Gait disorders and balance disturbances in Parkinson’s disease. Clinical update and pathophysiology

Department of Neurology, Donders Center for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Current Opinion in Neurology (Impact Factor: 5.31). 09/2008; 21(4):461-71. DOI: 10.1097/WCO.0b013e328305bdaf
Source: PubMed


Gait disorders and balance impairments are one of the most incapacitating symptoms of Parkinson's disease. Here, we discuss the latest findings regarding epidemiology, assessment, pathophysiology and treatment of gait and balance impairments in Parkinson's disease.
Recent studies have confirmed the high rate and high risk of falls of patients with Parkinson's disease. Therefore, it is crucial to detect patients who are at risk of falling and how to prevent falls. Several studies have shown that multiple balance tests improve the prediction of falls in Parkinson's disease. Difficulty turning may be caused by axial rigidity, affected interlimb coordination and asymmetries. Turning difficulties are easily assessed by timed performance and the number of steps during a turn. Impaired sensorimotor integration, inability of switching between sensory modalities and lack of compensatory stepping may all contribute to the high incidence of falls in patients with Parkinson's disease. Similarly, various studies highlighted that pharmacotherapy, neurosurgery and physiotherapy may adversely affect balance and gait in Parkinson's disease.
Insights into the pathophysiology of Parkinson's disease continue to grow. At the same time, it is becoming clear that some patients may in fact deteriorate with treatment. Future research should focus on the development and evaluation of multifactorial fall prevention strategies.

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Available from: Tjitske Boonstra, Mar 25, 2015
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    • "However, the disadvantage is that other gait parameters obviously do not improve comparably; in fact, noneof the other qualitative gait parameters tested in this study was significantly influenced by dopaminergic medication during ST straight walking. This widening gap between faster gait velocity and lack of improvement of variability and postural control associated gait parameters during ST straight walking under dopaminergic On-compared to Off-medication may increase dynamic balance deficits and risk of falling (Boonstra et al., 2008). These findings are in agreement with results described in previous studies. "
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    ABSTRACT: Background: In Parkinson's disease (PD), the effects of dopaminergic medication on straight walking and turning were mainly investigated under single tasking (ST) conditions. However, multitasking situations are considered more daily relevant. Methods: Thirty-nine early-to-moderate PD patients performed the following standardized ST and dual tasks as fast as possible for 1 min during On- and Off-medication while wearing inertial sensors: straight walking and turning, checking boxes, and subtracting serial 7s. Quantitative gait parameters as well as velocity of the secondary tasks were analyzed. Results: The following parameters improved significantly in On-medication during ST: gait velocity during straight walking (p = 0.03); step duration (p = 0.048) and peak velocity (p = 0.04) during turning; velocity of checking boxes during ST (p = 0.04) and DT (p = 0.04). Velocity of checking boxes was the only parameter that also improved during DT. Conclusion: These results suggest that dopaminergic medication does not relevantly influence straight walking and turning in early-to-moderate PD during DT.
    Full-text · Article · Jan 2016 · Frontiers in Aging Neuroscience
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    • "However, no study has performed a direct comparison of both types of vibration therapy. Among the core symptoms of PD, postural instability is probably the most relevant one because reduced mobility and falling increase morbidity, leading to a poor quality of life89101112. Postural instability is particularly challenging and difficult to treat as it does not respond well to dopaminergic therapy. Indeed, dopaminergic medication can increase some elements of postural dyscontrol[13]. "
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    ABSTRACT: Postural instability in Parkinson’s disease (PD) increases the risk of falls and is not improved by pharmacological therapy. Objective. We performed a double-blind, randomized sham-controlled study to test the effects of stochastic resonance (whole body vibration) therapy on postural stability in PD. Methods. Fifty-six PD participants were allocated to either experimental or sham groups. The experimental group received four series of vibration over eight days, with each series consisting of six stimulus trains of 60-second duration using a randomized whole body vibration. Participants allocated to the control group received a sham treatment. Results. Within-group analysis revealed that postural stability in the experimental group improved by 17.5% ( p = 0.005 ) comparing experimental and sham groups. The between-group analysis of change after treatment comparing both groups also showed a significant improvement of postural stability ( p = 0.03 ). Only in the within-group analysis several items were improved after Bonferroni correction, too, rigor 41.6% ( p = 0.001 ), bradykinesia 23.7% ( p = 0.001 ), tremor 30.8% ( p = 0.006 ), and U P D R S I I I sum score 23.9% ( p = 0.000 ), but did not reach the level of significance in the between-group analysis. Conclusions. Stochastic resonance therapy significantly enhanced postural stability even in individuals with increased risk of falling. Thus it offers a potential supplementation to canonical treatments of PD.
    Full-text · Article · Jan 2016 · Parkinson's Disease
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    • "Fall frequency in the past three months was determined retrospectively and patients were assigned one of three fall status categories: (1) no falls or near falls, (2) no falls but at least one near fall, and (3) one fall or more in the last 3 months. A fall was defined as an event resulting in a person coming to rest unintentionally on the ground or other level and not as the result of a major intrinsic event or overwhelming hazard [13, 14]. A near fall was defined as any loss of balance without hitting the floor or other lower surface (fall arrested by seeking support) [15]. "
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    ABSTRACT: This exploratory study aimed to identify which aspects of postural control are able to distinguish between subgroups of patients with Parkinson's disease (PD) and controls. Balance was tested using static and dynamic posturography. Freezers (n = 9), nonfreezers (n = 10), and controls (n = 10) stood on a movable force platform and performed 3 randomly assigned tests: (1) sensory organization test (SOT) to evaluate the effective use of sensory information, (2) motor control test (MCT) to assess automatic postural reactions in response to platform perturbations, and (3) rhythmic weight shift test (RWS) to evaluate the ability to voluntarily move the center of gravity (COG) mediolaterally and anterior-posteriorly (AP). The respective outcome measures were equilibrium and postural strategy scores, response strength and amplitude of weight shift. Patients were in the "on" phase of the medication cycle. In general, freezers performed similarly on SOT and MCT compared to nonfreezers. Freezers showed an intact postural strategy during sensory manipulations and an appropriate response to external perturbations. However, during voluntary weight shifting, freezers showed poorer directional control compared to nonfreezers and controls. This suggests that freezers have adequate automatic postural control and sensory integration abilities in quiet stance, but show specific directional control deficits when weight shifting is voluntary.
    Full-text · Article · Jun 2013 · Parkinson's Disease
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