Progression of postural control and gait deficits in Parkinson's disease and freezing of gait: A longitudinal study |
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| Affiliation: | 1. KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001, Leuven, Belgium;2. University Hospitals Leuven, Department of Neurology, Herestraat 49, 3000, Leuven, Belgium;3. KU Leuven, Department of Neurosciences, Herestraat 49, 3000, Leuven, Belgium;1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States;2. Department of Epidemiology, University of Washington, Seattle, WA, United States;3. Department of Neurology, Oregon Health and Science University, Portland, OR, United States;4. Portland Veterans Affairs Medical Center, Portland, OR, United States;5. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States;6. Division of Neurology, Greenville Health System and University of South Carolina Medical School-Greenville, United States;7. Department of Neurology, Emory University, Atlanta, GA, United States;8. Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States;9. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States;10. Department of Epidemiology, University of California, Irvine, CA, United States;11. Department of Pathology, University of Washington, Seattle, WA, United States;12. Parkinson''s Disease Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States;13. Department of Neurology, University of Washington, Seattle, WA, United States;14. Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, United States;1. Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA;2. Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy;3. APDM, Inc., Portland, OR, USA;4. Department of Research, Portland VA Medical Center, 3710 SW US Veterans Hospital Rd, Portland, OR, USA;1. National Institute for Athletic Health & Performance, Sanford USD Medical Center, United States;2. Sanford Orthopedics & Sports Medicine, Sanford USD Medical Center, United States;3. Sanford School of Medicine, University of South Dakota, United States;4. Methodology and Data Analysis Center, Sanford Research, United States;1. Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea;2. Center for Robotics Research, Korea Institute of Science and Technology, Seoul, South Korea;3. Department of Otolaryngology, Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea;4. Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea;5. Neuroscience Center, Samsung Medical Center, Seoul, South Korea;1. Posture and Locomotion Studies Laboratory, UNESP – Univ Estadual Paulista, Physical Education Departament, Bioscience Institute, Rio Claro, SP, Brazil;2. Research Group for Neuromotor Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium;3. Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, Canada |
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| Abstract: | Background and aimsThe relationship between impaired postural control and freezing of gait (FOG) in Parkinson's disease (PD) is still unclear. Our aim was to identify if postural control deficits and gait dysfunction progress differently in freezers compared to non-freezers and whether this relates to FOG development.Methods76 PD patients, classified as freezer (n = 17) or non-freezer (n = 59), and 24 controls underwent a gait and postural control assessments at baseline and after 12 months follow-up. Non-freezers who developed FOG during the study period were categorized as FOG converters (n = 5). Gait was analyzed during walking at self-preferred pace. Postural control was assessed using the Mini-BESTest and its sub-categories: sensory orientation, anticipatory, reactive and dynamic postural control.ResultsMini-BESTest scores were lower in PD compared to controls (p < 0.001), and in freezers compared to non-freezers (p = 0.02). PD has worse anticipatory (p = 0.01), reactive (p = 0.02) and dynamic postural control (p = 0.003) compared to controls. Freezers scored lower on dynamic postural control compared to non-freezers (p = 0.02). There were no baseline differences between converters and non-converters. Decline in postural control was worse in PD compared to controls (p = 0.02) as shown by a greater decrease in the total Mini-BESTest score. Similar patterns were found in freezers (p = 0.006), who also showed more decline in anticipatory (p < 0.001) and dynamic postural control (p = 0.02) compared to non-freezers. FOG converters had a greater decline in the total Mini-BESTest (p = 0.005) and dynamic postural control scores (p = 0.04) compared to non-converters. Gait outcomes showed no significant differences in any of the analyses.ConclusionFOG is associated with more severe decline in postural control, which can be detected by the clinical Mini-BESTest. |
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| Keywords: | Parkinson's disease Freezing of gait Balance Gait Progression Conversion |
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