The Impact of Dual-Tasking on Postural Stability in People With Parkinson’s Disease With and Without Freezing of Gait

Abstract

Background. Postural instability and freezing of gait (FOG) are major problems in patients with Parkinson’s disease (PD), and both contribute to falls. However, the interrelationship between these 2 deficits is still unclear. Objective. This study investigated whether dual-tasking influenced postural control differently in freezers (FOG+) and nonfreezers (FOG−). Methods. Thirty-three patients with PD (19 FOG+, 14 FOG−, well-matched) and 28 healthy controls underwent 4 postural control tasks, consisting of standing on either stable or unstable surfaces with eyes open or closed. Each condition was performed with and without a cognitive dual-task (DT). Center of pressure and center of mass variables and cognitive DT performance outcomes were investigated. Results. Postural stability decreased to a larger extent in FOG+ under DT conditions compared with the other groups, although overall most differences were found between FOG+ and controls. FOG+ exhibited worse postural control compared with FOG− under stable surface DT conditions, shown by higher medial-lateral sway measures (group × surface × task, P < .05). Also, postural DT cost (%) was higher in FOG+ than in FOG− in unstable surface conditions without vision. Controls performed better on the cognitive DT when balancing compared with sitting, whereas this improvement was absent in both PD subgroups and more so in FOG+. Conclusions. Postural stability in FOG+ deteriorated more than in FOG− and controls upon cognitive load. Our results extend earlier findings on gait that the compensatory mechanisms to cope with DT stance are insufficient in FOG+. The findings highlight the need for adapted rehabilitation programs for this subgroup, comprising motor-cognitive balance training.