Published: 2020-10-06 08:34 | Updated: 2020-10-06 08:41

New thesis about balance and gait in Parkinson's disease

Hi Hanna Johansson, PhD student at the Division of Physiotherapy, NVS. On October 23 you will defend your thesis “Balance and gait in Parkinson’s disease : from perceptions to performance”. What’s the main focus of the thesis?

Hanna Johansson, PhD student at the Division of Physiotherapy, NVS. Photo: Annika Clemes

In my thesis I have focused on balance and gait impairments in Parkinson’s disease (PD) and explored these from different perspectives. I have also sought to explore the current evidence for exercise-induced neuroplasticity in PD, as well the feasibility of investigating exercise-induced neuroplastic changes among people with PD.

Which are the most important results? 

From my interviews with people who live with PD it became clear how balance was perceived in the context of control and the ability to stay in control in everyday life. Shifting balance was managed by staying focused in challenging situations and by sheer determination not to let impairments keep them from doing things they wanted. Interviewees described using cognitive resources and self-talk as a way to compensate for the loss of automaticity during walking. The role of cognitive status became even more clear in my cross-sectional study where gait was studied both in single and dual-task conditions. Most aspects of gait deteriorated during dual-task walking, and it affected those with cognitive impairment most.

As of today, a majority of studies points to physical exercise potentially being able to induce positive neuroplastic changes in people with PD, but the level of evidence is very low. More high-quality trials of randomized controlled designs (RCT) are needed in order to move this body of research forward. Our proposed design for a large scale RCT investigating neuroplastic changes after ten weeks of highly challenging balance training proved feasible and acceptable to participants, given a few modifications ahead of the definitive trial.

How can this new knowledge contribute to the improvement of people’s health? 

My thesis increases the understanding of how people with PD perceive balance and gait impairments, but how their abilities here may differ with cognitive status. Such knowledge may help guide therapists in the process of motivating participants to training, and in tailoring rehabilitation in accordance with cognitive abilities.

Research on exercise-induced neuroplasticity in PD is still in its infancy, but knowledge gained through my doctoral project has layed the foundation for the development of a large scale RCT - the EXPANd trial. This trial will help move this body of research forward by elucidating if and how balance training affects brain structure and brain function in people with PD.

What´s in the future for you? Will you keep on conducting research? 

In the months after my thesis defense, I will dig deeper into the exiting area of dual task gait in PD. I’m going to analyze how walking in dual task conditions relates to brain structure and function as well as to different cognitive profiles in PD. My intention and hopes for the future after that is to continue with research in the field of neurorehabilitation.