Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal
Study Protocol


Melo, Gileno Edu Lameira de; Moura, Renata Calhes Franco de; Lopes, Jamile Benite Palma; Fonseca Junior, Paulo Roberto; Lazzari, Roberta Delasta; Duarte, Natália de Almeida Carvalho; Zaffalon Junior, Jose Robertto; Dumont, Arislander Jonathan Lopes; Kleiner, Ana Francisca Rozin; Galli, Manuela; Ferreira, Luiz Alfredo Braun; Okamoto, Erika; Oliveira, Claudia Santosx

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Background: Parkinson’s disease (PD) is a neurodegenerative condition that exerts a negative influence on postural control and mobility, predominantly among older adults, affecting mobility and increasing the risk of slipping, tripping and falls. Objectives: Determine the effectiveness of gait training with the aid of virtual reality on balance and gait in comparison to treadmill training and conventional gait training for subjects with PD. Methods/design: A prospective, randomized, controlled blind, clinical trial is proposed. The sample will comprise 45 individuals with Parkinson’s disease randomly allocated to three groups (Control: conventional gait training; Experimental I: treadmill training; and Experimental II: gait training involving virtual reality). Evaluations will be conducted on four occasions: 1) pre-intervention; 2) immediately after one session; 3) post-intervention; and 4) one month after last session. The evaluations will involve the Berg Balance Scale, Tinetti Test, Unified Parkinson’s Disease Rating Scale and Hoehn and Yahr Scale. The G-WALK (BTS) inertial sensor will be used for the evaluation of spatiotemporal gait variables, the Timed Up and Go test and the Six-Minute Walk Test. Training will involve 20-minute sessions held three times per week for four consecutive weeks. The results will be analyzed statistically by two-way ANOVA for the data with parametric distribution or Friedman’s two-way ANOVA for non-parametric data (α<0.05). Conclusion: The proposed study will compare gait conventional training, treadmill training and training with virtual reality with regard to improvements in gait and balance in patients with PD. The results will be published and will contribute evidence on the use of these interventions for individuals with PD.


Parkinson’s Disease, Gait, Virtual Reality Exposure Therapy, Balance.


1. Lord S, Godfrey A, Galna B, Mhiripiri D, Burn D, Rochester L. Ambulatory activity in incident Parkinson’s: more than meets the eye? J Neurol. 2013; 260(12): 2964–2972.

2. Sanfelice, E. Parkinson’s disease. Fisioter mov. 2004; 17(1): 11 - 24.

3. Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff J. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Rev Neurother. 2011; 11(7): 1057-1075.

4. Lopes J, Lameira de Melo G, Lazzari R, Santos C, Franco de Moura R, Dumont A et al. Measures used for the evaluation of balance in individuals with Parkinson’s disease: a systematic review. Journal of Physical Therapy Science. 2016;28(6):1936-1942.

5. Mehrholz J, Friis R, Kugler J, Twork S, Storch A, Pohl M. Treadmill training for patients with Parkinson’s disease. Cochrane Database of Systematic Reviews. 2009;(1): 1-33.

6. Petzinger G, Fisher B, Van Leeuwen J, Vukovic M, Akopian G, Meshul C et al. Enhancing neuroplasticity in the basal ganglia: The role of exercise in Parkinson’s disease. Mov Disord. 2010; 25(S1): S141-S145.

7. Zettergren K, Franca J, Antunes M, Lavallee C. The effects of Nintendo Wii Fit training on gait speed, balance, functional mobility and depression in one person with Parkinson’s disease. Med Health Sci J. 2011; 9(5): 18-24.

8. Buccello-Stout R, Bloomberg J, Cohen H, Whorton E, Weaver G, Cromwell R. Effects of Sensorimotor Adaptation Training on Functional Mobility in Older Adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2008; 63(5): P295-P300.

9. Mirelman A, Patritti B, Bonato P, Deutsch J. Effects of virtual reality training on gait biomechanics of individuals post-stroke. Gait & Posture. 2010;31(4):433-437.

10. Melo G, Lopes J, Lopes Dumont A, de Moura R, Lazzari R, Junior J et al. P5: Analysis of the immediate effect of gait training with virtual reality on the parkinsonian walking. Gait & posture 57(2017)203, 2017.

11. Galna B, Jackson D, Schofield G, McNaney R, Webster M, Barry G, et al. Retraining function in people with Parkinson’s disease using the Microsoft kinect: game design and pilot testing. J Neuroeng Rehabil. 2014; 11(1): 60.

12. Mendes F, Pompeu J, Lobo A, da Silva K, Oliveira T, Zomignani A et al, et al. Motor learning, retention and transfer after virtualrealitybased training in Parkinson’s disease – effect of motor and cognitive demands of games: a longitudinal, controlled clinical study. Physiotherapy. 2012; (98): 217223.

13. Ganesan M, Sathyaprabha T, Gupta A, Pal P. Effect of Partial Weight–Supported Treadmill Gait Training on Balance in Patients With Parkinson Disease. PM&R. 2014;6(1):22-33.

14. Miyamoto S, Lombardi Junior I, Berg K, Ramos L, Natour J. Brazilian version of the Berg balance scale. Brazilian Journal of Medical and Biological Research. 2004;37(9):1411-1421.

15. Martínez-Martín P, Gil-Nagel A, Gracia L, Gómez J, Martínez-Sarriés J, Bermejo F. Unified Parkinson’s disease rating scale characteristics and structure. Movement Disorders. 1994;9(1):76-83.

16. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967; 17(5): 427-42.

17. Schenkman M, Clark K, Xie T, Kuchibhatla M, Shinberg M, Ray L. Spinal Movement and Performance of a Standing Reach Task in Participants With and Without Parkinson Disease. Physical Therapy. 2001;81(8):1400-1411.

18. Galli M, Kleiner A, Gaglione M, Sale P, Albertini G, Stocchi F, et al. Timed Up and Go test and wearable inertial sensor: a new combining tool to assess change in subject with Parkinson’s disease after automated mechanical peripheral stimulation treatment. Int J Innov Technol. 2015; 4(11): 155-163.

19. Bugané F, Benedetti M, Casadio G, Attala S, Biagi F, Manca M, et al. Estimation of spatial-temporal gait parameters in level walking based on a single accelerometer: Validation on normal subjects by standard gait analysis. Computer Methods Programs in Biomedicine. 2012; 108(1): 129–137.

20. ATS - American Thoracic Society. ATS Statement: Guidelines For The SixMinute Walk Test. Amj Respir Care Med. 2005; 166: 111-117.

21. Enright P, McBurnie M, Bittner V, Tracy R, McNamara R, Arnold A, et al. The 6-min walk test: a quick measure of functional status in elderly adults. Chest. 2003; 123(2): 387-398.

22. Hirsch M, TooleT, Maitland C, Rider R. The balance training effects and high intensity resistance training in individuals with idiopathic Parkinson’s disease. Arch Phys Med Rehabil. 2003; 84: 1109-1117.

23. Betker A, Szturm T, Moussavi Z, Nett C. Exercises based on the video game for balance rehabilitation: a pilot project. Arch Phys Med Rehabil. 2006; 87(8): 1141-1149.

24. Nadeau A, Pourcher E, Corbeil P. Effects of 24 wk of Treadmill Training on Gait Performance in Parkinson’s Disease. Med Sci Sports Exerc. 2014; 46(4): 645-655.

25. Londeree B, Moeschberger M. Effect of age and other factors on maximal heart rate. Research quarterly for exercise and sport. 1982; 53(4): 297-304.

26. Lazzari R, Politti F, Belina S, Collange Grecco L, Santos C, Dumont A, et al. Effect of Transcranial Direct Current Stimulation Combined With Virtual Reality Training on Balance in Children With Cerebral Palsy: A Randomized, Controlled, Double-Blind, Clinical Trial. J Mot Behav. 2016; 49(3): 329-336.

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