Abstract
Introduction: Falling is one of the primary concerns for people with Parkinson's Disease and occurs predominately during dynamic movements, such as walking. Several methods have been proposed to quantify dynamic balance and to assess fall risk. However, no consensus has been reached concerning which method is most appropriate for examining walking balance during unperturbed and perturbed conditions, particularly in Parkinson's Disease individuals. Therefore, this systematic review aimed to assess the current literature on quantifying dynamic balance in healthy young, elderly and Parkinson's individuals during unperturbed and perturbed walking.Methods: The PubMed database was searched by title and abstract for publications quantifying dynamic balance during unperturbed and mechanically perturbed walking conditions in elderly adults and PD. Inclusion criteria required publications to be published in English, be available in full-text, and implement a dynamic balance quantification method. Exclusion criteria included clinical dynamic balance measures, non-mechanical perturbations, pathologies other than PD, and dual-tasking conditions. The initial database search yielded 280 articles, however, only 81 articles were included after title, abstract and full-text screening. Methodological quality and data were extracted from publications included in the final synthesis.Results: The dynamic balance articles included 26 Coefficient of Variation of Spatiotemporal Variability, 10 Detrended Fluctuation Analysis, 20 Lyapunov Exponent, 7 Maximum Floquet Multipliers, 17 Extrapolated Center of Mass, 11 Harmonic Ratios, 4 Center of Mass-Center of Pressure Separation, 2 Gait Stability Ratio, 1 Entropy, 3 Spatiotemporal Variables, 2 Center of Gravity and Center of Pressure, and 2 Root Mean Square in the final synthesis. Assessment of methodological quality determined that 58 articles had a low methodological rating, a 22 moderate rating, and 1 having a high rating.Conclusion: Careful consideration must be given when selecting a method to quantify dynamic balance because each method defines balance differently, reflects a unique aspect of neuromuscular stability mechanisms, and is dependent on the walking condition (unperturbed vs. perturbed). Therefore, each method provides distinct information into stability impairment in elderly and PD individuals.
Highlights
Falling is one of the primary concerns for people with Parkinson’s Disease and occurs predominately during dynamic movements, such as walking
Parkinson’s Disease (PD) is the second most common neurodegenerative disease in the world, with an increasing incidence within elderly individuals over the age of 60 (De Lau and Breteler, 2006; Hausdorff, 2009). It is well-established that people with Parkinson’s EpidemiologyParkinson’s Disease (PD) are at an increased risk of falling due to gait instability with fall rates are as high as 70% (Hausdorff et al, 1998; Plotnik et al, 2007, 2008; Plotnik and Hausdorff, 2008; Hausdorff, 2009; Kerr et al, 2010; Nantel et al, 2011)
After title and abstract screening, 216 publications were deemed eligible for full-text screening based on their relevance to quantifying dynamic stability during walking
Summary
Falling is one of the primary concerns for people with Parkinson’s Disease and occurs predominately during dynamic movements, such as walking. Parkinson’s Disease (PD) is the second most common neurodegenerative disease in the world, with an increasing incidence within elderly individuals over the age of 60 (De Lau and Breteler, 2006; Hausdorff, 2009) It is well-established that people with PD are at an increased risk of falling due to gait instability with fall rates are as high as 70% (Hausdorff et al, 1998; Plotnik et al, 2007, 2008; Plotnik and Hausdorff, 2008; Hausdorff, 2009; Kerr et al, 2010; Nantel et al, 2011). Previous research demonstrated that PD individuals ambulate with a reduced velocity, shorter stride lengths, increased double support time, reduced cadence and reduced interlimb coordination (Hausdorff et al, 2010)
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