutes ) , totaling 24 sessions . The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test ( BESTest ) scale to determine the effects of the intervention on postural control . RESULTS Significant improvement of postural control ( pre vs. post 15.1 vs. 9.6 cm2 ) was only reported in favor of BT group ( d=1.17 ) for one-legged st and condition on force platform . The st and ardized mean difference between groups was significantly ( P<0.02 ) , with 36 % of improvement for BT vs. 0.07 % for RT on this condition . Significant improvement ( P<0.05 ) was also observed in favor of BT ( in mean 3.2 % ) for balance gains in some BESTest scores , when compared to RT group ( -0.98 % ) . CONCLUSIONS Postural control in Parkinson 's disease is improved when training by a directional and specific balance program than a resistance training program . CLINICAL REHABILITATION IMPACT Balance training is superior to resistance training in regard to improving postural control of individuals with PD . Gold st and ard instruments ( high in cost and difficult to access ) were used to assess balance , as well as scales with clinical applicability ( low cost , easily acceptable , applicable and valid ) , which can guide the management of physiotherapists both in their decision-making and in clinical practice BACKGROUND Balance training has been demonstrated to improve postural control in patients with Parkinson 's disease ( PD ) . The objective of this pilot r and omized clinical trial was to investigate whether a balance training program using augmented visual feedback is feasible , safe , and more effective than conventional balance training in improving postural control in patients with PD . METHODS Thirty-three patients with idiopathic PD participated in a five-week training program consisting of ten group treatment sessions of 60 min . Participants were r and omly allocated to ( 1 ) an experimental group who trained on workstations consisting of interactive balance games with explicit augmented visual feedback ( VFT ) , or ( 2 ) a control group receiving conventional training .  St and ing balance , gait , and health status were assessed at entry , at six weeks , and at twelve weeks follow-up . RESULTS Sixteen patients were allocated to the control group and seventeen to the experimental group . The program was feasible to apply and took place without adverse events . Change scores for all balance measures favored VFT , but the change in the primary outcome measure , i.e. the Functional Reach test , did not differ between groups ( t(28 ) = -0.116 , p = .908 ) . No other differences between groups were statistically significant . CONCLUSIONS VFT proved to be a feasible and safe approach to balance therapy for patients with PD . In this proof-of-concept study VFT was not superior over conventional balance training although observed trends mostly favored VFT . These trends approached clinical relevance only in few cases : increasing the training load and further optimization of VFT may strengthen this effect . TRIAL REGISTRATION Controlled Trials , IS RCT N47046299
Conclusion ] Different methods , such as scales , tests , and equipment , are used for the evaluation of balance in patients with Parkinson 's disease .
[ Purpose ] The present literature review was conducted on the use of different measures for the evaluation of balance in patients with Parkinson 's disease .