Quantifying Postural Control in Premanifest and Manifest Huntington Disease Using Wearable Sensors

Abstract

Background. Impairments in postural control in Huntington disease (HD) have important consequences for daily functioning. This observational study systematically examined baseline postural control and the effect of sensory attenuation and sensory enhancement on postural control across the spectrum of HD. Methods. Participants (n = 39) included healthy controls and individuals in premanifest (pHD) and manifest stages (mHD) of HD. Using wearable sensors, postural control was assessed according to (1) postural set (sit vs stand), (2) sensory attenuation using clinical test of sensory integration, and (3) sensory enhancement with gaze fixation. Outcomes included sway smoothness, amplitude, and frequency. Results. Based on postural set, pHD reduced postural sway in sitting relative to standing, whereas mHD had pronounced sway in standing and sitting, highlighting a baseline postural deficit. During sensory attenuation, postural control in pHD deteriorated relative to controls when proprioceptive demands were high (eyes closed on foam), whereas mHD had significant deterioration of postural control when proprioception was attenuated (eyes open and closed on foam). Finally, gaze fixation improved sway smoothness, amplitude, and frequency in pHD; however, no benefit was observed in mHD. Conclusions. Systematic examination of postural control revealed a fundamental postural deficit in mHD, which further deteriorates when proprioception is challenged. Meanwhile, postural deficits in pHD are detectable when proprioceptive challenge is high. Sensory enhancing strategies using gaze fixation to benefit posture may be useful when introduced well before motor diagnosis. These findings encourage further examination of wearable sensors as part of routine clinical assessments in HD.

Measures of postural control and mobility during dual-tasking as candidate markers of instability in Huntington's disease

“…Decreased postural stability has significant repercussions, leading to increased falls, 32,33 decreased quality of life, 34 higher overall caregiver burden 35 and healthcare utilization 36 for persons with HD. The present research extends findings from separate studies showing impairments in people with HD while standing 11,37 and walking 38 under single and dual-task conditions. Importantly, the results demonstrate a potential distinction between static and dynamic postural control mechanisms and sensitivity of RMS of total sway during dual-task standing activities.…”

Postural control and gait measures derived from wearable inertial measurement unit devices in Huntington's disease: Recommendations for clinical outcomes

“…Consistent with previous findings, our results indicated significant differences between HD and non-HD peers across most variables of postural control that were measured within and across conditions. (Porciuncula et al, 2020;Salomonczyk et al, 2010;Tian et al, 1991) Individuals with HD performed significantly worse than non-HD peers on variables of postural control including greater sway area, greater acceleration values in static standing and sitting, and greater jerk values during quiet standing and sitting. These differences were more pronounced between non-HD peers and HD individuals with TFC scores below 11 (HD2).…”

“…(Horak and Mancini, 2013;Washabaugh et al, 2017) Several recent studies have also demonstrated their clinical utility in individuals with HD. (Dalton et al, 2013;Porciuncula et al, 2020;Purcell et al, 2020;Tortelli et al, 2021;Trojaniello et al, 2015) IMUs can measure discrete biomechanical properties of postural control quality and impairments, such as jerk, total sway, and acceleration values, which may be more sensitive to motor impairments than current clinical measures. (Adams et al, 2017;Andrzejewski et al, 2016) In order to address this need for quantitative measures of postural control, we analyzed postural control in sitting and standing conditions.…”

Quantification of the development of trunk control in healthy infants using inertial measurement units

“…The jerk, i.e. the third derivative of position [42], has been used to quantify postural balance in quiet stance in both Parkinson's disease patients [43] and Huntington's disease patients [44], where it was able to distinguish between healthy and affected subjects. Furthermore, a recent study showed that the jerk in quiet stance decreased with age for subjects from five years old to adulthood [40].…”