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.

scholarly journals Clinical Profile of Parkinson's Disease: Experience of Niger

2018 ◽  
Vol 09 (02) ◽  
pp. 214-218 ◽  
Author(s):  
Hamid Assadeck ◽  
Moussa Toudou Daouda ◽  
Fatimata Hassane Djibo ◽  
Djibo Douma Maiga ◽  
Eric Adehossi Omar
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Features ◽  
Outpatient Clinic ◽  
Clinical Profile ◽  
Stage Ii ◽  
Stage Iii ◽  
The Mean ◽  
Mean Time

ABSTRACT Background: Parkinson's disease (PD) is a chronic neurodegenerative pathology with unknown etiology. It is characterized clinically by the classic triad that associated tremors, bradykinesia, and rigidity. In Niger, there are no data on PD. Aims: We aimed to provide the demographic and clinical profile of PD in patients from Niger to create a database on PD in Niger. Patients and Methods: We conducted a retrospective study at the Neurology Outpatient Clinic of the Hôpital National de Niamey (HNN, Niger) over a period of 4.42 years from February 2009 to July 2013 collecting all cases of PD. The demographic and clinical features of all patients were collected and analyzed. Results: During the period of the study, 1695 patients consulted at the Neurology Outpatient Clinic of the HNN, among which 76 patients (4.48%) had secondary parkinsonism and 25 patients (1.47%) had features compatible with PD. Only patients with PD were included in this study. The mean age at onset of symptoms was 58 years (range: 42–74 years). The male sex was predominant (60%) with a sex ratio of 1.5. The mean time interval from the onset of symptoms to diagnosis of PD was 1.8 years (range: 1–5 years). The tremor was the most common symptom (84%). Bradykinesia represented 64% of the symptoms and rigidity 20%. At the time of the diagnosis of PD, 8 patients (32%) were in Stage I of the classification of Hoehn and Yahr, 16 patients (64%) in Stage II, and 1 patient (4%) in Stage III. The levodopa/carbidopa combination was the most used antiparkinsonian drug in our patients (88%). The mean time of follow-up of the patients was 2.5 years (range: 1–4.42 years). During the course of the disease, 9 patients (36%) were in Stage II of the classification of Hoehn and Yahr, 13 patients (52%) in Stage III, and 3 patients (12%) in Stage IV. Conclusion: Our study provides demographic and clinical data of PD in patients from Niger and shows that the hospital frequency of this disease is low (1.47%). The demographic and clinical features of our patients are similar to those of the patients of the prior studies reported in sub-Saharan Africa.

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.

scholarly journals Differences in Home Health Nursing Care for Patients with Parkinson’s Disease by Stage of Progress: Patients in Hoehn and Yahr Stages III, IV, and V

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Yumi Iwasa ◽  
Izumi Saito ◽  
Miyoko Suzuki
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Nursing Homes ◽  
Nursing Care ◽  
Clinical Care ◽  
Stage Iv ◽  
Home Health ◽  
Stage Iii ◽  
Home Health Nursing ◽  
Health Nursing

As societal aging progresses globally, the number of people with Parkinson’s disease (PD) is expected to increase worldwide. Accordingly, the need for home health nursing care for homebound patients with PD will continue to expand. We aimed to clarify the clinical care provided by nurses to homebound patients in each Hoehn and Yahr (HY) stage of the disease. We analyzed the visiting nursing records of patients and observed the clinical care provided by nurses in patients’ homes and nursing homes to compare the attributes of patients and differences in nursing care by HY stage. All 21 patients surveyed were at or above HY stage III. The nurses visited each patient nine times per month, on average. The number of visits was positively correlated with HY stage. All stage III patients were homebound, and medication dosage and dispensation assistance were quite common. Several stage IV patients were admitted into nursing homes. In stage V, assistance with hygiene, bedsore management, urine withdrawal/bladder catheters, and other excretory aids were among the most common forms of nursing care provided. As patients’ stages progressed, guidance/educational care meant to encourage self-care decreased and direct physical care increased. Clear differences in nursing care were observed between HY stages, suggesting that stage-based protocols regarding the nature and frequency of nursing visits may be useful for ensuring consistent, effective care of patients with PD.

scholarly journals Patient-Reported and Radiographic Outcomes in Primary and Revision Stage II, III, and IV Adult- Acquired Flatfoot Deformity Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0006
Author(s):  
Rusheel Nayak ◽  
Milap Patel ◽  
Anish R. Kadakia
Keyword(s):  
Patient Reported Outcomes ◽  
Stage Iv ◽  
Stage Ii ◽  
Stage Iii ◽  
Primary Stage ◽  
Radiographic Outcomes ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
Patient Reported ◽  
Adult Acquired Flatfoot Deformity

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult-Acquired Flatfoot Deformity (AAFD) is a progressive hindfoot and midfoot deformity that causes pain and disability. It presents as a plano-valgus deformity from the failure of static and dynamic medial osteoligamentous stabilizers. Stage II presents as a passively correctable, flexible deformity of the foot; stage III presents as a fixed or arthritic deformity of the foot; and stage IV presents with marked deformity of the foot caused by failure of the deltoid ligament and subsequent peritalar instability. Although operative treatment of AAFD is dependent on the stage, there is little data on patient- reported and radiographic outcomes stratified by primary versus revision stage II, III, and IV reconstruction surgery. Methods: Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores were prospectively obtained on 46 consecutive patients who underwent AAFD reconstruction between November 2013 and January 2019 with minimum 12-month follow-up (average 23 months). Twenty patients underwent stage II reconstruction, 5 of which were revision surgeries; 19 patients underwent stage III reconstruction, 8 of which were revision surgeries; and 7 patients underwent stage IV reconstruction, all of which were primary surgeries. Radiographic correction was measured pre- and post-operatively and correlated with PROMIS scores. Measurements included the talonavicular uncoverage angle, talonavicular uncoverage percent, AP talo-first metatarsal angle, Meary’s angle, medial cuneiform height, and medial cuneiform-fifth metatarsal height. Results: For the overall cohort, PROMIS PF increased significantly from 37.6+-5.7 to 42.4+-6.8 (p=0.0014). PROMIS PI improved significantly from 64.7+-6.3 to 54.6+-9.5 (p<0.0001). PROMIS scores were not statistically different between AAFD stages. Change in PROMIS PI was significantly greater in primary (-12.3) versus revision (-3.7) surgery (p=0.0157). Change in PROMIS PF was non- significantly greater in primary (+4.0) versus revision surgery (+2.3). All radiographic measurements improved significantly (p<0.05). In primary stage II AAFD, pre-operative PROMIS PI scores correlated with pre-operative medial cuneiform-fifth metatarsal height (r = -0.606, p = 0.0479). In addition, in primary stage II AAFD, post-operative PROMIS scores correlated with post-operative medial cuneiform height (PROMIS PF: r=0.7725, p=0.0020; PROMIS PI: r=-0.5692, p=0.0446). Conclusion: Patient-reported and radiographic outcomes improve significantly after AAFD reconstruction. There was no significant difference in PROMIS scores between AAFD stages. However, stage III patients had non-significantly lower improvements in PROMIS PF, likely due to loss of function after arthrodesis. Primary operations had better patient-reported outcomes compared to revision operations. In primary stage II AAFD, reconstructing the medial arch correlates significantly with improvement in pain and functionality. This survey of outcomes after primary and revision stage II, III, and IV reconstruction should help clinical decision making by providing data on expected surgical improvement.

scholarly journals The Impact of Parkinson’s Disease on Postural Control in Older People and How Sex can Mediate These Results: A Systematic Review

Geriatrics ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 105
Author(s):  
Mathieu Dallaire ◽  
Guillaume Gagnon ◽  
Émilie Fortin ◽  
Josée Nepton ◽  
Anne-France Severn ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Older People ◽  
Postural Control ◽  
Elderly People ◽  
Postural Instability ◽  
Current Evidence ◽  
Men And Women ◽  
Significant Difference ◽  
The Impact

Introduction: Parkinson’s disease is most prevalent among elderly people, 65 years and over, and leads to an alteration in motor control associated with postural instability. Current evidence shows that postural control decreases with the aging process. In addition, postural control is more altered in healthy aged men than in women. Until today, few studies have evaluated the combined impact of Parkinson’s disease and sex on postural control. This review has allowed to evaluate the impact of Parkinson’s disease and sex on postural control measurements in elderly people. Methodology: Studies have been selected from two main databases: PubMed and EBSCO using the keywords “Parkinson”, “postural control OR balance” and “sex”. Articles related to the evaluation of postural control, including men and women with Parkinson’s aged over 65 years old, regardless of stage, were included (n = 179). Articles were excluded if not written in French or English or not presenting original content. Results: Ten (10) studies out of 179 that fulfilled inclusion and exclusion criteria were reported in the final analysis, which cumulates a total of 944 individuals with Parkinson’s (410 women). In general, results show greater postural instability among people with Parkinson’s compared to healthy subjects, and this according to different objective measurements using stabilographic parameters from force platforms. Only two studies out of ten evaluated postural control while briefly considering distinctions between sex, but without showing a significant difference between men and women with Parkinson’s. Parkinson’s severity, length of time of Parkinson’s disease and cognitive state of the person are the three variables with a negative impact on postural control. Conclusion: Older people with Parkinson’s disease have greater postural instability. Sex does not seem to influence the postural control of elderly people with Parkinson’s, although more studies are necessary.

scholarly journals The Effect of Pramipexole Therapy on Balance Disorder and Fall Risk in Parkinson’s Disease at Early Stage: Clinical and Posturographic Assessment

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sibel Güler ◽  
Levent Sinan Bir ◽  
Beyza Akdag ◽  
Fusun Ardıc
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Drug Therapy ◽  
Fall Risk ◽  
Early Stage ◽  
Postural Instability ◽  
Assessment Tools ◽  
Control Subjects ◽  
Significant Difference ◽  
And Control

The aim of this study was to determine balance problems and severity and ratio of postural instability of newly diagnosed, early stage Parkinson’s patients who did not receive any antiparkinson treatment before, to evaluate fall risk clinically and posturographically and to examine the effects of pramipexole on these signs and symptoms. Detailed posturographic assessments which involved central vestibular, visual, peripheric vestibular somatosensory field tests were applied to both patient and control subjects and fall risk was determined. There was not statistically significant difference between patients and control subjects before and after drug therapy in the assesment of fall risk in posturography and there was not any improvement with drug usage in the patient group. However, in the analysis of subsystems separately, only the involvement in central vestibular field was more severe and could appear at all positions in Parkinson’s patients comparing with the control group, and pramipexole was partially effective in improving this disorder. Central vestibular field is the subsystem that should be examined with first priority. Posturography is relatively reliable in defining fall risk and postural instability ratio in Parkinson’s disease. But it should be considered that clinical assessment tools can be more sensitive in the evaluation of balance and postural disorders and in the follow-up of the response to drug therapy.

scholarly journals The features of KRAS gene transcriptional activity and significance in colorectal cancer

2019 ◽  
Vol 23 (1) ◽  
pp. 153-158
Author(s):  
М. А. Shyshkin ◽  
V. A. Tumanskiy
Keyword(s):  
Mrna Expression ◽  
Transcriptional Activity ◽  
Stage Iv ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Kras Gene ◽  
Ki 67 ◽  
Significant Difference ◽  
Medium Correlation

Colorectal adenocarcinoma (CRA) is the result of numerous mutations accumulation. The aim of the work was to study KRAS gene transcriptional activity at I, II, III, and IV stages of CRA development and to analyze the correlations between KRAS and Ki-67, TP53, CDH1, CTNNB1 genes transcriptional activity. Pathohistological and molecular-genetic study of surgical material from 40 patients with CRA, as well as sectional material of 10 fragments of the distal colonic wall was conducted. The following statistical methods were used: descriptive statistics, χ2 test, Kruskal-Wallis test, Spearman’s rank correlation coefficient. It was established that CRA is characterized by increased KRAS transcriptional activity: Me of mRNA expression is 0.42 (0.36; 0.43) at stage I, 1.31 (1.09; 2.91) at stage II, 1.75 (1.31; 2.93) at stage III, and 2.91 (1.85; 3.50) at stage IV. Decreasing of Ki-67 gene transcriptional activity was revealed: Me of mRNA expression is 3.20 (2.31; 3.59) at stage I, 2.92 (1.80; 3.50) at stage II, 1,27 (1.19; 2.08) at stage III, and 0.52 (0.28; 1.04) at stage IV. As about TP53 gene, increasing of transcriptional activity was detected: Me is 2.15 (0.82; 2.30) at stage I, 2.80 (1.32; 4.50) at stage II, 3.80 (2.32; 6.50) at stage III, 7.80 (5.99; 8.92) at stage IV. Also, a direct medium correlation between the KRAS and TP53 transcriptional activity levels was revealed. There is a decreasing of CDH1 transcriptional activity: Me is 0.88 (0.42; 1.14) at stage I, 0.48 (0.23; 1.13) at stage II, 0.15 (0.09; 0.36) at stage III and 0.08 (0.04; 0.41) at stage IV. A reverse medium correlation between KRAS and CDH1 was revealed. The study of CTNNB1 gene mRNA at different stages of CRA indicated the absence of statistically significant difference: Me is 2.88 (2.38; 5.38) at stage I, 3.83 (2.59; 5.99) at stage II, 2.02 (1.38; 6.95) at stage III, and 2.27 (1.23; 2.93) at stage IV. So, KRAS gene transcriptional activity increases from I to IV stages in CRA, affecting apoptosis and adhesive properties of cancer cells.

scholarly journals Postural instability in Parkinson's patients

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Amir Hassan Habibi ◽  
Sogand Arab ◽  
Farzad Sina ◽  
Saeed Razmeh
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Onset Time ◽  
Postural Instability ◽  
P Value ◽  
Time Interval ◽  
Disease Manifestation ◽  
Gender And Age ◽  
Significant Difference ◽  
The Mean

Postural instability is a major cause of disability in patients with Parkinson’s disease and therefore increases their dependence on other people and decreases the quality of life in these patients. This study aimed to determine the prevalence of Postural instability and its onset in patients with Parkinson’s disease. We evaluated 250 Parkinson’s patients who referred to the movement disorder Clinic during 2016. All patient information, including gender, age, onset time of symptoms, as well as the time interval between symptoms start to postural instability were recorded. A total of 41 patients (16.4%) had a Postural instability, there was no significant difference between the two groups with and without instability in the distribution of sex and mean age. The mean age for the onset of symptoms in men and women was 54±11/3 and 50/6±12.2 respectively Which was significantly lower in women than in men (P value: 0.026). Also, the mean time between the onset of symptoms of Parkinson’s disease and the onset of motor instability was 5.2±4.9. This time was 8.2±4.5 in men and 11.5±5.7 in women which is significantly shorter in men than women (P value: 0.047). In our society, 16.4% of patients with Parkinson’s disease have a motor instability .this outbreak is independent of the variables of gender and age of the patients. According to our study, although women tend to experience signs of Parkinson’s disease earlier than men, the time interval between the onset of the disease manifestation and the onset of postural instability in males was shorter than that of women.

The Role of Bone Marrow Examination in the Initial Evaluation of Pediatric Hodgkin’ Disease: The Canadian Perspective.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2326-2326
Author(s):  
David C. Simpson ◽  
Jun Gao ◽  
Conrad V. Fernandez ◽  
Margaret Yhap ◽  
Victoria E. Price ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Bone Marrow Examination ◽  
Pet Scan ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Significant Difference ◽  
The Impact

Abstract Hodgkin’s Disease (HD) is the most common lymphoma affecting young adults and teenagers. Bone marrow involvement is rare but if present, infers Stage IV disease and an inferior outcome. Adult studies have suggested that bone marrow examination (BME) may not be necessary unless certain risk factors are present. However, some pediatric centers continue to perform BME routinely on all children with HD. BME is invasive and generally performed under conscious sedation in children. We validated and administered an internet-based survey to examine the practice of all Canadian pediatric oncologists regarding BME in children with HD. We also retrospectively evaluated the impact of routine BME on the HD patients treated at our institution over the past 27 years. Forty-three percent of eligible physicians (n=93) completed the survey and 16 of a total of 17 Canadian pediatric oncology centers were represented. BME universally consisted of bilateral bone marrow aspirates and trephine biopsies. Routine BME for Stage III and IV disease was consistently practised nationally (by 92% and 97% of respondents, respectively). By contrast, 54% and 70% of respondents reported performing routine BME in low stage (Stage I and II) disease, respectively. Respondents were more likely to report performing routine BME in low stage patients, if their pediatric hematology/oncology training was entirely outside Canada (p=0.04 for Stage I and p=0.07 for Stage II) and if they practiced at smaller centers (p=0.05 for Stage I and p=0.03 for Stage II). There were no differences in practice regarding BME associated with the number of years in practice or the number of patients seen annually by the respondent. If not part of routine staging for all patients, BME was more likely performed if there were “B” symptoms, cytopenias, and/or bulky disease. Most respondents (95%) would proceed with BME following a positive PET scan. In the review of local institutional practice, 62 patients with HD and BME were eligible for analysis. Only 4 patients (6.5%) had a positive BME. No patient with otherwise low stage disease was found to have bone marrow involvement. Two patients, who would have been assigned as Stage III disease, were upstaged to Stage IV due to their BME. Comparison of staging with and without BME demonstrated no significant difference. Hemoglobin level was found to be the to be the only significant risk factor for marrow involvement based on univariate analysis(put in statisticp=0.006). Age, gender, histologic subtype, presence of “B” symptoms, and other blood parameters (white count, platelets, ESR and transaminases) were not significant factors. Practice regarding BME in children with low stage HD is highly variable across Canada. Bone marrow examination in pediatric patients with low stage HD should be abandoned, unless there is a specific indication to do so (for example positive PET scan or unexplained anemia). Moreover, BME does not appear to add any additional therapeutic direction for higher stage patients.

Sign in / Sign up

Export Citation Format

Share Document