Postural Control in Individuals with Parkinson’s Disease

Abstract

Parkinson's disease is the second most common neurodegenerative disorder in the elderly population. It is a complex, progressive, multisystem disease associated with motor and nonmotor impairments. Postural instability is a crucial component of functional mobility, often overlooked by both clinicians and patients with Parkinson's disease. It is a refractory drug complication for which rehabilitation is the most effective nonpharmacological aid. However, many interventions are based on empirical experience. Improving knowledge on the pathophysiology of postural control disorders is crucial to understand the multifaceted components affected and thus design specific rehabilitation protocols. This chapter intends to offer a comprehensive overview of the current knowledge on this topic starting from the pathophysiology of postural control disorders occurring in various ecological conditions to the most innovative multidisciplinary rehabilitation approaches.

Adaptation strategies and neurophysiological response in early-stage Parkinson's disease: BioVRSea approach

“…PD patients have less coordination of agonist and antagonist muscles, making it challenging to maintaining stability. They also frequently suffer from limb and axial rigidity that may reduce mobility (Gandolfi et al, 2018 ). All of those linked to a reduced mobility confidence may account for the reduced sway.…”

Effect of Parkinson’s Disease on Cardio-postural Coupling During Orthostatic Challenge

“…Muscle strength deficits and impaired cardiac baroreflex control are responsible for postural instability and contribute to falls in Parkinson’s disease ( De Pablo-Fernandez et al, 2017 ; Gandolfi et al, 2018 ; Chen et al, 2020 ). As a result, a thorough understanding of alterations in cardiac baroreflex and cardio-postural coupling might help comprehend the physiology of blood pressure regulation in Parkinson’s disease.…”

“…This decline in the interaction between SBP and in terms of significant time active may result in a limited effect of the muscle pump on blood pressure in Parkinson’s patients. The reduced active time may also reflect muscle imbalance and muscle relaxation deficits in Parkinson’s disease, caused by impaired voluntary motoneuron derecruitment control ( Grasso et al, 1996 ; Kato and Kanosue 2015 ; Gandolfi et al, 2018 ; Kato et al, 2019 ). A shorter significant time of interaction with blood pressure could be caused by dyssynchronous leg muscles contractions.…”

“…Such deficit, if not compensated via other regulatory mechanisms, could lead to dizziness resulting in an unexpected fall. Muscle weakness is prominent in Parkinson’s disease patients ( Inkster et al, 2003 ; Gandolfi et al, 2018 ), which could lead to reduced venous return, resulting in decreased cardiac output and blood pressure in Parkinson’s patients during standing ( Table 3 ).…”

Transcranial direct current stimulation for balance rehabilitation in neurological disorders: A systematic review and meta-analysis

“…Neural impairments related to such diseases impair the sensory-motor system and neuromuscular control, leading to deficits in mechanical and muscular coordination during postural/balance tasks (Horak et al, 1997(Horak et al, , 1992. Since adequate postural control is important to maintain balance during activities of daily living (Gandolfi et al, 2018), neurological-related impairments on postural control interfere with functional independence and quality of life, and increase the risk of falls (Nonnekes et al, 2018;Stolze et al, 2004). It is, therefore, reasonable that one major concern in the field refers to the development of enhanced J o u r n a l P r e -p r o o f 3 therapies to minimize postural impairments in neurological populations (Nonnekes et al, 2018).…”