Abstract
BackgroundTripping over obstacles is the major cause of falls in community-dwelling patients with Parkinson's disease (PD). Understanding the factors associated with the obstacle crossing behavior may help to develop possible training programs for crossing performance. This study aimed to identify the relationships and important factors determining obstacle crossing performance in patients with PD.MethodsForty-two idiopathic patients with PD (Hoehn and Yahr stages I to III) participated in this study. Obstacle crossing performance was recorded by the Liberty system, a three-dimensional motion capture device. Maximal isometric strength of the lower extremity was measured by a handheld dynamometer. Dynamic balance and sensory integration ability were assessed using the Balance Master system. Movement velocity (MV), maximal excursion (ME), and directional control (DC) were obtained during the limits of stability test to quantify dynamic balance. The sum of sensory organization test (SOT) scores was used to quantify sensory organization ability.ResultsBoth crossing stride length and stride velocity correlated significantly with lower extremity muscle strength, dynamic balance control (forward and sideward), and sum of SOT scores. From the regression model, forward DC and ankle dorsiflexor strength were identified as two major determinants for crossing performance (R2 = .37 to.41 for the crossing stride length, R2 = .43 to.44 for the crossing stride velocity).ConclusionsLower extremity muscle strength, dynamic balance control and sensory integration ability significantly influence obstacle crossing performance. We suggest an emphasis on muscle strengthening exercises (especially ankle dorsiflexors), balance training (especially forward DC), and sensory integration training to improve obstacle crossing performance in patients with PD.
Highlights
Parkinson’s disease (PD) is a neurological degenerative disease with symptoms of rigidity, tremor, bradykinesia, and impaired balance
Studies have suggested that PD patients adopt different strategies to cross obstacles compared with age-matched elderly individuals, demonstrating shorter step length, larger step width, reduced stride velocity, increased double limb support time, and decreased postural stability [3,4,5]
Yang et al [9] reported that center of mass (COM) displacement control while standing was significantly correlated with both walking speed and stride length in PD patients
Summary
Parkinson’s disease (PD) is a neurological degenerative disease with symptoms of rigidity, tremor, bradykinesia, and impaired balance. These symptoms may lead to decreased activities and falls [1]. It has been reported that over two-thirds of communitydwelling individuals with PD experience falls once per year [2], with tripping over obstacles as the major cause. Understanding the factors associated with obstacle crossing behavior in PD patients may explain their crossing performance and help preventing possible fall risks. Tripping over obstacles is the major cause of falls in community-dwelling patients with Parkinson’s disease (PD). Understanding the factors associated with the obstacle crossing behavior may help to develop possible training programs for crossing performance.
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