Efficacy of a single session of anticipatory postural adjustments training to support people with Parkinson’s overcoming freezing of gait: a multi-methods approach

Objective: To assess the efficacy of anticipatory postural adjustments training on the ability to successfully step from freezing of gait, and to evaluate the contribution of attentional processes to potential benefits using an additional attentional-control training intervention. Design: Crossover-design. Subjects/Patients: Nineteen people with Parkinson’s and freezing (females: 10; age:75.5 ± 7.5 years) tested while ON medication. Methods: Participants navigated a cluttered virtual domestic environment with freeze-provoking tasks. Assessments occurred in the laboratory at baseline, post-anticipatory postural adjustments training, and post-attentional-control training, with randomized training order. All training was video-based. Video annotation was used to identify freezing events. Participants’ immediately recollected thoughts they had during the tasks were analysed with content analysis. Perceived safety and effectiveness of the strategies were reported in follow-up calls held 4 weeks post-assessment. Results: Successful step initiations increased from 57% at baseline to 77% post-anticipatory postural adjustments training (p=0.034). Participants rated the interventions as safe and effective, reporting increased balance confidence (70% to 90%), and reduced fear (p=0.01), after the anticipatory postural training. Attentional-control training alone was perceived as less effective compared with more goaldirected anticipatory postural adjustments training. Conclusion: Video-based anticipatory postural adjustments training significantly improved step initiation from freezing when used during challenging tasks and in complex environments. Anticipatory postural adjustments training shows promise as an effective “rescue strategy” that could be learned remotely/at home.