Managing Gait, Balance, and Posture in Parkinson’s Disease

Debû, Bettina; Godeiro-Júnior, Clécio; Lino, Jarbas Correa; Moro, Elena

doi:10.1007/s11910-018-0828-4

Cited by 85 publications

(82 citation statements)

References 179 publications

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“…Studies have pointed out that STN-DBS can improve the balance function in the case of sensory deprivation and sensory input inconsistency [ 13 ]. In addition to improving the bradykinesia, rigidity, and tremor symptoms of PD, STN-DBS may also improve the complications camptocormia, dyskinesia, and symptom fluctuations, which is helpful for improving balance function [ 14 ] while in other study, it tends to have no effect [ 15 ] that STN-DBS improves camptocormia, especially if surgery is performed more than 18 months after camptocormia installation [ 16 ]. And STN-DBS does improve balance in the short term (1–3 years) but that balance dysfunction then increases again with disease progression.…”

Section: Discussionmentioning

confidence: 99%

Effect of Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) on balance performance in Parkinson's disease

Liang

et al. 2020

PLoS ONE

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To study the effect of STN-DBS on balance performance of Parkinson's disease. Method 16 idiopathic PD patients treated with bilateral STN-DBS (DBS Group) and 20 PD patients treated with Levodopa (Medicine group) were included in the study. Clinical material including Levodopa Equivalent Daily Dose (LEDD, mg/day), life quality (PDQ-39) were collected. For DBS group and Medicine group, The motor disability (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale , MDS-UPDRSIII) and balance performance (MDS-UPDRS 3.12, Berg Balance Scale BBS) and the Limits of Stability (LoS) (target acquisition percentage, trunk swing angle standard deviation, time) in state of Med-Off/Med-On at preoperation, postoperation, 6 months postoperation and 12 months postoperation were evaluated. Repeated ANOVA was used to analyze the effect of STN-DBS on balance performance. Result The Clinical material (age, gender, duration, LEDD preoperation, PDQ39), motor disability (Med-on/Med-Off), balance performance (Med-on/Med-Off) and LoS preoperation had no differences in DBS-group and Medical-group (P>0.05). During the follow up, LEDD, PDQ39, Motor disability (MDS-UPDRSIII), balance performance (MDS-UPDRS 3.12, BBS) in Medicine-group had no significant changes in both Med-Off and Med-On. For DBS-group, immediately improvement of motor disability (MDS-UPDRSIII), LoS (target acquisition percentage, trunk swing angle standard deviation, time) and LEDD were observed postoperation (P<0.05); PDQ39, balance performance (MDS-UPDRS 3.12, BBS) began to improve at 6 months and 12 months postoperation. Repeated ANOVA showed that DBS could significantly improve the motor disability, balance performance and LoS in PD.

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Section: Discussionmentioning

confidence: 99%

Effect of Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) on balance performance in Parkinson's disease

Liang

et al. 2020

PLoS ONE

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“…Balance disorders are one of the most debilitating motor deficits in PD patients, which increase during the disease progression ( 20 ). STN-DBS has been initially shown to have a modest effect on static and dynamic stability ( 5 – 10 ) but long-term studies revealed more conflicting results ( 11 – 15 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

The Neuromodulatory Impact of Subthalamic Nucleus Deep Brain Stimulation on Gait and Postural Instability in Parkinson's Disease Patients: A Prospective Case Controlled Study

et al. 2018

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Background: Subthalamic nucleus deep brain stimulation (STN-DBS) has been an established method in improvement of motor disabilities in Parkinson's disease (PD) patients. It has been also claimed to have an impact on balance and gait disorders in PD patients, but the previous results are conflicting.Objective: The aim of this prospective controlled study was to evaluate the impact of STN-DBS on balance disorders in PD patients in comparison with Best-Medical-Therapy (BMT) and Long-term-Post-Operative (POP) group.Methods: DBS-group consisted of 20 PD patients (8F, 12M) who underwent bilateral STN DBS. POP-group consisted of 14 post-DBS patients (6F, 8M) in median 30 months-time after surgery. Control group (BMT-group) consisted of 20 patients (11F, 9M) who did not undergo surgical intervention. UPDRS III scale and balance tests (Up And Go Test, Dual Task- Timed Up And Go Test, Tandem Walk Test) and posturography parameters were measured during 3 visits in 9 ± 2months periods (V1, V2, V3) 4 phases of treatment (BMT-ON/OFF, DBS-ON/OFF).Results: We have observed the slowdown of gait and postural instability progression in first 9 post-operative months followed by co-existent enhancement of balance disorders in next 9-months evaluation (p < 0.05) in balance tests (Up and Go, TWT) and in posturography examination parameters (p < 0.05). The effect was not observed neither in BMT-group nor POP-group (p > 0.05): these groups revealed constant progression of static and dynamic instability (p > 0.05).Conclusions: STN-DBS can have modulatory effect on static and dynamic instability in PD patients: it can temporarily improve balance disorders. mainly during first 9 post-operative months, but with possible following deterioration of the symptoms in next post-operative months.

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“…Parkinson's disease (PD) is the second most common neurodegenerative disorder and affects approximately 1 million people in the US [1], with total annual health care costs approaching 11 billion dollars [2]. Gait and balance problems affect the majority of people with PD (PwPD) [3] and substantially impact their independence and quality of life [4]. Current pharmacological and surgical PD treatments are either only mildly effective, expensive, or associated with a variety of side-effects [5].…”

Section: Introductionmentioning

confidence: 99%

Cerebellar Transcranial Direct Current Stimulation in People with Parkinson’s Disease: A Pilot Study

et al. 2020

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People with Parkinson’s disease (PwPD) often experience gait and balance problems that substantially impact their quality of life. Pharmacological, surgical, and rehabilitative treatments have limited effectiveness and many PwPD continue to experience gait and balance impairment. Transcranial direct current stimulation (tDCS) may represent a viable therapeutic adjunct. The effects of lower intensity tDCS (2 mA) over frontal brain areas, in unilateral and bilateral montages, has previously been explored; however, the effects of lower and higher intensity cerebellar tDCS (2 mA and 4 mA, respectively) on gait and balance has not been investigated. Seven PwPD underwent five cerebellar tDCS conditions (sham, unilateral 2 mA, bilateral 2 mA, unilateral 4 mA, and bilateral 4 mA) for 20 min. After a 10 min rest, gait and balance were tested. The results indicated that the bilateral 4 mA cerebellar tDCS condition had a significantly higher Berg Balance Scale score compared to sham. This study provides preliminary evidence that a single session of tDCS over the cerebellum, using a bilateral configuration at a higher intensity (4 mA), significantly improved balance performance. This intensity and cerebellar configuration warrants future investigation in larger samples and over repeated sessions.

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Managing Gait, Balance, and Posture in Parkinson’s Disease

Cited by 85 publications

References 179 publications

Effect of Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) on balance performance in Parkinson's disease

Effect of Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) on balance performance in Parkinson's disease

The Neuromodulatory Impact of Subthalamic Nucleus Deep Brain Stimulation on Gait and Postural Instability in Parkinson's Disease Patients: A Prospective Case Controlled Study

Cerebellar Transcranial Direct Current Stimulation in People with Parkinson’s Disease: A Pilot Study

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