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Table 5 The balance-training program

From: Postural control learning dynamics in Parkinson’s disease: early improvement with plateau in stability, and continuous progression in flexibility and mobility

WeekDist. level*Exercises with Balance RobotOverground balance exercises and conventional exercises
Limit of stability (LOS)a
target (size, distance)b
Random controlc
circle (size, speed)d
Postural stabilitye
1–2No Dist.Size: 1–5
distance: 1–3
Size: 1–5
Speed: 1–4
Week 1: –
Week 2: Dist1
Stance on rigid surface with combination of these conditions (from easier to more difficult):
Eyes open/eyes closed
Semi-tandem/tandem/one-leg
With ball in hands
Walking:
In tandem gait with eyes open and closed,
Forward, backward, sideways,
Step around and over obstacles
Combined with sit-to-stand-up
3–4Dist1Size: 1–5
Distance: 1–3
Size: 1–5
Speed: 1–4
Week 3: Dist 1
week 4: Dist 2
Standing on foam with combination of these conditions (from easier to more difficult):
Eyes open/eyes closed
Tandem/one-leg/one-leg and rolling a rod, turning a rod, or writing their name, or rhythmically tap a step of 7.5 cm height with other leg
With ball in hands, throwing ball to different directions, given shoulder pulls by the trainer, rotating head and the trunk, squat
Combined with sit-to-stand-up
Walking:
Combined with sit-to-stand-up
Crossing obstacles, kicking a ball, with ball in hands, throwing ball to different directions, rotating head and the trunk
5–6Dist 2Size: 1–5
Distance: 1–3
Size: 1–5
Speed: 1–4
Week 5: Dist 2
week 6: -
  1. aLOS exercise repetitions in each session: 3–7 rep
  2. bTarget sizes: 1–5 (size 1 is the largest target circle, and size 5 the smallest target circle); Target distances: 1–3 (distance 1 is the nearest distance at 50% of each patient’s maximum forward lean; distance 2 is at 80% of each patient’s maximum forward lean; and distance 3 is at 100% of each patient’s maximum forward lean. Distances were pre-calibrated and set according to each patient’s maximum forward lean at the beginning of each session
  3. cRandom Control exercise repetitions in each session: 2–3 rep
  4. dCircle sizes: 1–5 (size 1 is the largest circle size, and size 5 the smallest circle size); Circle speed: 1–4 (speed 1 is the slowest, and speed 4 is the fastest almost affordable speed)
  5. ePostural Stability exercise repetitions in each session: 2–3 rep. The Postural Stability exercise was performed on the random tilt disturbances of support surface in anterior–posterior direction, either with setting Dist1 or Dist2 as described below
  6. * Two exercises with Balance Robot, i.e., Limit of Stability (LOS) and Random Control were performed on an stationary support surface (‘No Disturbance’) during weeks 1–2, or on the disturbing support surface with two levels of ‘Dist1’, and ‘Dist2’, during weeks 3–6. The disturbances were in the form of random-amplitude and random-speed sequences of tilt motions in the anterior–posterior direction. The amplitude was randomly set in the range of 1° to 7° in Dist1, and 2° to 11° in Dist2. The speed was also randomly selected from the range of 1 deg/s to 10 deg/s in Dist1 and to 15 deg/s in Dist2