Gait disorders and balance disturbances in Parkinsonʼs disease: clinical update and pathophysiology

Boonstra, Tjitske; Kooij, Herman van der; Munneke, Marten; Bloem, Bastiaan R.

doi:10.1097/wco.0b013e328305bdaf

Cited by 227 publications

(197 citation statements)

References 85 publications

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“…Consistent with previous research, 3,4,7 it confirms that they fall frequently. This program it has shown that attendance at CBC was effective in improving some aspects of dynamic balance in the target population, as measured by the Step Test.…”

Section: Discussionsupporting

confidence: 80%

“…3,4 There are also a range of non-motor features of PD, including autonomic dysfunction, neuropsychiatric disturbance and cognitive impairment, which may further contribute to the risk of falling. 4 Falls and fractures have been well documented to cause significant morbidity 5 and mortality 6 in older people and have been shown to be the most common reason for patients with PD to require admission to hospital. 7 Poor Imbalance is also an independent risk factor for admission to a nursing home for patients with PD.…”

mentioning

confidence: 99%

“…9 Impairments of postural control in people with PD are complex., Possible reasons for this includewith the aetiology proposed to include reduced inter-limb coordination; reduced proprioception somatosensation; asymmetry in gait and balance control; difficulties initiating compensatory movements; and axial stiffness. 4 The most challenging balance tasks for patients are turning, standing with a narrow base of support and standing on one foot. 10 Patients with PD have also been shown to overestimate their limits of stability, an effect which is compounded with worsening disease.…”

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confidence: 99%

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Evaluation of a Circuit Training Program for People with Parkinson’s Disease: A Pilot Study

Lan¹,

Goodwin²,

Bew³

2018

HPMIJ

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Objective: The 3 objectives of this study were to determine if a circuit group exercise program targeting balance was effective and feasible for patients with Parkinson's disease; to determine if any improvements were sustained at 6 months post-intervention and to evaluate patients' quality of life pre-and post-intervention.Design: A pre and post observational clinical study.Subjects: Participants were community-dwelling patients with PD referred outpatient rehabilitation at metropolitan hospital. Methods:The intervention involved a weekly 1-hour circuit training class conducted for 8 weeks. Clinical measures of balance, mobility and quality of life were taken on commencement of the program, on completion of the program and at six months post completion.Results: There were significant improvements in some aspects of balance following completion of the program however these were not sustained at 6-months postintervention. Self-rated health status was generally poor, but program satisfaction was high. Conclusion:For this group of patient circuit balance classes were feasible and safe. Further studies are required to better examine the effects of this treatment approach for people with Parkinson's disease. The 3 objectives were to determine if a groupbased exercise program targeting balance was effective in patients with Parkinson's disease (PD); determine the sustainability of any improvements at 6 months postintervention and evaluate quality of life (QoL) pre-and post-intervention. Participants are community-dwelling patients with PD and balance impairment attending circuit balance classes between 2007 and 2010 (N=19). The intervention involves a weekly 1-hour group-based circuit training exercise class over 8 weeks. The outcome measures were: Timed Up and Go, Functional Reach, Step Test, and EQ-5D Health Questionnaire etc. There was a significant improvement in performance on the Step Test after the intervention. This was not sustained at 6-months post-intervention. Selfrated health status was generally poor, but program satisfaction was high. Circuit balance classes result in a short-term improvement in balance in patients with PD, but do not appear to alter QoL. The exercise intervention may offer additional benefits.

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Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of a Circuit Training Program for People with Parkinson’s Disease: A Pilot Study

Lan¹,

Goodwin²,

Bew³

2018

HPMIJ

View full text Add to dashboard Cite

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“…Postural instability, which increases with duration and severity of the disease including gait disorders, balance impairments with subsequent falls and fall-related injuries affects the quality of life negatively [4,7]. The cardinal features of PD are rest tremor, rigidity and bradykinesia; disease-specific features include stooped posture, slow movements, trunk imbalance with shuffling gait, and expressionless facies [4].…”

Section: Introductionmentioning

confidence: 99%

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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Only a few reports exist concerning biomechanical challenges spine surgeons face when treating Parkinson's disease (PD) patients with spinal deformity. We recognized patients suffering from spinal deformity aggravated by the burden of PD to stress the principles of sagittal balance in surgical treatment. Treatment of sagittal imbalance in PD is difficult due to brittle bone and (the neuromuscular disorder) with postural dysfunction. We performed a retrospective review of 23 PD patients treated surgically for spinal disorders. Mean ASA score was 2.3 (2-3). Outcome analysis included review of medical records focusing on failure characteristics, complications, and radiographic analysis of balance parameters to characterize special risk factors or precautions to be considered in PD patients. The sample included 15 female and 8 male PD patients with mean age of 66.3 years (57-76) at index surgery and 67.9 years (59-76) at follow-up. 10 patients (43.5%) presented with the sequels of failed previous surgery. 18 patients (78.3%) underwent multilevel fusion (C3 level) with 16 patients (69.6%) having fusion to S1, S2 or the Ilium. At a mean follow-up of 14.5 months (1-59) we noted medical complications in 7 patients (30.4%) and surgical complications in 12 patients (52.2%). C7-sagittal center vertical line was 12.2 cm (8-57) preoperatively, 6.9 cm postoperatively, and 7.6 cm at follow-up. Detailed analysis of radiographs, sagittal spinal, and spino-pelvic balance, stressed a positive C7 off-set of 10 cm on average in 25% of patients at follow-up requiring revision surgery in 4 of them. Statistical analysis revealed that patients with a postoperative or follow-up sagittal imbalance (C7-SVL [10 cm) had a significantly increased rate of revision done or scheduled (p = 0.03). Patients with revision surgery as index procedure also were found more likely to suffer postoperative or final sagittal imbalance (C7-SPL, 10 cm; p = 0.008). At all, 33% of patients had any early or late revision performed. Nevertheless, 78% of patients were satisfied or very satisfied with their clinical outcome, while 22% were either not satisfied or uncertain regarding their outcome. The surgical history of PD patients treated for spinal disorders and the reasons necessitating redo surgery for recalcitrant global sagittal imbalance in our sample stressed the mainstays of spinal surgery in Parkinson's: If spinal surgery is indicated, the reconstruction of spinopelvic balance with focus on lumbar lordosis and global sagittal alignment is required.

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“…Postural instability (PI) is known to be a levodopa-resistant characteristic of advanced idiopathic Parkinson's disease (IPD) that worsens with disease progression [1][2][3]. High frequency deep brain stimulation of the globus pallidus internus (GPI-DBS) has been shown to elicit significant anti-parkinsonian effects superior to best medical therapy reducing tremor, bradykinesia and rigidity, and suppressing levodopa-induced dyskinesias [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Interactive effects of GPI stimulation and levodopa on postural control in Parkinson's disease

et al. 2015

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Gait disorders and balance disturbances in Parkinsonʼs disease: clinical update and pathophysiology

Abstract: 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.

Cited by 227 publications

References 85 publications

Evaluation of a Circuit Training Program for People with Parkinson’s Disease: A Pilot Study

Evaluation of a Circuit Training Program for People with Parkinson’s Disease: A Pilot Study

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

Interactive effects of GPI stimulation and levodopa on postural control in Parkinson's disease

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