Objective: This study aims to assess the impact of balance training and early detection of stability limits in PD on the responsiveness of young and late-onset PD patients to the same assessment and treatment program over one year.

Background: Although extensive research has predominantly focused on late-onset Parkinson’s  (LOPD), there is growing interest in understanding young-onset Parkinson’s (YOPD) and the unique postural control challenges associated with each subtype. While early-stage YOPD patients tend to exhibit greater asymmetry in motor symptoms, with more pronounced rigidity and bradykinesia, LOPD patients experience a more rapid decline in balance, leading to more frequent falls and greater impairments in weight shifting and sensory integration. Additionally, gait disturbance is more commonly observed as an initial symptom in LOPD, further contributing to postural instability.

Method: Two cases were diagnosed with Parkinson’s disease (PD): one with young-onset PD (diagnosed at age 26) and another with late-onset PD (diagnosed at age 60). Both patients exhibited moderate postural instability and frequent risk of falling according to the UPDRS.

Each underwent a structured daily one-hour biofeedback balance exercise session for one year. A comparative quantitative and qualitative analysis was conducted monthly using the Biodex Balance system and the UPDRS .

The intervention targeted the following aspects: risk of falling reduction strategies, single-limb support training, maze control training, and weight-bearing training on progressively challenging steps as follows: standing on firm and stable platforms with open then closed eyes with double then single limb support followed by repeating the previous steps on foam and a movable platform.

Results: The sway index of both patients improved after 1 year of training with moderate maintenance levels from 2.5 to 1.5 and 2.05 to 1.0 with a reduction in the number of errors .and the percentage of weight-bearing improved from 20% to 43 % and 40% to 57 % for late and young-onset PD, respectively.

Conclusion: These findings underscore the importance of early intervention and balance training programs in mitigating postural instability in PD ,YOPD demonstrated slightly greater gains in sway index reduction.

Balance Error Scoring system

weight bearing test results

Fall risk test results

References: Mehanna, R., & Jankovic, J. (2019). Young-onset Parkinson’s disease: its unique features and their impact on quality of life. Parkinsonism & Related Disorders, 65, 39-48.

Becker, D., Maric, A., Schreiner, S. J., Büchele, F., Baumann, C. R., & Waldvogel, D. (2022). Onset of postural instability in Parkinson’s disease depends on age rather than disease duration. Parkinson’s Disease, 2022(1), 6233835.

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Mehanna, R., & Jankovic, J. (2019). Young-onset Parkinson’s disease: its unique features and their impact on quality of life. Parkinsonism & Related Disorders, 65, 39-48.

Schrag, A., Hovris, A., Morley, D., Quinn, N., & Jahanshahi, M. (2003). Young‐versus older‐onset Parkinson’s disease: impact of disease and psychosocial consequences. Movement disorders: official journal of the Movement Disorder Society, 18(11), 1250-1256.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparative-study-of-limits-of-stability-improvements-in-young-onset-vs-late-onset-parkinsons-disease-following-one-year-biofeedback-balance-training/