TY - JOUR
T1 - Relating Anticipatory Postural Adjustments to Step Outcomes During Loss of Balance in People With Parkinson’s Disease
AU - Peterson, Daniel
AU - Lohse, Keith R.
AU - Mancini, Martina
N1 - Funding Information:
This work was supported directly by the US Department of Veteran’s Affairs Rehabilitation Research and Development Service (Career Development Award-1: #I01BX007080; PI: DSP) and the Medical Research Foundation of Oregon (Early Investigator Award; PI: DSP). Over the past 12 months, authors have also been funded by the Canadian Institutes of Health Research (PTJ 153330; CoI: KRL), Auburn University Internal Grants Program (IGP Project # 170138; PI: KRL), Federal Aviation Administration—Center for Excellence for Teaching Training and Human Performance (FAA 16-C-TTHP-AU; CoI: KRL), and the NIH: Career Development Award R00 HD078492 (PI, MM) and SBIR 1R43AG056012-01 (CoI: MM). The contents do not represent the views of the US Department of Veterans Affairs or the US government.
Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported directly by the US Department of Veteran’s Affairs Rehabilitation Research and Development Service (Career Development Award-1: #I01BX007080; PI: DSP) and the Medical Research Foundation of Oregon (Early Investigator Award; PI: DSP). Over the past 12 months, authors have also been funded by the Canadian Institutes of Health Research (PTJ 153330; CoI: KRL), Auburn University Internal Grants Program (IGP Project # 170138; PI: KRL), Federal Aviation Administration—Center for Excellence for Teaching Training and Human Performance (FAA 16-C-TTHP-AU; CoI: KRL), and the NIH: Career Development Award R00 HD078492 (PI, MM) and SBIR 1R43AG056012-01 (CoI: MM). The contents do not represent the views of the US Department of Veterans Affairs or the US government.
Publisher Copyright:
© The Author(s) 2018.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background. Effective protective steps are critical for fall prevention, and anticipatory postural adjustments (APAs) after a perturbation but prior to protective steps affect step performance. Although APAs prior to protective steps are altered in people with Parkinson’s disease (PD), whether these changes affect subsequent step performance is poorly understood. Objective. Characterize the relationship between mediolateral APA size and protective step outcomes in response to anteroposterior balance perturbations in people with PD. Methods. Twenty-eight individuals with PD completed 25 forward and 25 backward protective steps in response to support surface translations. Multilevel linear models related mediolateral APA size to protective step outcomes. Results. During forward protective stepping, larger mediolateral APAs were associated with delayed (P <.001) and larger (P =.004) steps. Larger APAs were also associated with smaller mediolateral (P <.001) but larger anterior-posterior center of mass movement at foot off (P <.001). During backward stepping, larger APAs were associated with later steps (P <.001) and smaller anterior-posterior margin of stability at first foot contact (P <.001). During backward stepping, larger APAs were also associated with worse clinical (ie, UPDRS [Unified Parkinson’s Disease Rating Scale]; P =.005) and balance (ie, MiniBEST [Mini-Balance Evaluation Systems Test]; P =.021) outcomes. Conclusions. During forward protective stepping, larger APAs were associated with larger and later steps, suggesting APA size may have mixed effects on the subsequent step. During backward stepping, larger APAs were associated with worse stepping outcomes (ie, later steps, smaller anterior-posterior margin of stability, worse clinical outcomes). Interventions aimed at improving APAs in PD should monitor spatial and temporal protective step outcomes to ensure treatment does not negatively affect protective steps, particularly for forward stepping.
AB - Background. Effective protective steps are critical for fall prevention, and anticipatory postural adjustments (APAs) after a perturbation but prior to protective steps affect step performance. Although APAs prior to protective steps are altered in people with Parkinson’s disease (PD), whether these changes affect subsequent step performance is poorly understood. Objective. Characterize the relationship between mediolateral APA size and protective step outcomes in response to anteroposterior balance perturbations in people with PD. Methods. Twenty-eight individuals with PD completed 25 forward and 25 backward protective steps in response to support surface translations. Multilevel linear models related mediolateral APA size to protective step outcomes. Results. During forward protective stepping, larger mediolateral APAs were associated with delayed (P <.001) and larger (P =.004) steps. Larger APAs were also associated with smaller mediolateral (P <.001) but larger anterior-posterior center of mass movement at foot off (P <.001). During backward stepping, larger APAs were associated with later steps (P <.001) and smaller anterior-posterior margin of stability at first foot contact (P <.001). During backward stepping, larger APAs were also associated with worse clinical (ie, UPDRS [Unified Parkinson’s Disease Rating Scale]; P =.005) and balance (ie, MiniBEST [Mini-Balance Evaluation Systems Test]; P =.021) outcomes. Conclusions. During forward protective stepping, larger APAs were associated with larger and later steps, suggesting APA size may have mixed effects on the subsequent step. During backward stepping, larger APAs were associated with worse stepping outcomes (ie, later steps, smaller anterior-posterior margin of stability, worse clinical outcomes). Interventions aimed at improving APAs in PD should monitor spatial and temporal protective step outcomes to ensure treatment does not negatively affect protective steps, particularly for forward stepping.
KW - Parkinson’s disease
KW - anticipatory postural adjustments
KW - protective stepping
KW - rehabilitation
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U2 - 10.1177/1545968318798937
DO - 10.1177/1545968318798937
M3 - Article
C2 - 30198384
AN - SCOPUS:85054897633
SN - 1545-9683
VL - 32
SP - 887
EP - 898
JO - Neurorehabilitation and Neural Repair
JF - Neurorehabilitation and Neural Repair
IS - 10
ER -