More information about text formats
I am pleased to respond to Dr Sandip Kumar Dash’s letter dated 3rd July 2007. I wish to reassure Dr Kumar Dash that the home based exercise programme used in the trial was built on the published evidence and the consensus of physiotherapists at the time. It included six levels of
exercise progression and strategies for movement initiation and compensation as well as fall prevention.
I must draw to Dr Kumar Dash’s attention the limitations of the two papers to which he makes reference. Sidaway’s paper (2006) was an account of a single subject and therefore, although interesting, was not generalisable. Morris’ paper (2000) was a theoretical paper on modelling
therapy. In her concluding paragraph she states ‘Randomised clinical trials are now needed to evaluate the specific effects of physiotherapy and to validate this model of care for people with PD’.
Our RCT was testing therapy and did where appropriate include techniques for initiating movement (cues)as part of the management. The results of our study and those of Nieuwboer et al JNNP 2007; (78) 2: 134-140 (specific focus on cueing techniques), which were published within months of each other, will make major contributions to what was previously a spartan evidence base for physiotherapy for people with PD.
Professor of Rehabilitation
I have read the article by Ann Ashburn et al (1), with interest and found it to be very useful for improving the quality of life of patients of Parkinson’s disease by giving them home exercise. This study is having a large number of patients and showed a reduction of fall and near fall in patients of Parkinson’s disease. How- ever I would like to have a few comments.
This study (1), showed...
This study (1), showed a significant improvement in functional reach test at 6 months in patients of exercise group. Though the fall rates in exercise group did not reach statically significant, there was a trend towards lower fall rates in exercise group at 8 weeks and at 6 months, the near fall rates were significant.Sidaway Ben et al (2) in their study found that 1 month training with visual cues was successful in establishing a lasting improvement in gait speed and stride length, while increasing the stability of underlying motor control system. Meg E Morris (3) also suggested that physical therapy offers symptomatic relief by teaching people strategies for bypassing defective basal ganglion in order
to move free easily. He has suggested physical therapy using cues and attentional strategies in different stages of the disease, according to Hoehn and Yahr scale. Over the years various tricks like visual tricks, movement tricks, mental tricks, auditory and tactile tricks have been devised to decrease the duration of freezing .These tricks help one to take the next step more quickly.
So in the present study (1), if in the home based exercise progamme cues would have been done as a part of protocol in the study, then reduction in fall and injurious fall among participants in the exercise group could have reached a significant value and might have caused a
difference in Berge balance test, timed up go test, and this would have thrown a light for future home based exercise studies in Parkinson’s disease.
1 Ann Ashburn, Louise Fazakarley, Claire Ballinger, Ruth Pickering, Lindsay D McLellan, and Carolyn Fitton--A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people
with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2007; 78: 678-684
2.Ben Sidway,Jenifer Anderson,Garth Davidson,Lucas Martin,Garth Smith,-Effects Of longterm gait training using visual cues in an individual with Parkinsons disease. Physical Therapy, 2006, vol86, no2, 186-194.
3.Meg morris—Movement disorders in people with Parkinsons disease: A model fort physical therapy—Physical Therapy,2000,vol 80,no 6,578-597.