Objective: This study aims to determine the impact of a 12-week Hula program on balance in patients with Parkinson’s Disease (PD) and to investigate changes in biomechanical characteristics across three standardized balance tests using a markerless motion capture (OpenCap), Inertial Measurement Unit sensor (IMU), and force plate.

Background: Patients with PD fall 3 times more often than their non-PD age-matched counterparts (IRR 2.1 vs 0.7).¹ Increased fall risk can be due to declines in balance and increase the probability of bone fractures^{2-6, 8}, hospitalization⁵, and mortality.^{4, 7-9} In the PD population, various dance programs have been shown to significantly improve balance.^10-11 Many studies utilize balance tests such as the Berg Balance Scale, Mini-BESTest, or timed-up-and-go test that do not account for lateral movement. Assessing balance parameters such as lower extremity strength, motor control, and vestibular system integrity will provide a comprehensive balance profile. Adding biomechanical technologies such as OpenCap, IMU sensors, and force plates may offer valuable insight into other longitudinal changes in balance.

Method: Thirty-seven participants with PD capable of ambulation with or without assistive devices completed baseline testing. Balance was assessed using the Four-Square Step Test (4SST), Five Times Sit-to-Stand (5TSTS), quantitative Romberg, Freezing of Gait Questionnaire, and UPDRS Part III. Participants were randomized to a 12-week Hula intervention or control condition.

Results: Significant differences between sex were observed for years with symptoms (p = .040, η² = .12), years since diagnosis (p = .020, η² = .15), height (p < .001, η² = .46), and weight (p = .002, η² = .26). No significant differences were observed for 4SST (p = .216, η² = .05) or 5TSTS (p = .195, η² = .05) completion times. Nine participants (24.3%) exceeded 15 seconds on the 4SST, and fifteen (40.5%) exceeded 15 seconds on the 5TSTS, indicating elevated fall risk. Ten participants (27.0%) required more than two trials to complete the 4SST.

Conclusion: Overall 48.6% of participants were observed at baseline to have increased risk of falling (>15 seconds completion time) for at least 1 test or were unable to perform the test due to physical limitations. Analysis of biomechanical variables for baseline assessments is ongoing and determination of the impact of the 12-week Hula program will be performed.

References: 1. Silva De Lima AL, Smits T, Darweesh SKL, et al. Home‐Based Monitoring of Falls Using Wearable Sensors in Parkinson’s Disease. Movement Disorders. 2020;35(1):109-115. doi:10.1002/mds.27830
2. Contreras A, Grandas F. Risk of Falls in Parkinson’s Disease: A Cross-Sectional Study of 160 Patients. Parkinson’s Disease. 2012;2012:1-10. doi:10.1155/2012/362572
3. Kalilani L, Asgharnejad M, Palokangas T, Durgin T. Comparing the Incidence of Falls/Fractures in Parkinson’s Disease Patients in the US Population. Kado D, ed. PLoS ONE. 2016;11(9):e0161689. doi:10.1371/journal.pone.0161689
4. Karadsheh MS, Weaver M, Rodriguez K, Harris M, Zurakowski D, Lucas R. Mortality and Revision Surgery Are Increased in Patients With Parkinson’s Disease and Fractures of the Femoral Neck. Clin Orthop Relat Res. 2015;473(10):3272-3279. doi:10.1007/s11999-015-4262-5
5. Paul SS, Harvey L, Canning CG, et al. Fall‐related hospitalization in people with Parkinson’s disease. Euro J of Neurology. 2017;24(3):523-529. doi:10.1111/ene.13238
6. Wood BH. Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. Journal of Neurology, Neurosurgery & Psychiatry. 2002;72(6):721-725. doi:10.1136/jnnp.72.6.721
7. Harris-Hayes M, Willis AW, Klein SE, Czuppon S, Crowner B, Racette BA. Relative Mortality in U.S. Medicare Beneficiaries with Parkinson Disease and Hip and Pelvic Fractures. Journal of Bone and Joint Surgery. 2014;96(4):e27. doi:10.2106/JBJS.L.01317
8. Huang YF, Cherng YG, Hsu SPC, et al. Risk and adverse outcomes of fractures in patients with Parkinson’s disease: two nationwide studies. Osteoporos Int. 2015;26(6):1723-1732. doi:10.1007/s00198-015-3052-y
9. Matinolli M, Korpelainen JT, Sotaniemi KA, Myllylä VV, Korpelainen R. Recurrent falls and mortality in Parkinson’s disease: a prospective two-year follow-up study: Recurrent falls and mortality in PD. Acta Neurologica Scandinavica. 2011;123(3):193-200. doi:10.1111/j.1600-0404.2010.01386.x
10. Sharp K, Hewitt J. Dance as an intervention for people with Parkinson’s disease: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2014;47:445-456. doi:10.1016/j.neubiorev.2014.09.009
11. Simpkins C, Yang F. Do dance style and intervention duration matter in improving balance among people with Parkinson’s disease? A systematic review with meta-analysis. Parkinsonism & Related Disorders. 2023;106:105231. doi:10.1016/j.parkreldis.2022.105231

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-hula-on-balance-outcomes-in-parkinsons-disease/