Balance differences in people with Parkinson disease with and without freezing of gait

Abstract

Background Freezing of gait (FOG) is a relatively common and remarkably disabling impairment associated with Parkinson disease (PD). Laboratory-based measures indicate that individuals with FOG (PD+FOG) have greater balance deficits than those without FOG (PD-FOG). Whether such differences also can be detected using clinical balance tests has not been investigated. We sought to determine if balance and specific aspects of balance, measured using Balance Evaluation Systems Test (BESTest), differs between PD+FOG and PD-FOG. Furthermore, we aimed to determine if time-efficient clinical balance measures (i.e. Mini-BESTest, Berg Balance Scale (BBS)) could detect balance differences between PD+FOG and PD-FOG. Methods Balance of 78 individuals with PD, grouped as either PD+FOG (n = 32) or PD-FOG (n =46), was measured using the BESTest, Mini-BESTest, and BBS. Between-groups comparisons were conducted for these measures and for the six sections of the BESTest using analysis of covariance. A PD composite score was used as a covariate. Results Controlling for motor sign severity, PD duration, and age, PD+FOG had worse balance than PD-FOG when measured using the BESTest (p=0.008, F=7.35) and Mini-BESTest (p=0.002, F=10.37), but not the BBS (p=0.27, F=1.26). BESTest section differences were noted between PD+FOG and PD-FOG for reactive postural responses (p<0.001, F=14.42) and stability in gait (p=0.003, F=9.18). Conclusions The BESTest and Mini-BESTest, which specifically assessed reactive postural responses and stability in gait, were more likely than the BBS to detect differences in balance between PD+FOG and PD-FOG. Because it is more time efficient to administer, the Mini-BESTest may be the preferred tool for assessing balance deficits associated with FOG.

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

“…Postural control and balance [40,41] were affected more significantly in PD patients with FOG compared with non-FOG group. FOG often occurs when turning also suggests that the postural control impairment probably contributes to freezing.…”

Reliability, validity and minimal detectable change of the Mini-BESTest in Greek participants with chronic stroke

“…The clinical evaluation of balance is, therefore, of great importance in identifying risks of falling as well as in organizing appropriate rehabilitation protocols for those patients (Duncan et al, 2015). The literature identifies various ways of balance assessment either via observation of the patient's balance performance or via patients' self-reports in regards their balance confidence, or their fear of falling (Yelnik and Bonan, 2008).…”

Low to moderate relationships between gait and postural responses in Parkinson disease

“…Relationships between the gait summated score (Mini-BESTest items [10][11][12][13][14] and the postural response summated score (Mini-BESTest items 4-6) were low to moderate for all participants, as well as for freezers and non-freezers. Relationships between the gait summated score and the 4 spatiotemporal gait parameters were moderate (Table VI).…”

“…Because the spatiotemporal parameters of gait and the postural response items varied in measurement type (continuous vs. ordinal), we correlated summated scores from the gait items (10)(11)(12)(13)(14) and postural response items (4-6) of the Mini-BESTest. In addition, we correlated the gait summated score with the spatiotemporal parameters of gait.…”

“…FOG is a brief, episodic inability to produce effective stepping (9), typically preceded by reduced stride length with increased cadence (8). Overall balance performance is worse in people with PD with FOG, especially in reactive postural responses and stability of gait (10,11). There is debate about whether FOG and postural response impairment share pathophysiology (11)(12)(13).…”