Postural instability in Parkinson’s disease: Review and bottom-up rehabilitative approaches

Viseux, Frédéric; Delval, Arnaud; Defebvre, Luc; Simoneau, Martin

doi:10.1016/j.neucli.2020.10.013

Cited by 18 publications

(22 citation statements)

References 116 publications

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“…This inappropriate adaptive adjustment implies poor interpretation of sensory information from muscle and joint receptors of the trunk and axial skeleton, and/or extrapyramidal effects on axial muscle tone. Interestingly, improving sensory feedback from cutaneous afferents has been shown to improve postural control in patients with PD [ 9 ] despite diminished joint proprioception [ 47 ]. Furthermore, advances in neuroanatomical methods, and in particular on the basal ganglia circuitry, has linked activity from the substantia nigra with the degree of muscle tone as part of the extrapyramidal system [ 48 ] suggesting a complex central and peripheral involvement in kyphotic postures.…”

Section: Discussionmentioning

confidence: 99%

“…Maintaining an upright position during stance (postural control) is dependent upon accurate sensory cues. In PD however there is impaired integration of proprioception [ 9 , 10 ] which may alter the perception of an abnormal trunk position. To compensate for this, postural control in PD becomes increasingly dependent upon trunk muscle strength [ 11 ] and visual information [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

et al. 2021

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Parkinson’s disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

et al. 2021

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“…1 Postural instability is a cardinal feature of PD, together with rest tremor, rigidity and bradykinesia. 2 It represents a highly disabling symptom that becomes increasingly common with disease progression and is a main source for reduction of quality of life in patients with PD. 2,3 The pathogenesis of postural instability in PD involves impaired postural reflexes, pathological postures, increased postural sway, compensatory attentional strategies and disordered sensory systems.…”

Section: Introductionmentioning

confidence: 99%

“…2 It represents a highly disabling symptom that becomes increasingly common with disease progression and is a main source for reduction of quality of life in patients with PD. 2,3 The pathogenesis of postural instability in PD involves impaired postural reflexes, pathological postures, increased postural sway, compensatory attentional strategies and disordered sensory systems. 1,4 This may result in changes about the strategies of postural control during standing tasks, unexpected destabilizing perturbations and voluntary movements, such as walking.…”

Section: Introductionmentioning

confidence: 99%

“…1,4,5 Rehabilitation is an adjuvant treatment to pharmacological and surgical procedures for PD in order to maximize functional ability, level of mobility and independence, also minimizing secondary complications. 2,6 To date, a number of rehabilitative approaches has been proposed to treat the disabling features of PD, including physiotherapy (i.e. stretching procedures, muscle strengthening, therapeutic exercises), occupational therapy, treadmill training and advanced technologies.…”

Section: Introductionmentioning

confidence: 99%

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Effects of robot-assisted gait training on postural instability in Parkinson's disease: a systematic review

Picelli

Capecci

Filippetti

et al. 2021

Eur J Phys Rehabil Med

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Pain and Parkinson's disease: Current mechanism and management updates

Viseux

Delval

Simoneau

et al. 2023

European Journal of Pain

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The aim of this comprehensive review was to provide an overview of pain in Parkinson's disease (PD) by identifying different clinical features and potential mechanisms, and presenting some data on the evaluation and management of pain in PD. PD is a multifocal degenerative and progressive disease, which could affect the pain process at multiple levels. Pain in PD has a multifactorial aetiology, with a dynamic process based on pain intensity, complexity of symptoms, pain pathophysiology and presence of comorbidities. In fact, pain in PD responds to the concept of multimorphic pain, which can evolve, in relation to the different factors, whether they are linked to disease and its management. Understanding the underlying mechanisms will help in guiding of treatment choices. Providing scientific support useful for clinicians and health professionals involved in management of PD, the aim of this review was to bringing practical suggestions and clinical perspectives on the development of a multimodal approach guided by a multidisciplinary clinical intervention through a combination of pharmacological and rehabilitative approaches, to manage pain to improve the quality of life on individuals with PD.

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Postural instability in Parkinson’s disease: Review and bottom-up rehabilitative approaches

Cited by 18 publications

References 116 publications

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

Effects of robot-assisted gait training on postural instability in Parkinson's disease: a systematic review

Pain and Parkinson's disease: Current mechanism and management updates

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