The effects of vibrotactile biofeedback training on trunk sway in Parkinson's disease patients.

BACKGROUND: Postural instability in Parkinson's disease (PD) can lead to falls, injuries and reduced quality of life. We investigated whether balance in PD can improve by offering patients feedback about their own trunk sway as a supplement to natural sensory inputs. Specifically, we investigated the effect of artificial vibrotactile biofeedback on trunk sway in PD. METHODS: Twenty PD patients were assigned to a control group (n = 10) or biofeedback group (n = 10). First, all patients performed two sets of six gait tasks and six stance tasks (pre-training assessment). Subsequently, all subjects trained six selected tasks five times (balance training). During this training, the feedback group received vibrotactile feedback of trunk sway, via vibrations delivered at the head. After training, both groups repeated all twelve tasks (post-training assessment). During all tasks, trunk pitch and roll movements were measured with angular velocity sensors attached to the lower trunk. Outcomes included sway angle and sway angular velocity in the roll and pitch plane, and task duration. RESULTS: Overall, patients in the feedback group had a significantly greater reduction in roll (P = 0.005) and pitch (P < 0.001) sway angular velocity. Moreover, roll sway angle increased more in controls after training, suggesting better training effects in the feedback group (P < 0.001). CONCLUSIONS: One session of balance training in PD using a biofeedback system showed beneficial effects on trunk stability. Additional research should examine if these effects increase further after more intensive training, how long these persist after training has stopped, and if the observed effects carry over to non-trained tasks.

Balance problems with Parkinson's disease: are they anxiety-dependent?

Non-motor symptoms, such as fear of falling and anxiety, are frequently reported in Parkinson's disease (PD). Recent evidence of anxiety and fear directly influencing balance control in healthy young and older adults, raises the question whether fear of falling and anxiety also directly contribute to the balance deficits observed in PD. The goal of the current study was to examine whether PD patients and controls responded similarly or differently to experimentally induced increases in anxiety. For this purpose, 14 PD patients (tested during a subjective optimal ON state) and 16 healthy age-matched control subjects stood in three conditions of different levels of postural threat: normal threat (quiet standing at ground level); medium threat (standing at the edge of a surface elevated to 80 cm); and high threat (same, but to 160 cm). Outcome measures included mean position, mean power of frequency (MPF) and root mean square (RMS) of centre of pressure (COP) displacements in the anterior-posterior (AP) and medial-lateral (ML) directions. Physiological and psychosocial measures of fear and anxiety were also recorded. Increased threat changed postural control similarly in PD patients and controls; MPF of AP and ML COP increased and the mean COP position was shifted backward in both groups. These results indicate that during the ON state, static balance in PD patients and controls is equally susceptible to the influence of anxiety. Significant correlations observed between COP changes and measures of fear and anxiety provide evidence to support the proposed neural links between structures controlling emotion and postural control. Future studies should further address this issue by including more severely affected patients, by testing the influence of dopaminergic medication, by including more anxious patients, and by using dynamic measures of balance.

Genetic evaluation of fertility traits of dairy cattle using a multiple-trait animal model.

A genetic evaluation system was developed for 5 fertility traits of dairy cattle: interval from first to successful insemination and nonreturn rate to 56 d of heifers, and interval from calving to first insemination, nonreturn rate to 56 d, and interval first to successful insemination of cows. Using the 2 interval traits of cows as components, breeding values for days open were derived. A multiple-trait animal model was applied to evaluate these fertility traits. Fertility traits of later lactations of cows were treated as repeated measurements. Genetic parameters were estimated by REML. Mixed model equations of the genetic evaluation model were solved with preconditioned conjugate gradients or the Gauss-Seidel algorithm and iteration on data techniques. Reliabilities of estimated breeding values were approximated with a multi-trait effective daughter contribution method. Daughter yield deviations and associated effective daughter contributions were calculated with a multiple trait approach. The genetic evaluation software was applied to the insemination data of dairy cattle breeds in Germany, Austria, and Luxembourg, and it was validated with various statistical methods. Genetic trends were validated. Small heritability estimates were obtained for all the fertility traits, ranging from 1% for nonreturn rate of heifers to 4% for interval calving to first insemination. Genetic and environmental correlations were low to moderate among the traits. Notably, unfavorable genetic trends were obtained in all the fertility traits. Moderate to high correlations were found between daughter yield-deviations and estimated breeding values (EBV) for Holstein bulls. Because of much lower heritabilities of the fertility traits, the correlations of daughter yield deviations with EBV were significantly lower than those from production traits and lower than the correlations from type traits and longevity. Fertility EBV were correlated unfavorably with EBV of milk production traits but favorably with udder health and longevity. Integrating fertility traits into a total merit selection index can halt or reverse the decline of fertility and improve the longevity of dairy cattle.