A posturographic procedure assessing balance disorders in Parkinson's disease: a systematic review

Abstract

Postural instability is common in Parkinson’s disease (PD), often contributing to falls, injuries, and reduced mobility. In the clinical setting, balance disorder is commonly diagnosed using clinical tests and balance scales, but it is suggested that the most sensitive measurement is the force platform. The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD. A systematic review was conducted of papers published from 2000 to 2017. Databases searched were PubMed and EBSCO. Studies must have involved patients with PD, used force platform or motion analysis system as a measurement tool, and described posturographic procedure. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. A total of 32 studies met the inclusion criteria. The PEDro scores ranged from 5 to 7 points. The analysis of the objective methods assessing balance disorders revealed a large discrepancy in the duration and procedures of measurements. The number of repetitions of each trial fluctuated between 1 and 8, and the duration of a single trial ranged from 10 to 60 seconds. Overall, there are many scales and tests used to assess the balance disorders and disabilities of people with PD. Although in many included studies the authors have used posturography as a method to evaluate the postural instability of PD patients, the results are contradictory. To solve this issue, it is indicated to establish a “gold standard” of procedures of measures of balance.

Quantitative assessment of postural instability in spinocerebellar ataxia type 3 patients

“…The postural parameters in static stability were correlated to SARA subscores of stance, and the postural parameters in dynamic stability were correlated to SARA subscores of gait. Posturographic platforms have been useful in providing objective evaluation of postural stability deficits in neurodegenerative diseases such as Parkinson's disease 15,17,23,[33][34][35] and Multiple Sclerosis. 36,37 Outside of SCA3, this method has also been used to assess postural instability in other subtypes of spinocerebellar ataxia.…”

“…Future research would benefit from an expansion of the current method and the implementation of a longitudinal study. First, while the parameters we chose provided reliable assessments of static and dynamic stability, 17 we only used six parameters including eight variables for this study from a much wider range of potential measures available in the Pro-kin system. Second, our group comparison is cross-sectional and the evaluation of disease progression is retrospective; the predictive validity of key measures remains to be explored in terms of monitoring the progression of disease in a longitudinal study; Third, the common nonataxia symptoms of SCA3, such as peripheral neuropathy, dystonia, and parkinsonism, may affect postural stability.…”

“…In order to quantify the dispersion of COP measurements, we also included two additional parameters, total sway area, and total sway perimeter. 17 The sway range SD and velocity of body sway are defined as the mean error and velocity of COP, respectively. The total sway area is the area ellipse containing 90% of the sampled positions of the COP, and the total sway perimeter is measured using the layout of a line connecting the different positions of the COP.…”

“…15,16 The balance assessment consists of static and dynamic stability measures which provide a foundation for characterizing patients' postural and balance instability. 17,18 Previous research suggests static stability may be correlated with disease severity. 15 In addition, ataxia patients may experience poor body control in dynamic balance.…”

Effect of a Concurrent Cognitive Task, with Stabilizing Visual Information and Withdrawal, on Body Sway Adaptation of Parkinsonian’s Patients in an Off-Medication State: A Controlled Study

“…Postural balance requires constant shifts in the center of gravity and neuromuscular responses to maintain within the limits of stability. Most patients complain of abnormal postural deficits including impairment of sensory integration, postural reflexes, reduction of limits of stability, instability and difficulty reacting to external challenges or unexpected perturbations [ 2 ]. However, at an earlier stage, assessment using a low difficulty balance task could underestimate perturbations or responsiveness to medication.…”