Balance in Parkinson's disease patients changing the visual input

Neurologia i Neurochirurgia Polska, 2011

Background and purpose: The aim of the study was to evaluate the influence of visual control on parameters of postural stability among patients with Parkinson disease (PD) in comparison with control subjects. Material and methods: Fifty patients diagnosed with idiopathic PD and 50 control subjects without features of central nervous system injury were selected for the study. The clinical diagnosis of idiopathic PD was established according to the clinical criteria of the United Kingdom Parkinson's Disease Society Brain Bank. Only patients in stages I-III according to the Hoehn-Yahr scale were included. The range of sway of the centre of foot pressure (COP) in the frontal plane (COPx) and in the sagittal plane (COPy), as well as the total path length in both axes (COPxy), was tested during quiet standing with and without visual control. Results: COPxy with and without visual control was the smallest in the group of patients in stage II in comparison with patients in stage I and III according to Hoehn-Yahr and in comparison with the control group. Conclusions: Visual control significantly affects the parameters of postural stability in PD patients.

Physiotherapy, 2016

Objectives Postural instability is one of the most disabling features in Parkinson's disease (PD), and often leads to falls that reduce mobility and functional capacity. The objectives of this study were to analyse the limit of stability (LOS) and influence of the manipulation of visual, somatosensorial and visual-vestibular information on postural control in patients with PD and healthy subjects. Design Cross-sectional. Setting Movement Disorders Unit, university setting. Participants Eighty-two subjects aged between 37 and 83 years: 41 with Parkinson's disease in the 'on' state and 41 healthy subjects with no neurological disorders. Both groups were matched in terms of sex and age. Main outcome measures Unified Parkinson's Disease Rating Scale (UPDRS)-motor score, modified Hoehn and Yahr staging, Dynamic Gait Index (DGI) and posturography with integrated virtual reality. The parameters analysed by posturography were LOS area, area of body centre of pressure excursion and balance functional reserve in the standing position in 10 conditions (open and closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual-vestibular interaction). Results The mean UPDRS motor score and DGI score were 27 [standard deviation (SD) 14] and 21 (SD 3), respectively. Thirteen participants scored between 0 and 19 points, indicating major risk of falls. Posturographic assessment showed that patients with PD had significantly lower LOS area and balance functional reserve values, and greater body sway area in all posturographic conditions compared with healthy subjects.

Motricidade, 2015

Postural sway variability was evaluated in Parkinson's disease (PD) patients at different stages of disease. Twenty PD patients were grouped into two groups (unilateral, 14; bilateral, 6) according to disease severity. The results showed no significant differences in postural sway variability between the groups (p ≥ 0.05). Postural sway variability was higher in the antero-posterior direction and with the eyes closed. Significant differences between the unilateral and bilateral groups were observed in clinical tests (UP-DRS, Berg Balance Scale, and retropulsion test; p ≤ 0.05, all). Postural sway variability was unaffected by disease severity, indicating that neurological mechanisms for postural control still function at advanced stages of disease. Postural sway instability appears to occur in the antero-posterior direction to compensate for the stooped posture. The eyes-closed condition during upright stance appears to be challenging for PD patients because of the associated sensory integration deficit. Finally, objective measures such as postural sway variability may be more reliable than clinical tests to evaluate changes in balance control in PD patients.

2018

The aim of this examination was to assess the postural adjust in individuals with Parkinson’s disease by using clinical and instrumental techniques and specify the most direction in the balance instability in the Parkinson’s patient. Methods: Twenty male patients, ages ranged from 55 to 75 years, stage ΙΙ & ΙΙΙ according to modified Hoehn and Yahr (1997) classification of disabilities and ten male healthy elderly subjects, ages ranged from 55 to 75 years, participated in this study. All subjects were recruited for postural balance assessment and done by using; Berg Balance Scale (BBS) &Timed Up and Go test (TUG) as clinical tools in measuring the postural balance as well as the instrumental assessment by using the Biodex Stability System (BSS) to determine the correlation between those methods. The results showed significant differences in detecting balance instability by using BBS and BSS, while there was no significant difference between both groups by using TUG test. BSS determin...

The evaluation of impairment degree in Parkinson's disease (PD) patients is normally based on symptomatic evaluation scales, such as UPDRS, which are only qualitative and lack quantitative precision. However, it is very difficult to prepare a proper scale for PD patients always suitable and quickly executable in relation to the variety of symptom of this disease. Many scales are applied only to single settings, for example to daily activities or to motor or psychic impairments related to PD. The symptoms shown by the PD patient are different depending on static or dynamic situations. Investigation of corrective responses to small and short perturbations of upright standing, such as force pulses applied to the sternum, might contribute to unveil the mechanisms underlying the neural control of posture. The contributions of the motor components can be divided into 3 classes: (1) muscular, (2) reflex and anticipatory. Manoeuvres based on pushing force pulses applied to the sternum are often used clinically: in fact, they are part of a popular test of functionality of postural control (Tinetti's performance test). One of the long-term goals of our researche is to understand the spinal and supraspinal mechanisms that mediate the control of standing posture, and how they change under pathological conditions (spasticity, Parkinsonian rigidity, ageing, etc), by the use of electromyographic and posturographic responses. In the context of the present paper, we investigated the interaction among the various compensatory mechanisms activated in response to perturbations of standing posture (expected or unexpected, with and without vision): central, reflex and intrinsic (i.e., due to muscle mechanical properties) based on posturographic and electromyographic data.

Parkinson's Disease, 2015

Balance dysfunction (BD) in Parkinson's disease (PD) is a disabling symptom, difficult to treat and predisposing to falls. The dopaminergic drugs or deep brain stimulation does not always provide significant improvements of BD and rehabilitative approaches have also failed to restore this condition. In this study, we investigated the suitability of quantitative posturographic indicators to early identify patients that could develop disabling BD. Parkinsonian patients not complaining of a subjective BD and controls were tested using a posturographic platform (PP) with open eyes (OE) and performing a simple cognitive task [counting (OEC)]. We found that patients show higher values of total standard deviation (SD) of body sway and along the medio-lateral (ML) axis during OE condition. Furthermore, total and ML SD of body sway during OE condition and total SD of body sway with OEC were higher than controls also in a subgroup of patients with normal Berg Balance Scale. We conclude that BD in Parkinsonian patients can be discovered before its appearance using a PP and that these data may allow developing specific rehabilitative treatment to prevent or delay their onset.

Global Journal of Health Science, 2011

BioMed research international, 2015

Stability and mobility in functional motor activities depend on a precise regulation of phasic and tonic muscular activity that is carried out automatically, without conscious awareness. The sensorimotor control of posture involves a complex integration of multisensory inputs that results in a final motor adjustment process. All or some of the components of this system may be dysfunctional in Parkinsonian patients, rendering postural instability one of the most disabling features of Parkinson's disease (PD). Balance control is critical for moving safely in and adapting to the environment. PD induces a multilevel impairment of this function, therefore worsening the patients' physical and psychosocial disability. In this review, we describe the complex ways in which PD impairs posture and balance, collecting and reviewing the available experimental evidence.

Experimental Brain Research, 2007

Postural instability is one of the most disabling features of idiopathic Parkinson's disease (PD). In this study, we focused on postural instability as the main factor predisposing parkinsonians to falls. For this purpose, changes in sway characteristics during quiet stance due to visual feedback exclusion were studied. We searched for postural sway measures that could be potential discriminators for an increased fall risk. A group of 110 subjects: 55 parkinsonians (Hoehn and Yahr: 1-3), and 55 age-matched healthy volunteers participated in the experiment. Their spontaneous sway characteristics while standing quiet with eyes open and eyes closed were analyzed. We found that an increased mediolateral sway and sway area while standing with eyes closed are characteristic of parkinsonian postural instability and may serve to quantify well a tendency to fall. These sway indices signiWcantly correlated with disease severity rated both by the Hoehn and Yahr scale as well as by the Motor Section of the UPDRS. A forward shift of a mean COP position in parkinsonians which reXects their Xexed posture was also signiWcantly greater to compare with the elderly subjects and exhibited a high sensitivity to visual conditions. Both groups of postural sway abnormalities identiWed here may be used as accessible and reliable measures which allow for quantitative assessment of postural instability in Parkinson's disease.

International Journal of Rehabilitation Research, 2004

Physical therapy can improve performance of balance tests in patients with Parkinson's disease. Parkinson's disease is a chronic progressive neurological disturbance with significant effect on movements, cognitive functions, autonomous systems and psychosocial activities. The effects of physical therapy are rarely reported and not sufficiently studied. This prospective study comprised 40 persons with stage III Parkinson's disease, according to Hoehn and Yahr (1967) aged over 50 years and 20 healthy controls of the same age. Patients were medically stable and had no other neurological deficits, postural hypotensia, visual disturbances or musculo-skeletal deficits. Balance tests before and after physical therapy were analysed according to Smithson et al., 1998. Balance tests in patients with Parkinson's disease resulted in significant differences of values for tandem stance, one leg stance, step test and external perturbation when compared to the controls, and between groups with and without falling tendency. Tandem stance, one leg stance, step test and external perturbation can be used for differentiation between groups with and without a tendency to fall. Physical therapy resulted in significant improvement of these tests in both the groups analysed. Systematic application of physical therapy, as part of team treatment, improves the balance of patients with Parkinson's disease.