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Balance improvement in Parkinson's Disease: from laboratory practice to dance and exercise


While considerable progress has been made in understanding postural control in people with PD in the literature, there is still work to be done in order to identify the best ways of improving their postural control, either using laboratory practice, community based dance/exercise practice or a combination of the two. Furthermore, little is known about the best way of evaluating the effectiveness of balance improvement programs regardless of setting. We believe that a self-contained, ambitious collaborative project on balance improvement in PD should address the following goals: 1. Identify the key tasks and training procedures used in the laboratory and in community programs in order to increase resilience to critical loss of balance, thereby reducing fall risk. 2. Select appropriate tasks representative of balance resilience to intrinsic (caused by the participant's own movement) or extrinsic (caused by an external force) perturbations for evaluation of balance training gains. 3.Apply the selected tasks/procedures in forthcoming investigations in laboratory and community based settings, to test the hypothesized principles of balance training. 4. Design a joint project comparing effects of training including either intrinsic or extrinsic perturbations in applied settings of balance training in people with PD and healthy age-matched controls.Our collaboration aims to develop a theoretical and experimental framework to assess the issue of balance improvement in the laboratory and in community settings. Our ambition is to develop a program of balance practice for people with PD that combines the advantages of laboratory practice with community-based dance programs. Developing such a program will be made possible by LA Teixeira (USP) who is an expert on laboratory balance training protocols. In previous work by Teixeira and colleagues different aspects of dynamic balance stability have been assessed in neurologic patients, including individuals with PD. In the current project, funded by FAPESP, the aim is to evaluate the effect of perturbation training through unpredictable support base displacements on ability to recover balance following a perturbation in PD patients. This is an individual 8-week program, whose results will be compared against a control group training for physical fitness. This expertise by L.A. Teixeira will be complemented by M. Doumas (QUB) who is an expert on postural control in clinical populations and is currently running a project contrasting traditional exercise and Dance for PD using 12-week dance trial (2 times/week) on balance control in people with PD and healthy controls. This program is run by Doumas' PhD student Anna Carapellotti and two MSc students. Carapellotti was a professional ballet dancer and has many years of expertise teaching dance in people with PD. The first 12-week dance trial started in September with a second planned to start in February 2019. The exchange activities funded by SPRINT will enable the initiation of a fruitful and exciting collaboration of the Teixeira and Doumas' groups who have common and complementary expertise in the field of postural control and PD.The goals of the project will be addressed by the two PIs as well as members of their teams. Specifically, in their bilateral visits to USP and QUB the visiting researchers will have the opportunity to: 1. Work closely with graduate students in the host institution. Specifically, Teixeira will have the opportunity to work closely with one PhD and two MSc students running the dance intervention and Doumas will have the opportunity to work with two MSc students running balance training protocols in Teixeira's group. The aim of this work would be to contribute to ongoing and plan future investigations leading to funding applications. 2. Deliver lectures and seminars to the university community and to undergraduate and graduate students. (AU)

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