Background: Postural instability is a particularly incapacitating disorder, whose loss of motor independence by\nParkinsonÃ?´s Disease (PD) patients marks a significant stage of disease onset. Evidence suggests that deficits in\nautomatic motor control, sensory integration and attention are associated with the lack of balance in PD.\nPhysiotherapy together with medication play an important role in the treatment of this state, although no\nconsensus has been reached on the best treatment modality. The aim of this randomized controlled trial protocol\nis to evaluate the effects of balance training with rhythmical (BRT), which is a motor program to improve balance\nassociated with rhythmical auditory cues (RACs). This study is ongoing in the stage 1.\nMethods and design: A total of 150 PD patients at H&Y stages IIââ?¬â??III and asymptomatic for depression and dementia\nare enrolled in a single-blind randomized study. Randomization is achieved via a computer-generated random-sequence\ntable. All patients should also present a fall history. They will be assigned into one of three groups, and their balance and\ngait will be assessed before and after 10 training sessions, and after 4 and 30 weeks subsequent to the end of the\ntraining. The BRT group will receive a motor program to improve balance associated with RACs, the MT group will\nperform motor training with the same aims as those in the BRT group but without RACs, and the control group (CG)\nwill be trained only in orientations. The exercise program specific to balance is of 5 weeksââ?¬â?¢ duration with two sessions\nper week, 45 min each, and consists of general physiotherapy exercises. Each session will be divided into five warm-up\nminutesââ?¬â?30 min for the main part and 10 min for the cool down. The training progresses and intensifies each week\ndepending on the individualââ?¬â?¢s performance. The subjects should be able to execute 10 repetitions of the exercise\nsequences correctly to progress to the next movement.\nDiscussion: This randomized study protocol will evaluate the effects of a motor program designed to improve balance\nassociated with RACs, and will also assess whether balance training leads to activation of balance reactions at the\nappropriate time. We hypothesize that if this motor program is maintained long-term, it will prevent falls.
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