1. JOSÉ EDUARDO POMPEU - Physical Therapist - Phd Student: Neuroscience and Behavior - São Paulo University (Brazil) - Professor: Paulista and São Camilo Universities

2. Introduction  Parkinson's disease (PD):  second more frequent degenerative disease of nervous system that causes:  Rest tremor  Bradykinesia  Rigidity  POSTURAL INSTABILITY (PI) (Albin, Young et al., 1995; Mcauley, 2003;)

3. Introduction  Postural instability is the most refractory symptoms  Falls: PD x Elderly FALLS FRACTURE FEAR IMMOBILISM (Pickering, Grimbergen et al., 2007; Hely, Reid et al., 2008)

4. Introduction  Patients with PD:  use cortically mediated strategies to compensate the impaired automatic balance control.  increase the body sway in dual task conditions (DT). (O'shea, Morris et al., 2002; Rochester, Hetherington et al., 2004; Rochester, Nieuwboer et al., 2008; Yu e Mak, 2008; Speciali, Oliveira et al., 2009 )

5. Introduction ↓ FALLS RISK BALANCE DISORDERS (PD) NEW TREATMENT STRATEGIES

6. Introduction  What is the best strategy to improve the balance of patients with PD? 1. Training in single task with attention focused on balance? 2. Training in multi task cognitive motor condition?

7. Introduction  Thus, a training program was devised to improve balance in PD patients in which automatic balance responses were stimulated under conditions of high cognitive demand.

8. Purpose  To compare the effectiveness of motor and cognitive training versus motor training alone for improving balance and functional performance in PD patients.

9. Method  Randomized Clinical Trial  Approved by a local ethical committee  Local:  Brasil Parkinson Association  São Paulo University

10. Method Inclusion CriteriaExclusion Criteria  Idiopathic PD diagnosed by a neurologist  GDS-15 < 6 (Almeida e Almeida, 1999)  MEMS > 23  I – II stages – H & Y  Aged between 65 – 85 years old  Both genders  Didn’t agree with consent term  Associated neurological and orthopedic diseases  Clinics Fluctuations

11. n=20 CG (n=10) Before training assessment 14 sessions - 30’ Global exercises - 30’ Motor Training After training assessmentFollow up - 60 days EG (n=10) Before training assessment 14 sessions - 30’ Global exercises - 30’ Cognitive Motor Training After training assessmentFollow up - 60 days

12. Method  Balance Assessment  Balance Berg Scale (BBS)  Dynamic Gait Index (DGI)  Postural Stress Test (PST)  Unipedal Stance Test (UST) Statistical Analysis: ANOVA/Pos hoc test Tukey (p<0,05)

13. Results Assessment and Group Effects (ANOVA; p<0,05)  BBS  DGI  UST

14. CONCLUSION  MCT was found to be superior to MT for:  improving compensatory and anticipatory balance responses in PD patients  led to improved balance during gait  greater confidence with regard to susceptibility to falls.

15. Implication  Postural stability in PD patients can be improved by stimulating automatic balance control through training which combines both motor and cognitive tasks.

16. Thank you! José Eduardo Pompeu j.e.pompeu@usp.br +55 11 9298-7750