Neurophysiological and clinical effects of blindfolded balance training (BBT) in Parkinson's disease patients: a preliminary study

BACKGROUND:Recent evidence supports the hypothesis that rehabilitative strategies based on sensorimotor stimulation in the neurorehabilitation of Parkinson's disease (PD) may be useful to improve gait in PD patients. AIM:We supposed that sensorimotor stimulation produces modulation of anticipatory postural adjustments (APAs) arising from the supplementary motor area (SMA). We aimed to investigate the clinical and neurophysiological effects of a blindfolded balance training (BBT). DESIGN:Randomized controlled trial. SETTING:Italian hospital. POPULATION:Sixteen PD patients. METHODS:The patients were randomized in two groups, one group treated with two-weeks BBT and one group treated with two-weeks of physical therapy (PT). We assessed gait parameters (swing, stance, double stance phase of cycle gait) and neurophysiological measurement (functional connectivity between SMA and motor area M1) before and after treatments. RESULTS:We found a decrease of stance and double stance phase and increase of swing phase respect to gait cycle, in BBT group compared to PT group, paralleled by a selective modulation in functional connectivity between M1 and SMA for BBT group. CONCLUSIONS:Our findings support that BBT represents a complementary rehabilitative strategy, based on visual deprivation and proprioceptive perturbation in recovery of gait in PD patients, in short time window, likely involving vestibular system and its connections with motor areas. CLINICAL REHABILITATION IMPACT:The use of vestibular system stimulation, involving SMA-M1 circuits, may be useful to improve gait control in PD patients.