scholarly journals Early Postural Instability in Parkinson’s Disease: A Biomechanical Analysis of the Pull Test

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Javier Ricardo Pérez-Sánchez ◽  
Francisco Grandas
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Healthy Subjects ◽  
Postural Instability ◽  
Biomechanical Analysis ◽  
Stage Iii ◽  
Clinical Test ◽  
Pull Force ◽  
Pull Test ◽  
Postural Responses

Postural instability in Parkinson’s disease (PD) is commonly assessed by the pull test. This clinical test may be biased by the variability of the pull force applied. Our objective was to study the postural responses elicited by reproducible pull forces in healthy subjects and PD patients at different stages of the disease. We performed a multimodal approach that included a systematic analysis of the pull force needed to reach the backward limit of stability (FBLoS) assessed by mechanically produced forces, the displacements of the center of pressure (CoP) recorded on a force platform, and the latencies and patterns of activation of the stabilizing muscles. Comparisons between groups were performed by univariate and multivariate statistical analyses. Sixty-four healthy subjects and 32 PD patients, 22 Hoehn–Yahr (H–Y) stages I-II and 10 H–Y stage III, were studied. In healthy subjects, FBLoS decreased with aging and was lower in females. Mean (SD) FBLoS was 98.1 (48.9) Newtons (N) in healthy subjects, 70.5 (39.8) N in PD patients H–Y stages I-II, and 37.7 (18.9) N in PD patients H–Y stage III. Compared to healthy subjects and when adjusted for age and gender, PD patients H–Y stages I-II exhibited the following: (a) a reduced FBLoS; (b) larger CoP displacements and higher velocities for the same applied force; and (c) combined ankle and hip strategies elicited by less intense pull forces. All of these abnormalities were more pronounced in H–Y stage III PD patients compared to H–Y stages I-II PD patients. In conclusion, patients in the early stages of PD already exhibit a degree of postural instability due to inefficient postural adjustments, and they can more easily be destabilized by small perturbations than healthy subjects. This balance impairment becomes more pronounced in more advanced PD. In the pull test, pull force to step back should be a variable to consider when testing balance in clinical practice.

Evaluation of the pull test technique in assessing postural instability in Parkinson's disease

Neurology ◽  
2004 ◽  
Vol 62 (1) ◽  
pp. 125-127 ◽  
Author(s):  
R. P. Munhoz ◽  
J. -Y. Li ◽  
M. Kurtinecz ◽  
P. Piboolnurak ◽  
A. Constantino ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postural Instability ◽  
Test Technique ◽  
Pull Test

scholarly journals Quantitative Analysis of Postural Instability in Patients with Parkinson’s Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yang Yu ◽  
Siquan Liang ◽  
Yue Wang ◽  
Yanan Zhao ◽  
Jiaojiao Zhao ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Stage Iv ◽  
Postural Instability ◽  
Stage Ii ◽  
Stage Iii ◽  
Clinical Trial Registry ◽  
Yahr Stage ◽  
Significant Difference ◽  
Postural Abnormalities

Introduction. Postural instability is commonly observed in Parkinson’s disease, leading to an increasing risk of falling and worsening as the disease progresses. We found that limit of stability can be applied to reflect the dynamic evolution of postural instability in patients with Parkinson's disease. Methods. Forty-three patients (9 of Hoehn and Yahr stage I, 12 of stage II, 14 of stage III, and 8 of stage IV) met the criteria for the diagnosis of idiopathic Parkinson’s disease and could stand independently for at least 10 minutes. Twelve healthy controls with no sign of parkinsonism were also recruited. Postural instability was assessed by posturography in different directions (forward, backward, right, left, forward-right, forward-left, backward-right, and backward-left). This study trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR1900022715). Results. All participants were able to complete the limit of stability tasks without any complications. Patients in stages II to IV exhibited smaller end point excursion and slower time to complete than controls, suggesting an impaired limit of stability. The patients in stage II exhibited a remarkable decline in most directions compared to controls, except for right and left, and forward and backward decline occurred the earliest. For patients in stage III, right was the only direction with no significant difference from controls. In stage IV patients, the limit of stability declined significantly in all directions ( p < 0.05 ). Conclusions. The postural abnormalities of Parkinson’s disease can occur at early stages, and the pattern of decline is more severe in the forward-backward direction. This trial is registered with ChiCTR1900022715.

A Wearable Device to Support the Pull Test for Postural Instability Assessment in Parkinson’s Disease

2018 ◽  
Vol 67 (1) ◽  
pp. 218-228 ◽  
Author(s):  
Bruno Ando ◽  
Salvatore Baglio ◽  
Vincenzo Marletta ◽  
Antonio Pistorio ◽  
Valeria Dibilio ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postural Instability ◽  
Wearable Device ◽  
Pull Test

Rapid assessment of postural instability in Parkinson’s disease (RAPID): a pilot study

2011 ◽  
Vol 18 (2) ◽  
pp. 260-265 ◽  
Author(s):  
R. K. Y. Chong ◽  
J. Morgan ◽  
S. H. Mehta ◽  
I. Pawlikowska ◽  
P. Hall ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pilot Study ◽  
Rapid Assessment ◽  
Postural Instability

THREE DAYS MONITORING OF ACTIVITIES OF DAILY LIVING AMONG YOUNG HEALTHY ADULTS AND PARKINSON’S DISEASE PATIENTS

2021 ◽  
Vol 57 (2) ◽  
pp. 177-183
Author(s):  
Seong Hyun Moon ◽  
◽  
Rahul Soangra ◽  
Christopher F. Frames ◽  
Thurmon E. Lockhart ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Healthy Subjects ◽  
Neurodegenerative Disorder ◽  
Activity Level ◽  
Measurement Unit ◽  
Great Promise ◽  
Butterworth Filters

Parkinson’s Disease (PD) is a neurodegenerative disorder affecting the substantia nigra, which leads to more than half of PD patients are considered to be at high risk of falling. Recently, Inertial Measurement Unit (IMU) sensors have shown great promise in the classification of activities of daily living (ADL) such as walking, standing, sitting, and laying down, considered to be normal movement in daily life. Measuring physical activity level from longitudinal ADL monitoring among PD patients could provide insights into their fall mechanisms. In this study, six PD patients (mean age=74.3±6.5 years) and six young healthy subjects (mean age=19.7±2.7 years) were recruited. All the subjects were asked to wear the single accelerometer, DynaPort MM+ (Motion Monitor+, McRoberts BV, The Hague, Netherlands), with a sampling frequency of 100 Hz located at the L5-S1 spinal area for 3 days. Subjects maintained a log of activities they performed and only removed the sensor while showering or performing other aquatic activities. The resultant acceleration was filtered using high and low pass Butterworth filters to determine dynamic and stationary activities. As a result, it was found that healthy young subjects performed significantly more dynamic activities (13.2%) when compared to PD subjects (7%), in contrast, PD subjects (92.9%) had significantly more stationary activities than young healthy subjects (86.8%).

scholarly journals Postural instability in Parkinson?s disease ? 120 years after Charcot?s death

2014 ◽  
Vol 72 (8) ◽  
pp. 633-635 ◽  
Author(s):  
Hélio Afonso Ghizoni Teive ◽  
Renato Puppi Munhoz
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postural Instability

The authors present the original Charcot’s description of postural instability in Parkinson’s disease as well as the evolution of this sign after 120 years of Charcot’s death.

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