Lateral Stepping for Postural Correction in Parkinson's Disease

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

King LA, Horak FB. Lateral stepping for postural correction in Parkinson's disease. Objective: To characterize the lateral stepping strategies for postural correction in patients with Parkinson's disease (PD) and the effect of their anti-parkinson medication. Design: Observational study. Setting: Outpatient neuroscience laboratory. Participants: Thirteen participants with idiopathic PD in their on (PD on) and off (PD off) levodopa state and 14 healthy elderly controls. Interventions: Movable platform with lateral translations of 12cm at 14.6cm/s ramp velocity. Main Outcome Measures: The incidence and characteristics of 3 postural strategies were observed: lateral side-step, crossover step, or no step. Corrective stepping was characterized by latency to step after perturbation onset, step velocity, and step length and presence of an anticipatory postural adjustment (APA). Additionally, percentages of trials resulting in falls were identified for each group. Results: Whereas elderly control participants never fell, PD participants fell in 24% and 35% of trials in the on and off medication states, respectively. Both PD and control participants most often used a lateral side-step strategy; 70% (control), 67% (PD off), and 73% (PD on) of all trials, respectively. PD participants fell most often when using a crossover strategy (75% of all crossover trials) or no-step strategy (100% of all no-step trials). In the off medication state, PD participants' lateral stepping strategies were initiated later than controls (370±37ms vs 280±10ms, P.05). Conclusions: PD participants showed significantly more postural instability and falls than age-matched controls when stepping was required for postural correction in response to lateral disequilibrium. Although PD participants usually used a similar lateral stepping strategy as controls in response to lateral translations, lack of an anticipatory lateral weight shift, and bradykinetic characteristics of the stepping responses help explain the greater rate of falls in participants with PD. Differences were not found between the levodopa on and off states. The results suggest that rehabilitation aimed at improving lateral stability in PD should include facilitating APAs before a lateral side-stepping strategy with faster and larger steps to recover equilibrium.

Original languageEnglish (US)
Pages (from-to)492-499
Number of pages8
JournalArchives of Physical Medicine and Rehabilitation
Volume89
Issue number3
DOIs
StatePublished - Mar 2008

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Parkinson Disease
Levodopa
Architectural Accessibility
Neurosciences
Cross-Over Studies
Observational Studies
Outpatients
Rehabilitation
Outcome Assessment (Health Care)
Weights and Measures

Keywords

  • Accidental falls
  • Parkinson's disease
  • Posture
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation

Cite this

Lateral Stepping for Postural Correction in Parkinson's Disease. / King, Laurie; Horak, Fay.

In: Archives of Physical Medicine and Rehabilitation, Vol. 89, No. 3, 03.2008, p. 492-499.

Research output: Contribution to journalArticle

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title = "Lateral Stepping for Postural Correction in Parkinson's Disease",
abstract = "King LA, Horak FB. Lateral stepping for postural correction in Parkinson's disease. Objective: To characterize the lateral stepping strategies for postural correction in patients with Parkinson's disease (PD) and the effect of their anti-parkinson medication. Design: Observational study. Setting: Outpatient neuroscience laboratory. Participants: Thirteen participants with idiopathic PD in their on (PD on) and off (PD off) levodopa state and 14 healthy elderly controls. Interventions: Movable platform with lateral translations of 12cm at 14.6cm/s ramp velocity. Main Outcome Measures: The incidence and characteristics of 3 postural strategies were observed: lateral side-step, crossover step, or no step. Corrective stepping was characterized by latency to step after perturbation onset, step velocity, and step length and presence of an anticipatory postural adjustment (APA). Additionally, percentages of trials resulting in falls were identified for each group. Results: Whereas elderly control participants never fell, PD participants fell in 24{\%} and 35{\%} of trials in the on and off medication states, respectively. Both PD and control participants most often used a lateral side-step strategy; 70{\%} (control), 67{\%} (PD off), and 73{\%} (PD on) of all trials, respectively. PD participants fell most often when using a crossover strategy (75{\%} of all crossover trials) or no-step strategy (100{\%} of all no-step trials). In the off medication state, PD participants' lateral stepping strategies were initiated later than controls (370±37ms vs 280±10ms, P.05). Conclusions: PD participants showed significantly more postural instability and falls than age-matched controls when stepping was required for postural correction in response to lateral disequilibrium. Although PD participants usually used a similar lateral stepping strategy as controls in response to lateral translations, lack of an anticipatory lateral weight shift, and bradykinetic characteristics of the stepping responses help explain the greater rate of falls in participants with PD. Differences were not found between the levodopa on and off states. The results suggest that rehabilitation aimed at improving lateral stability in PD should include facilitating APAs before a lateral side-stepping strategy with faster and larger steps to recover equilibrium.",
keywords = "Accidental falls, Parkinson's disease, Posture, Rehabilitation",
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