Direction specific preserved limits of stability in early progressive supranuclear palsy: A dynamic posturographic study

Ganesan, Mohan; Pasha, Shaik Afsar; Pal, Pramod Kumar; Yadav, Ravi; Gupta, Anupam

doi:10.1016/j.gaitpost.2011.12.012

Cited by 17 publications

(11 citation statements)

References 31 publications

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“…The sensory organization (SOT) and limits of stability (LOS) tests were consistent with previous studies in PSP [6, 15] and are therefore presented in supplementary material.…”

Section: Resultssupporting

confidence: 83%

Impaired perception of surface tilt in progressive supranuclear palsy

et al. 2017

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IntroductionProgressive supranuclear palsy (PSP) is characterized by early postural instability and backward falls. The mechanisms underlying backward postural instability in PSP are not understood. The aim of this study was to test the hypothesis that postural instability in PSP is a result of dysfunction in the perception of postural verticality.MethodsWe gathered posturography data on 12 subjects with PSP to compare with 12 subjects with idiopathic Parkinson’s Disease (PD) and 12 healthy subjects. Objective tests of postural impairment included: dynamic sensory perception tests of gravity and of surface oscillations, postural responses to surface perturbations, the sensory organization test of postural sway under altered sensory conditions and limits of stability in stance.ResultsPerception of toes up (but not toes down) surface tilt was reduced in subjects with PSP compared to both control subjects (p≤0.001 standing, p≤0.007 seated) and subjects with PD (p≤0.03 standing, p≤0.04 seated). Subjects with PSP, PD and normal controls accurately perceived the direction of gravity when standing on a tilting surface. Unlike PD and control subjects, subjects with PSP exerted less postural corrective torque in response to toes up surface tilts.DiscussionDifficulty perceiving backward tilt of the surface or body may account for backward falls and postural impairments in patients with PSP. These observations suggest that abnormal central integration of sensory inputs for perception of body and surface orientation contributes to the pathophysiology of postural instability in PSP.

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“…The sensory organization (SOT) and limits of stability (LOS) tests were consistent with previous studies in PSP [6, 15] and are therefore presented in supplementary material.…”

Section: Resultssupporting

confidence: 83%

Impaired perception of surface tilt in progressive supranuclear palsy

et al. 2017

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“…Participants were required to achieve the target from the centre position using the shortest vertical or horizontal path. The path used was given a score by the instrument; the total LOS score and the LOS results in all directions, including forward (FW), backward (BW), right (RT), left (LT), forward-right (FW-RT), forward-left (FW-LT), backward-right (BW-RT) and backward-left (BW-LT) were recorded [%] [32] . In a particular direction, the maximum achievable perfect score was 100.…”

Section: Balance Measurementmentioning

confidence: 99%

An observational study of balance and proprioception function in patients with spinocerebellar ataxias type 3

Liu¹,

Liu²,

Xu³

et al. 2020

Preprint

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BackgroundPostural instability is one of the most disabling features of spinocerebellar ataxias type 3 (SCA3) and often leads to falls that reduce mobility and functional capacity. This study aimed to quantitatively analyse static and dynamic balance and proprioception function on postural control in patients with SCA3 using the Pro-kin system and optimise rehabilitation programmes for them.MethodsEight-one clinically diagnosed SCA3 patients (38 women, 43 men; aged 39.00 ± 9.66) and 62 healthy controls were studied and evaluated using the Pro-kin system (PK254P, Tecnobody S.r.l, Dalmine, Italy). The measurements included (1) a static balance test in two visual feedback conditions: eyes open (EO) and eyes closed (EC); (2) a dynamic balance test measuring limits of stability (LOS); and (3) a proprioception function test to obtain proprioceptive measurements on a multiaxial balance evaluator for both right and left lower limbs.ResultsCompared to controls, SCA3 patients showed significantly higher values of all static balance outcome variables with eyes open and eyes closed, implying postural instability. SCA3 patients showed significantly higher values in the standard deviation of body sway along the medio-lateral (ML) axis and in the velocity of body sway along the anterior-posterior (AP) axis. The overall scores and the scores for all eight LOS components were significantly lower in the SCA3 patients than in the controls. The mean values of AP index (API), ML index (MLI), Stability index (SI) and average trace error (ATE) were significantly greater in SCA3 patients compared to HC subjects, while API showed a trend toward higher values.ConclusionsSCA3 patients have a significant postural control disorder, and are likely to fall on the AP plane and prefer performing postural adjustments in the ML direction; a decreased proprioception function in the knee and ankle is also evident. Visual cues and proprioception should be emphasized in balance rehabilitation training. Attention should also be paid to improve muscle strength and range of motion.Trial registrationThe Chinese clinical test registration center. ChiCTR1800020133. Registered 15 december 2018 - Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=33950

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“…Computerized posturography testing can differentiate early PSP from early PD ( 51 ) and age-matched controls ( 52 ). Ondo and colleagues utilized the sensory organization test (SOT), where subjects are asked to stand still under a variety of altered sensory conditions ( 51 ).…”

Section: Progressive Supranuclear Palsymentioning

confidence: 99%

“…The limit of stability test (LOS) was also found to be abnormal in PSP ( 51 , 52 ). LOS measures path sway, time, and distance traveled by the patient’s center of gravity from an initial starting point to eight different points ( 51 ).…”

Section: Progressive Supranuclear Palsymentioning

confidence: 99%

Vestibular Deficits in Neurodegenerative Disorders: Balance, Dizziness, and Spatial Disorientation

2017

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The vestibular system consists of the peripheral vestibular organs in the inner ear and the associated extensive central nervous system projections—from the cerebellum and brainstem to the thalamic relays to cortical projections. This system is important for spatial orientation and balance, both of critical ecological importance, particularly for successful navigation in our environment. Balance disorders and spatial disorientation are common presenting features of neurodegenerative diseases; however, little is known regarding central vestibular processing in these diseases. A ubiquitous aspect of central vestibular processing is its promiscuity given that vestibular signals are commonly found in combination with other sensory signals. This review discusses how impaired central processing of vestibular signals—typically in combination with other sensory and motor systems—may account for the impaired balance and spatial disorientation in common neurodegenerative conditions. Such an understanding may provide for new diagnostic tests, potentially useful in detecting early disease while a mechanistic understanding of imbalance and spatial disorientation in these patients may enable a vestibular-targeted therapy for such problems in neurodegenerative diseases. Studies with state of the art central vestibular testing are now much needed to tackle this important topic.

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Direction specific preserved limits of stability in early progressive supranuclear palsy: A dynamic posturographic study

Cited by 17 publications

References 31 publications

Impaired perception of surface tilt in progressive supranuclear palsy

Impaired perception of surface tilt in progressive supranuclear palsy

An observational study of balance and proprioception function in patients with spinocerebellar ataxias type 3

Vestibular Deficits in Neurodegenerative Disorders: Balance, Dizziness, and Spatial Disorientation

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