Gait Difficulty, Postural Instability, and Muscle Weakness Are Associated with Fear of Falling in People with Parkinson's Disease

The present study aimed to examine the contribution of gait impairment, postural stability and muscle weakness to the level of fear of falling in people with Parkinson's disease (PD). Fifty-seven community-dwelling individuals with PD completed the study. Fear of falling was assessed by the Activities-specific Balance Confidence (ABC) scale. Postural stability and gait difficulty were determined by the posture and gait subscores of the Unified Parkinson's Disease Rating Scale (UPDRS-PG). A Cybex dynamometer was used to measure isokinetic knee muscle strength. Individuals with PD achieved a mean ABC score of73.6±19.3. In the multiple regression analysis, after accounting for basic demographics, fall history and disease severity, the UPDRS-PG score remained independently associated with the ABC score, accounting for 13.4% of the variance (P<0.001). The addition of knee muscle strength significantly improved the prediction model and accounted for an additional 7.3% of the variance in the ABC score (P<0.05). This is the first study to demonstrate that the UPDRS-PG score and knee muscle strength are important and independent determinants of the level of fear of falling in individuals with PD. Improving balance, gait stability and knee muscle strength could be crucial in promoting balance confidence in the appropriately targeted PD population.

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A new postural stability-indicator to predict the level of fear of falling in Parkinson’s disease patients

BioMedical Engineering OnLine ◽

10.1186/s12938-020-00808-w ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Ehsan Pourghayoomi ◽

Saeed Behzadipour ◽

Mehdi Ramezani ◽

Mohammad Taghi Joghataei ◽

Gholam Ali Shahidi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Postural Stability ◽

Fear Of Falling

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Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear

Knee Surgery and Related Research ◽

10.1186/s43019-019-0027-x ◽

2020 ◽

Vol 32 (1) ◽

Cited By ~ 3

Author(s):

Jin Hyuck Lee ◽

Dae-Hee Lee ◽

Jong-Hoon Park ◽

Dong Won Suh ◽

Eunseon Kim ◽

...

Keyword(s):

Muscle Strength ◽

Postural Stability ◽

Lateral Meniscus ◽

Stability Index ◽

Acl Rupture ◽

Meniscus Tear ◽

Significant Difference ◽

Knee Muscle ◽

Dynamic Postural Stability ◽

Knee Muscle Strength

Abstract Background Only limited data are available regarding postural stability between anterior cruciate ligament (ACL)-injured patients with medial meniscus (MM) tear and those with lateral meniscus (LM) tear. The purpose of this study was to compare preoperative postural stability for both involved and uninvolved knees in ACL rupture combined with MM and LM tears. It was hypothesized that there would be a significant difference in postural stability between these two groups. Methods Ninety-three ACL-injured patients (53 combined with MM tears vs. 40 combined with LM tears) were included. Static and dynamic postural stability were evaluated with the overall stability index (OSI), anterior–posterior stability index (APSI), and medial–lateral stability index (MLSI) using stabilometry. Knee muscle strength was evaluated using an isokinetic testing device. Results In the static postural stability test, none of the stability indices showed significant differences between the two groups for both knees (p > 0.05). In the dynamic postural stability test for involved side knees, the OSI and APSI were significantly higher in the LM tear group compared to the MM tear group (OSI: 2.0 ± 0.8 vs. 1.6 ± 0.5, p = 0.001; APSI: 1.5 ± 0.6 vs. 1.3 ± 0.5, p = 0.023), but not the MLSI (p > 0.05). In the static and dynamic postural stability tests in each group, there were no significant differences between the involved and uninvolved side knees (p > 0.05). There was no significant difference in the knee muscle strength between the two groups (p > 0.05). All postural stability showed no significant correlation with knee muscle strength (p > 0.05). Conclusion Dynamic postural stability was poorer in patients with ACL rupture combined with LM tear than in those with MM tear. Therefore, close monitoring for postural stability would be necessary during preoperative and postoperative rehabilitation, especially for patients with ACL rupture combined with LM tear. Level of evidence: Level III

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Core Stability, Knee Muscle Strength, and Anterior Translation Are Correlated with Postural Stability in Anterior Cruciate Ligament-Reconstructed Patients

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000000177 ◽

2015 ◽

Vol 94 (4) ◽

pp. 280-287 ◽

Cited By ~ 8

Author(s):

Ozge Cinar-Medeni ◽

Gul Baltaci ◽

Kezban Bayramlar ◽

Ibrahim Yanmis

Keyword(s):

Anterior Cruciate Ligament ◽

Muscle Strength ◽

Postural Stability ◽

Cruciate Ligament ◽

Core Stability ◽

Anterior Translation ◽

Anterior Cruciate ◽

Knee Muscle ◽

Knee Muscle Strength

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Concurrent and Discriminative Validity of the Mini Balance Evaluation Systems Test (miniBESTest) in People with Parkinson's Disease

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-26-2-43 ◽

2015 ◽

Vol 26 (2) ◽

pp. 43-48

Author(s):

Margaret KY Mak

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Healthy Subjects ◽

Balance Performance ◽

Discriminative Validity ◽

Evaluation Systems ◽

Balance Confidence ◽

Analysis Laboratory ◽

Abc Scale ◽

The University

Abstract Purpose To examine the concurrent and discriminative validity of the miniBESTest in individuals with Parkinson's disease (PD). Method Thirty-four individuals with PD participated in study 1. Thirty-one healthy subjects and 127 individuals with PD completed study 2. All participants were assessed at the University Balance and motion analysis laboratory. Balance performance was assessed using the miniBESTest and Berg's balance scale (BBS). Self-perceived balance confidence level of subjects was measured by the activities-specific balance confidence (ABC) scale. Results In study 1, results of Pearson's correlation showed that the scores of the miniBESTest correlated well with BBS (r=0.765; p<0.001) and moderately well with ABC scores (r=0.587; p<0.001). For study 2, results of one-way analysis of variance demonstrated significant differences in miniBESTest scores among healthy subjects, PD non-fallers (PD-NF) and PD fallers (PD-F). Healthy subjects obtained the highest mini-BESTest score of 88.2 ± 8.9%, followed by PD-NF (73.6 ± 14.7%) and PDF (57.1 ± 17.0%) (all p<0.001). Significant differences were also observed among healthy subjects, PD-NF and PD-F for each miniBESTest domain score (all p<0.05). Conclusion The miniBESTest is a valid method to document balance performance in individuals with PD. Both total and domain miniBESTest scores could differentiate between healthy subjects, PD-NF and PD-F.

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A New Postural Stability-Indicator to Predict the Level of Fear of Falling In Parkinson’s Disease Patients

10.21203/rs.3.rs-32976/v1 ◽

2020 ◽

Author(s):

Ehsan Pourghayoomi ◽

Saeed Behzadipour ◽

Mehdi Ramezani ◽

Mohammad Taghi Joghataei ◽

Gholamali shahidi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Postural Stability ◽

Human Error ◽

Fear Of Falling ◽

Center Of Pressure ◽

Threshold Level ◽

Berg Balance Scale ◽

Self Report ◽

Timed Up And Go

Abstract Background Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. 70% of Parkinson’s disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error. Objectives In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTRi’s; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF related behavior(s). Results FTR 1/2 (the ratio between FTR1 and FTR2) was strongly correlated with the FES-I (r = − 0.63, P < 0.001), Pull Test (r = − 0.65, P < 0.001), Timed Up and Go test (r = − 0.57, P < 0.001), and Berg Balance Scale (r = 0.62, P < 0.001). The model of FTR1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions Using the proposed assessment technique we can accurately predict the intensity of FoF in PD patients. Also, The FTR1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

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A New Postural Stability-Indicator to Predict the Level of Fear of Falling in Parkinson’s Disease Patients

10.21203/rs.3.rs-32976/v2 ◽

2020 ◽

Author(s):

Ehsan Pourghayoomi ◽

Saeed Behzadipour ◽

Mehdi Ramezani ◽

Mohammad Taghi Joghataei ◽

Gholamali Shahidi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Postural Stability ◽

Human Error ◽

Fear Of Falling ◽

Center Of Pressure ◽

Threshold Level ◽

Berg Balance Scale ◽

Self Report ◽

Timed Up And Go

Abstract Background: Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. Seventy percent of Parkinson’s disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error.Objectives: In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods: Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTRi’s; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF related behavior(s). Results: FTR1/2 (the ratio between FTR1 and FTR2) was strongly correlated with the FES-I (r = −0.63, P < 0.001), Pull Test (r = −0.65, P < 0.001), Timed Up and Go test (r = −0.57, P < 0.001), and Berg Balance Scale (r = 0.62, P < 0.001). The model of FTR1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions: Using the proposed assessment technique we can accurately predict the intensity of FoF in PD patients. Also, The FTR1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

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A New Postural Stability-Indicator to Predict the Level of Fear of Falling in Parkinson’s Disease Patients

10.21203/rs.3.rs-32976/v3 ◽

2020 ◽

Author(s):

Ehsan Pourghayoomi ◽

Saeed Behzadipour ◽

Mehdi Ramezani ◽

Mohammad Taghi Joghataei ◽

Gholamali Shahidi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Postural Stability ◽

Human Error ◽

Fear Of Falling ◽

Center Of Pressure ◽

Threshold Level ◽

Berg Balance Scale ◽

Self Report ◽

Timed Up And Go

Abstract Background: Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. Seventy percent of Parkinson’s disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error.Objectives: In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods: Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTRi’s; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF related behavior(s). Results: FTR1/2 (the ratio between FTR1 and FTR2) was strongly correlated with the FES-I (r = −0.63, P < 0.001), Pull Test (r = −0.65, p < 0.001), Timed Up and Go test (r = −0.57, p < 0.001), and Berg Balance Scale (r = 0.62, p < 0.001). The model of FTR1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions: Using the proposed assessment technique we can accurately predict the intensity of FoF in PD patients. Also, The FTR1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

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The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

Physical Medicine and Rehabilitation ◽

10.31532/physmedrehabil.2.1.003 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Sarah Uno ◽

Elizabeth Jusko ◽

Breanna Roderos ◽

Jennifer D. Hastings

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Range Of Motion ◽

Outcome Measures ◽

Tilt Angle ◽

Head Tilt ◽

Balance Confidence ◽

Postural Alignment ◽

Abc Scale ◽

Heel Lift

This study expands upon the Hastings et al (2018) study on the use of heel lifts to change static postural alignment in persons with Parkinson's Disease (PD) and further explores whether the use of heel lifts provide improvements in dynamic gait parameters, Timed Up and Go (TUG) scores, and balance confidence. Outcome measures were taken with and without the heel lifts in place, at two data collection dates. Photographs were analyzed for postural alignment measures using ImageJ software and video was analyzed for gait and turning parameters utilizing the Dite and Temple scale. The Activities-specific Balance Confidence (ABC) scale was collected at baseline and after two weeks of heel lift use, otherwise outcome measures were performed in the reverse order on the first and second session to account for ordering, practice, and fatigue effects. Statistical analysis included paired t-tests for outcome measures and Pearson product correlation between the degree of plantarflexion contracture and ABC scale and overall balance confidence and fall history. We found that head tilt angle and turn time significantly improved (p = .037) (p = .002) with use of heel lifts. Turn time correlated to overall balance confidence (r = -.802, p = .000) and overall balance confidence correlated to fall history (r = -.501, p = .041). This study showed that accommodating a lack of ankle dorsiflexion range of motion with heel lifts significantly improves head tilt angle and decreases turn time as compared to without heel lifts, but has no significant effect on step length, gait speed, or overall TUG score in individuals with PD. Because our work shows that limited range of motion at the ankle contributes to real and perceived balance difficulties healthcare providers working with any population of patients exhibiting balance problems should include this measurement in their assessment and consider intervention with a heel lift when limitations are found.

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