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Table 1 Parkinson’s disease (PD) specific balance components, constraints affecting balance and exercises designed to reduce these constraints

From: A novel conceptual framework for balance training in Parkinson’s disease-study protocol for a randomised controlled trial

Balance components Constraints in PD Exercise principles Exercise objectives
SENSORY INTEGRATION  
Integration of sensory information (somatosensory, visual and vestibular) for estimation of body position - Impaired somatosensory integration Walking tasks on varying surface with or without visual constraints Improve interpretation of and reliance on somatosensory information
  - Poor proprioception   
  - Visual dependency   
APAs  
Prediction and control of perturbation related to voluntary movements - Poorly timed and scaled APAs Voluntary arm/leg/trunk movements focusing on movement velocity and amplitude, and postural transitions Improve APA strategies regarding quality (timing, amplitude) and task- specific adaptation
  - Bradykinesia   
MOTOR AGILITY  
Coordination between body parts and movement adaptation, e.g. regulation of movement and quick shifts between tasks - Bradykinesia Whole-body coordination during varying gait conditions and reciprocal movements. Quick shifts of movement characteristics (velocity, amplitude and direction) during predictable and unpredictable conditions Improve whole-body coordination, ability to adapt movement and quick shifts between different tasks
  - Impaired whole-body coordination   
  - Biomechanical constraints   
  - Inflexible motor programming   
STABILITY LIMITS  
Whole-body regulation relative to the BoS - Reduced functional stability limits Voluntary leaning tasks in standing with varying BoS-stimulating weight shifts in multiple directions through arm and trunk movements Improve the ability to safely control CoM within BoS to increase functional limits of stability
  - Biomechanical constraints   
  - Poor proprioception   
  - Impaired somatosensory integration   
  1. APAs = anticipatory postural adjustments; BoS = base of support; CoM = centre of mass.