Abstract
Introduction Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson's disease (PD). Computerized posturography employing a force platform system provides objective, quantitative assessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. Methods Participants—42 individuals with PD (Hoehn and Yahr stage = 2.33 ± 0.77) and 55 age-matched healthy adults—were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independent t-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann–Whitney U test for PD subtypes. Results The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P=0.013, CI-95% = 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P=0.001, CI-95% = 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1–3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with the Posture Gait Instability subtype demonstrating poorer balance performance than Tremor Dominant subtype. Conclusion These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regarding intrinsic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD.
Highlights
Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson’s disease (PD)
Research Design. is study examines the differences in postural control between individuals with PD and an ageand gender-matched healthy cohort, as measured by standardized tests on the NeuroCom force platform system. e study analyzes between-group comparisons on the limits of stability (LOS) test, motor control test (MCT), and sensory organization test (SOT), and examines if there were differences in test performance within the PD cohort based on disease stage, PD subtype, and age grouping
Individuals with PD had reduced postural stability on the SOT (Comp Eq score), lower equilibrium scores in conditions requiring e ective use of vestibular cues (Vestib ratio), and an increased number of falls during the SOT when compared to healthy controls, re ective of sensory integration de cits a ecting balance control. e SOT di erentiated between PD and healthy controls, as the composite equilibrium score (Comp Eq) score was estimated to be 5.88 higher in healthy individuals than those with PD when controlling for age
Summary
Parkinson’s disease (PD) is a chronic progressive neurological disorder that involves both motor and nonmotor symptoms [1, 2]. e most common motor symptoms of PD include bradykinesia, rigidity, tremor, and postural instability, which result in functional decline and disability [2]. Individuals with PD have reduced reactive postural responses, which can result in insufficient balance strategies in response to perturbations and increased fall risk [13]. When examining patients with PD, it is important to assess the mechanisms of postural instability and underlying balance impairments to identify fall risk and guide physical therapy interventions. Regarding the PD population, limited research supports that FP measures may identify balance impairments, even in early disease stages, and may detect balance decline with disease progression [32,33,34,35]. Is research may help clinicians select examination measures to identify balance deficits across disease stages in persons with PD, which may direct balance interventions to reduce fall risk This study will assist clinicians in determining if these standardized FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. is research may help clinicians select examination measures to identify balance deficits across disease stages in persons with PD, which may direct balance interventions to reduce fall risk
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