BackgroundClinicians need a practical, objective test of postural control that is sensitive to mild neurological disease, shows experimental and clinical validity, and has good test-retest reliability. We developed an instrumented test of postural sway (ISway) using a body-worn accelerometer to offer an objective and practical measure of postural control.MethodsWe conducted two separate studies with two groups of subjects. Study I: sensitivity and experimental concurrent validity. Thirteen subjects with early, untreated Parkinson’s disease (PD) and 12 age-matched control subjects (CTR) were tested in the laboratory, to compare sway from force-plate COP and inertial sensors. Study II: test-retest reliability and clinical concurrent validity. A different set of 17 early-to-moderate, treated PD (tested ON medication), and 17 age-matched CTR subjects were tested in the clinic to compare clinical balance tests with sway from inertial sensors. For reliability, the sensor was removed, subjects rested for 30 min, and the protocol was repeated. Thirteen sway measures (7 time-domain, 5 frequency-domain measures, and JERK) were computed from the 2D time series acceleration (ACC) data to determine the best metrics for a clinical balance test.ResultsBoth center of pressure (COP) and ACC measures differentiated sway between CTR and untreated PD. JERK and time-domain measures showed the best test-retest reliability (JERK ICC was 0.86 in PD and 0.87 in CTR; time-domain measures ICC ranged from 0.55 to 0.84 in PD and from 0.60 to 0.89 in CTR). JERK, all but one time-domain measure, and one frequency measure were significantly correlated with the clinical postural stability score (r ranged from 0.50 to 0.63, 0.01 < p < 0.05).ConclusionsBased on these results, we recommend a subset of the most sensitive, reliable, and valid ISway measures to characterize posture control in PD: 1) JERK, 2) RMS amplitude and mean velocity from the time-domain measures, and 3) centroidal frequency as the best frequency measure, as valid and reliable measures of balance control from ISway.

Timed Up and Go (TUG) test is a widely used clinical paradigm to evaluate balance and mobility. Although TUG includes several complex subcomponents, namely: sit-to-stand, gait, 180° turn and turn-to-sit; the only outcome is the total time to perform the task. We have proposed an instrumented TUG, called iTUG, using portable inertial sensors to improve TUG in several ways: automatic detection and separation of subcomponents, detailed analysis of each one of them and a higher sensitivity than TUG. Twelve subjects in early stages of Parkinson's Disease (PD) and twelve age matched control subjects were enrolled. Stop-watch measurements did not show a significant difference between the two groups. The iTUG, however, showed a significant difference in cadence between early PD and control subjects (111.1±6.2 vs. 120.4±7.6 step/min, p < 0.006) as well as in angular velocity of arm-swing (123±32.0 vs. 174.0 ± 50.4 °/sec, p < 0.005), turning duration (2.18 ± 0.43 vs. 1.79 ± 0.27 seconds, p < 0.023) and time to perform turn-to-sits (2.96 ± 0.68 vs. 2.40 ± 0.33 seconds, p < 0.023). By repeating the tests for a second time, the testretest reliability of iTUG was also evaluated. Among the subcomponents of iTUG, gait, turning and turn-to-sit were the most reliable and sit-to-stand was the least reliable.

The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson’s Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesize that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 meters (traditional TUG) to 7 meters. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect abnormalities in early-to-mid stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the UPDRS Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.

Background The effects of levodopa on balance and gait function in people with Parkinson’s disease (PD) is controversial. This study compared the relative responsiveness to levodopa on six domains of balance and gait: postural sway in stance, gait pace, dynamic stability, gait initiation, arm swing, and turning in people with mild and severe PD, with and without dyskinesia. Methods We studied 104 subjects with idiopathic PD (Hohen & Yahr II (n=52) and III-IV (n=52)) and 64 age-matched controls. Subjects performed a mobility task in the practical OFF state and ON levodopa: standing quietly for 30 seconds, initiating gait, walking 7 meters, and turning 180 degrees. Thirty-four measures of mobility were computed from inertial sensors. Standardized response means were used to determine the relative responsiveness to levodopa. Results The largest improvements with levodopa were found for arm swing and pace-related gait measures. Gait dynamic stability was unaffected by PD and not responsive to levodopa. Levodopa reduced turning duration, but only in subjects with severe PD. In contrast to gait, postural sway in quiet standing increased with levodopa, especially in the more severely affected subjects. The increase in postural sway, as well as decrease in turning duration and exaggerated arm swing with levodopa was observed only for subjects with dyskinesia at the time of testing. Conclusions The observed spectrum of levodopa responsiveness in balance and gait measures suggests multiple neural circuits control balance and gait. Many of the negative effects of levodopa may be directly or indirectly caused by dyskinesia.

While several studies have shown that subjects with advanced Parkinson's disease (PD) exhibit abnormalities in sway parameters during quiet standing, abnormalities of postural sway associated with untreated PD have not been reported. Although not clinically apparent, we hypothesized that spontaneous sway in quiet stance is abnormal in people with untreated PD. We examined 13 subjects, recently diagnosed with PD, who were not yet taking any anti-parkinsonian medications and 12 healthy, age-matched control subjects. Postural sway was measured with a linear accelerometer on the posterior trunk (L5 level) and compared with traditional forceplate measures of sway. Subjects stood for two minutes under two conditions: eyes open (EO) and eyes closed (EC). One of the most discriminative measures of postural changes in subjects with untreated PD was the increased ‘JERK’ of lower trunk in the EO condition, measured with the accelerometer. Root mean square and the frequency dispersion of postural sway in the EO condition also discriminated sway in untreated PD subjects compared to controls subjects. We conclude that accelerometer-based sway metrics could be used as objective measures of postural instability in untreated PD. Accelerometer-based analysis of spontaneous sway may provide a powerful tool for early clinical trials and for monitoring the effects of treatment of balance disorders in subjects with PD.