Objective: To examine the effect of Balance based Torso Weighing (BBTW) on immediate gait and balance outcomes in patients with parkinsonism (PWP) with clinical balance difficulties.

Background: PWP are at increased risk of falls due to postural instability. Common interventions for management of postural instability in these patients often have inadequate benefits. There is a need for interventions that can improve balance in this population.  BBTW, a Commercially available device that uses weight placements based on individual responses to balance perturbations, has shown improvement of gait and balance in patients with multiple sclerosis.1

Method: Using the Mobility Lab system (APDM) with 6 wearable sensors placed on feet, wrists, sacrum and sternum, we objectively assessed different aspects of balance, namely static balance (quiet standing), preparation to gait (Anticipatory Postural Adjustments), ongoing gait and turning in 20 PWP. Trials were: 1) baseline (BBTW without weights), 2) BBTW with therapeutic weights, 3) BBTW with sham weights. Order of the last two conditions was randomized. Patient and clinician global impression of change (PGIC, CGI respectively) evaluated changes in gait after each condition. Subjects and raters were blinded to treatment arms. Mixed-effect models was used accounting for repeated measurements over time and serial correlation within individual subjects.

Results: Twenty subjects completed the study. All subjects were men, age 70.4±10 years. There was no significant improvement in quiet stance, ongoing gait or turn between sham and therapeutic groups. The only positive outcome was Postural preparation to gait (APA magnitude) that showed significant improvement with therapeutic weights ( Sham (Mean ± SD): 0.43 ± 0.25 and therapeutic weight: 0.29± 0.11, p= 0.01). There was no difference between patient or physician’s report of change with therapeutic or sham weights (p= 1.00 and p= 0.66 respectively).

Conclusion: In this pilot study, using BBTW did not acutely improve objective gait measures in PWP except for APA. Limitations include small sample size, short duration of BBTW treatment and many objective measurements tested which could lead to false positives related to multiple comparisons. However, APA can minimize postural perturbations that are about to occur and influence balance. longer studies and larger cohort are warranted to examine benefits and mechanisms of BBTW rehabilitation outside of office settings.

References: 1. Horn, K.K., et al., Effects of Torso-Weighting on Standing Balance and Falls During the Sensory Organization Test in People with Multiple Sclerosis. Int J MS Care, 2018. 20(2): p. 68-75.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-balanced-based-torso-weighting-on-gait-in-parkinsonism/