Effect of Balance Training on Postural Instability in Patients With Idiopathic Parkinson’s Disease Clinical and posturographic correlates of falling in Parkinson's disease. Clinimetrics of postural instability in Parkinson’s disease The Effect of Balance Training on Postural Control in Patients with Parkinson's Disease Using a Virtual Rehabilitation System. Balance versus resistance training on postural control in patients with Parkinson's disease: a randomized controlled trial. Instrumented Test of Sensory Integration for Balance: A Validation Study A novel conceptual framework for balance training in Parkinson’s disease-study protocol for a randomised controlled trial The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Improved asymmetry of gait in Parkinson's disease with DBS: gait and postural instability in Parkinson's disease treated with bilateral deep brain stimulation in the subthalamic nucleus. The effect of deep brain stimulation randomized by site on balance in Parkinson's disease. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease. Diagnosis of Fall Risk in Parkinson Disease: An Analysis of Individual and Collective Clinical Balance Test Interpretation Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson’s disease Exercise programs improve mobility and balance in people with Parkinson's disease. Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson’s Disease Working on asymmetry in Parkinson’s disease: randomized, controlled pilot study PPNa-DBS for gait and balance disorders in Parkinson’s disease: a double-blind, randomised study
Background . Postural instability ( PI ) is a disabling sign of Parkinson ’s disease ( PD ) not easily amenable to treatment with medication . Objective . To evaluate the effects of balance training on PI in patients with PD . Methods . A total of 64 patients with PI were r and omly assigned to the experimental group ( n = 33 ) for balance training or to the control group ( n = 31 ) for general physical exercises . Each patient received 21 treatment sessions of 50 minutes each . Patients were evaluated by a blinded rater before and after treatment as well as 1 month posttreatment using the Berg Balance Scale ( BBS ) , Activities-Specific Balance Confidence Scale ( ABC ) , postural transfer test , self-destabilization of the center of foot pressure test , number of falls , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , modified Hoehn and Yahr ( H&Y ) Staging Scale , and Geriatric Depression Scale ( GDS ) . Results .At the end of treatment , the experimental group showed significant improvements in all outcome measures , except for the UPDRS and the H&Y scale . Improvement was maintained at the 1-month follow-up in all outcome measures except for the GDS . No significant changes in performance were observed in the control group . Conclusions . A program of balance training can improve PI in patients with PD Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson 's disease ( IPD ) .  Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling . The purpose of this study was to determine the efficacy of clinical tests , balance scales , and  stable-platform posturography  in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort . Forty-eight PD subjects ( Hoehn & Yahr stage 1 - 3 ) and 17 age-matched controls had the following assessment s : Activities-specific Balance Confidence scale , Berg Balance Scale , Unified Parkinson 's Disease Rating Scale ( UPDRS ) ( motor ) , pull-test , timed up- and -go , static posturography , and dynamic posturography to assess multidirectional leaning balance . Of the clinical assessment s , all but the pull-test were closely correlated with a history of falling .  Static posturography  discriminated between PD fallers and controls but not between PD fallers and non-fallers , whereas  dynamic posturography ( reaction time , velocity , and target hit-time ) also discriminated between fallers and non-fallers . Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospect i ve assessment of falls risk in PD patients . A further prospect i ve study is now required to assess their predictive value . © 2013 Movement Disorder Society Abstract Judgement of the ability to recover balance after a sudden shoulder pull is used as a clinical measure of postural instability in Parkinson ’s disease . To further evaluate its merits , we compared this ‘ retropulsion test ’ with dynamic posturography in 23 Parkinson patients .  Dynamic posturography involved 20 serial ‘ toe-up ’ support surface rotations , which induced backward body sway . We found a moderate correlation ( Spearman ’s ρ = 0.54 ; P < 0.05 ) between the retropulsion test and body sway after platform rotations during the ‘ off ’ phase , but no correlation during the ‘ on ’ phase ( Spearman ’s ρ = 0.43 ; P = 0.11 ) . These results cast doubt on the use of the retropulsion test as a measure of postural instability in Parkinson ’s disease OBJECTIVES Parkinson 's disease ( PD ) is a progressive neurodegenerative disorder characterized by motor clinical alterations among others . Postural problems have serious consequences for patients , not only limiting their daily life but also increasing some risks , like the risk of fall . Inadequate postural control and postural instability is a major problem in PD patients . A Virtual Motor Rehabilitation System ( VMR ) has been tested in patients with PD in the intervention period . Our purpose was to analyze the evolution of the spatial postural control during the intervention period , to see if there are any changes caused precisely by this intervention . METHODS Ten people with PD carried out 15 virtual rehabilitation sessions .  We tested a groundbreaking system based on Virtual Motor Rehabilitation in two periods of time ( baseline evaluation and final evaluation ) . In the training sessions , the participants performed a customizable treatment using a low-cost system , the Active Balance Rehabilitation system ( ABAR ) . We stored the pressure performed by the participants every five hundredths of a second , and we analyzed the patients ' pressure when they maintained their body on the left , on the right , and in the center in sitting position . Our system was able to measure postural control in every patient in each of the virtual rehabilitation sessions . RESULTS There are no significant differences in the performance of postural control in any of the positions evaluated throughout the sessions . Moreover , the results show a trend to an improvement in all positions . This improvement is especially remarkable in the left/right positions , which are the most important positions in order to avoid problems such as the risk of fall . With regard to the suitability of the ABAR system , we have found outst and ing results in enjoyment , success , clarity , and helpfulness . CONCLUSIONS Although PD is a progressive neurodegenerative disorder , the results demonstrate that patients with PD maintain or even improve their postural control in all positions . We think that the main factor influencing these results is that patients use more of their available cognitive processing to improve their postural control . The ABAR system allows us to make this assumption because the system requires the continuous attention of patients , promoting cognitive processing BACKGROUND Evidence s have shown that physiotherapy programs may improve the balance of individuals with Parkinson 's disease ( PD ) , although it is not clear which specific exercise program is better . AIM The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients . DESIGN R and omized controlled trial . SETTING The study was conducted in a physiotherapy outpatient clinic of a university hospital . POPULATION A total of 40 PD participants were r and omly divided into two groups : balance training ( BT ) and resistance training ( RT ) . METHODS The BT group focused on balance training , functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk , both supervised by trained physiotherapists . Therapy sessions were held twice a week ( at 60 minutes ) , totaling 24 sessions . The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test ( BESTest ) scale to determine the effects of the intervention on postural control . RESULTS Significant improvement of postural control ( pre vs. post 15.1 vs. 9.6 cm2 ) was only reported in favor of BT group ( d=1.17 ) for one-legged st and condition on force platform . The st and ardized mean difference between groups was significantly ( P<0.02 ) , with 36 % of improvement for BT vs. 0.07 % for RT on this condition . Significant improvement ( P<0.05 ) was also observed in favor of BT ( in mean 3.2 % ) for balance gains in some BESTest scores , when compared to RT group ( -0.98 % ) . CONCLUSIONS Postural control in Parkinson 's disease is improved when training by a directional and specific balance program than a resistance training program . CLINICAL REHABILITATION IMPACT Balance training is superior to resistance training in regard to improving postural control of individuals with PD . Gold st and ard instruments ( high in cost and difficult to access ) were used to assess balance , as well as scales with clinical applicability ( low cost , easily acceptable , applicable and valid ) , which can guide the management of physiotherapists both in their decision-making and in clinical practice Background and Purpose : Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment . Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative . This is the first study to compare the modified Clinical Test of Sensory Integration for Balance ( i-mCTSIB ) to the laboratory test of the Sensory Organization Test ( SOT ) with dynamic posturography in a group of participants with Parkinson 's disease ( PD ) and subtle balance limitations . The purpose of this study was to ( 1 ) determine the concurrent validity of the i-mCTSIB with the SOT ( 6 and 4 conditions ) and ( 2 ) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months . Methods : This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson 's Disease Rating Scale score of 32.7 ( 13.5 ) out of 108 . Results : The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated : composite scores r = −0.64 ( P ⩽ .001 ) , C1 r = −0.43 ( P = .03 ) , C3 r = −0.60 ( P ⩽ .01 ) , and C4 r = −0.54 ( P ⩽ .001 ) . A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers ( P = .04 ) . In contrast , the SOT composite was not significantly different between fallers and nonfallers ( P = 0.31 ) . Discussion : The results suggest that the i-mCTSIB may be a valid and clinical ly meaningful measure of sensory organization in persons with PD , even those with mild postural instability as measured by the median Hoehn and Yahr score ( 2.0 ) . Future research should evaluate predictive validity of the i-mCTSIB for prospect i ve falls . Conclusion : The instrumented mCTSIB with portable , body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT . Instrumenting mCTSIB may also distinguish between fallers and nonfallers Background There is increasing scientific knowledge about the interaction between physiological ( musculoskeletal , neuromuscular , cognitive and sensory ) systems and their influence on balance and walking impairments in Parkinson ’s disease . We have developed a new conceptual framework for balance training , emphasising specific components of balance control related to Parkinson ’s disease symptoms by using highly challenging , progressive and varying training conditions . The primary aim of this proposed r and omised controlled trial will be to investigate the short-term and long-term effects of a 10-week balance training regime in elderly with Parkinson ’s disease . Methods / Design Eighty participants with mild to moderate idiopathic Parkinson ’s disease will be recruited and r and omly allocated to an intervention group receiving balance training or a control group whose participants will continue to receive their usual care . The intervention will consist of a 10-week group training regime ( 1-hour training , three times per week ) , which will be led by two physiotherapists to ensure training progression and safety . The conceptual framework will be applied by addressing specific balance components ( sensory integration , anticipatory postural adjustments , motor agility , stability limits ) through varying training conditions and structured progression . Assessment will be conducted through a multi-dimensional battery of outcomes , prior to and immediately after the 10-week intervention , and at 9 and 15 months ’ follow-up after entering the study . Primary outcome measures will be balance performance ( assessed using the Mini Balance Evaluation Systems Test ) , change in gait velocity ( m/s ) between single and dual task walking , and fear of falling ( evaluated using the Fall Efficacy Scale International ) . Discussion This study has the potential to provide new insight and knowledge of the effects of specific , varied and challenging balance training on a wide health spectrum in elderly with PD . If found to be effective , this pragmatic approach with translation of theory into practice , can be implemented in existing outpatient care . Trial registration OBJECTIVE To assess immediate and near-term effects of 2 exercise training programs for persons with idiopathic Parkinson 's disease ( IPD ) . DESIGN R and omized control trial . SETTING Public health facility and medical center . PARTICIPANTS Fifteen persons with IPD . INTERVENTION Combined group ( balance and resistance training ) and balance group ( balance training only ) underwent 10 weeks of high-intensity resistance training ( knee extensors and flexors , ankle plantarflexion ) and /or balance training under altered visual and somatosensory sensory conditions , 3 times a week on nonconsecutive days . Groups were assessed before , immediately after training , and 4 weeks later . MAIN OUTCOME MEASURES Balance was assessed by computerized dynamic posturography  , which determined the subject 's response to reduced or altered visual and somatosensory orientation cues ( Sensory Orientation Test [ SOT ] ) . Muscle strength was assessed by measuring the amount of weight a participant could lift , by using a st and ardized weight- and -pulley system , during a 4-repetition-maximum test of knee extension , knee flexion , and ankle plantarflexion . RESULTS Both types of training improved SOT performance . This effect was larger in the combined group . Both groups could balance longer before falling , and this effect persisted for at least 4 weeks . Muscle strength increased marginally in the balance group and substantially in the combined group , and this effect persisted for at least 4 weeks . CONCLUSION Muscle strength and balance can be improved in persons with IPD by high-intensity resistance training and balance training Postural instability is a sign of progression of Parkinson 's disease ( PD ) and often resistant to levodopa treatment . To explore the effect of bilateral deep brain stimulation ( DBS ) of the subthalamic nucleus ( STN ) on postural stability and gait , full body gait analyses were performed without medication , OFF and ON DBS in eight PD patients and 12 healthy age-matched controls . DBS setting was changed at least 3 hours before gait analysis . To describe asymmetry most and least affected sides ( MAS and LAS ) were rated with the Unified Parkinson 's Disease Rating Scale , motor part and quantitative gait analysis with the Vicon 612 gait analysis system . Stride length and gait velocity but not cadence improved ON DBS . The distances between the heel markers and center of mass ( COM ) were asymmetric and reduced OFF DBS . STN DBS  increased the distances significantly and reduced asymmetry . The improvement in heel to COM distance was larger on the MAS compared with the LAS . OFF DBS knee momentum asymmetry was inversed so that LAS was more impaired than MAS . ON DBS asymmetry improved . PD patients OFF  DBS place the heel too close to COM . The most affected body side has the most impaired swing and the result is a smaller knee moment on the opposite and least affected body side and an asymmetric gait pattern with disturbed balance OFF STN DBS . The asymmetry OFF DBS improved ON DBS . We suggest that DBS facilitates symmetric gait and thereby improves balance during gait BACKGROUND The effect of the surgical site of DBS on balance and gait in Parkinson 's Disease ( PD ) is uncertain . This is the first double-blind study of subjects r and omized to either the STN ( N = 14 ) or GPi ( N = 14 ) who were assessed on a range of clinical balance measures . METHODS Balance testing occurred before and 6 months postsurgery . A control PD group was tested over the same period without surgery ( N = 9 ) . All subjects were tested on and off medication and DBS subjects were also tested on and off DBS . The Postural Instability and Gait Disability items of the UPDRS and additional functional tests , which we call the Balance and Gait scale , were assessed . Activities of Balance Confidence and Activities of Daily Living question naires were also recorded . RESULTS Balance was not different between the best-treated states before and after DBS surgery for both sites . Switching DBS on improved balance scores , and scores further improved with medication , compared to the off state . The GPi group showed improved performance in the postsurgery off state and better ratings of balance confidence after surgery , compared to the STN group . CONCLUSIONS Clinical measures of balance function for both the STN and GPi sites showed that balance did not improve beyond the best medically treated state before surgery . Both clinical balance testing in the off/off state and self-reported balance confidence after surgery showed better performance in the GPi than the STN group OBJECTIVE To compare the effects of whole body vibration ( WBV ) and conventional physiotherapy ( PT ) on levodopa-resistant disturbances of balance and gait in idiopathic Parkinson 's disease ( PD ) . DESIGN R and omized controlled rater-blinded trial comparing 2 active interventions , final follow-up assessment 4 weeks after termination of active intervention . SETTING Specialized referral center , hospitalized care . PARTICIPANTS Patients with PD and dopa-resistant imbalance on stable dopamine replacement medication ( N=27 ) were r and omized ( intent-to-treat population ) to receive WBV  ( n=13 ) or  conventional PT ( controls , n=14 ) . Twenty-one patients ( per protocol population ) completed follow-up ( 14 men , 7 women ; mean age , 73.8 y ; age range , 62 - 84 y ; mean disease duration , 7.2 y ; mean dopa-equivalent dose , 768 mg/d ) . INTERVENTION Subjects were r and omized to receive 30 sessions ( two 15-min sessions a day , 5 days a week ) of either WBV on an oscillating platform or conventional balance training including exercises on a tilt board .  Twenty-one subjects ( 10 with WBV , 11 controls ) were available for follow-up 4 weeks after treatment termination . MAIN OUTCOME MEASURES The primary measure was Tinetti Balance Scale score . Secondary clinical ratings included st and -walk-sit test , walking velocity , Unified Parkinson 's Disease Rating Scale ( section III motor examination ) score , performance in the pull test , and dynamic posturography . RESULTS The Tinetti score improved from 9.3 to 12.8 points in the WBV group and from 8.3 to 11.7 in the controls . All secondary measures , except posturography , likewise improved at follow-up compared with baseline in both groups . Quantitative dynamic posturography only improved in patients with WBV ( 1937 - 1467 mm ) whereas there was no significant change in controls ( 1832 - 2030 mm ) . CONCLUSIONS Equilibrium and gait improved in patients with PD receiving conventional WBV or conventional PT in the setting of a comprehensive rehabilitation program . There was no conclusive evidence for superior efficacy of WBV compared with conventional balance training Background and Purpose : Parkinson disease ( PD ) results in an increased frequency of falls relative to the frequency in neurologically healthy people . The purpose of this study was to compare the accuracy of PD fall risk diagnosis based on one test with that based on the collective interpretation of multiple tests . Participants : Seventy people with PD ( mean age=73.91 years ) participated in this study . Method : Clinical balance tests were conducted during the initial examinations of people with PD .  Validity indices were calculated for individual tests and compared with validity indices calculated for a combination of multiple tests . Results : Thirty-six participants reported a fall history . Analysis of individual tests revealed broad variations in validity indices , whereas the collective interpretation of multiple tests improved sensitivity and negative likelihood ratios . Discussion and Conclusion : Collective interpretation of clinical balance tests result ed in fewer false-negative results and more substantial adjustments to the posttest probability of being a “ faller ” than the interpretation of one test alone . These results should be confirmed in a prospect i ve examination of fall risk in PD Background : Impaired postural stability places individuals with Parkinson ’s at an increased risk for falls . Given the high incidence of fall-related injuries within this population , ongoing assessment of postural stability is important . Objective : To evaluate the validity of the Nintendo Wii ® balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson ’s . Subjects : Twenty individuals with Parkinson ’s participated . Intervention : Subjects completed testing on two balance tasks with eyes open and closed on a Wii ® balance board and biomechanical force platform . Main Measures : Bl and –Altman plots and a two-way , r and om-effects , single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data . Results : Concurrent validity was demonstrated to be excellent across balance tasks ( intraclass correlation coefficients = 0.96 , 0.98 , 0.92 , 0.94 ) . Conclusions : This study suggests that the Wii ® balance board is a valid tool for the quantification of postural stability among individuals with Parkinson ’s Compromised balance and loss of mobility are among the major consequences of Parkinson 's disease ( PD ) . The literature documents numerous effective interventions for improving balance and mobility . The purpose of this study was to verify the effectiveness of two exercise programs on balance and mobility in people with idiopathic PD . Thirty-four participants , with idiopathic PD that ranged from Stage I to Stage III on the Hoehn & Yahr ( H&Y ) scale , were assigned to two groups . Group 1 ( n = 21 ; 67+/-9 years old ) was engaged in an intensive exercise program ( aerobic capacity , flexibility , strength , motor coordination and balance ) for 6 months : 72 sessions , 3 times a week , 60 minutes per session ; while Group 2 ( n = 13 ; 69+/-8 years old ) participated in an adaptive program ( flexibility , strength , motor coordination and balance ) for 6 months : 24 sessions , once a week , 60 minutes per session . Balance and basic functional mobility were assessed in pre- and post-tests by means of the Berg Balance Scale and the Timed Up and Go Test . Before and after the interventions , groups were similar in clinical conditions ( H&Y , UPDRS , and Mini-Mental ) . A MANOVA 2 ( programs ) by 2 ( moments ) revealed that both groups were affected by the exercise intervention . Univariate analyses showed that participants improved their mobility and balance from pre- to post-test . There were no differences between groups in either mobility or balance results . Both the intensive and adaptive exercise programs improved balance and mobility in patients with PD Background . Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson ’s disease ( PD ) . However , there are inconsistent findings on the effects of balance and gait training on balance confidence . Objective . To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups . Methods . A total of 51 PD patients were r and omly assigned to a balance and gait training ( BAL ) group or to an active control ( CON ) group . The BAL group received balance and gait training with augmented feedback , whereas CON participants received lower-limb strength training for 12 weeks . Outcome measures included Activities-Specific Balance Confidence ( ABC ) Scale , limits-of-stability test , single-leg-stance test , and spatiotemporal gait characteristics . All tests were administered before intervention ( Pre ) , immediately after training ( Post ) , and at 3 months ( Post3 m ) and 12 months ( Post12 m ) after treatment completion . Results . The ABC score improved marginally at Post and significantly at Post3 m and Post12 m only in the BAL group ( P < .017 ) . Both participant groups increased their end point excursion at Post , but only the BAL group maintained the improvement at Post3 m . The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3 m and Post12 m ( P < .05 ) . For gait characteristics , both participant groups increased gait velocity , but only the BAL group increased stride length at Post , Post3 m , and Post12 m ( P < .017 ) . Conclusions . Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD Abstract Posture , gait and balance problems are very disabling symptoms in Parkinson ’s disease ( PD ) . An increased stride-to-stri de variability , reduction of automaticity and asymmetry of lower limbs function characterize parkinsonian gait . These features predispose to freezing of gait ( FOG ) , which often leads to falls . The aim of this study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and reduce FOG , thus preventing falls .  Twenty-eight PD patients entered a double-blind pilot feasibility controlled study and were evaluated at baseline and after 3 months of a rehabilitative program ( performed twice a week ) by means of the motor part of the Unified Parkinson ’s Disease Rating Scale ( UPDRS-III ) , Gait and Falls Question naire , Tinetti balance and gait scale , Short Physical Performance Battery ( SPPB ) , European Quality of Life question naire . Patients were r and omly assigned to three treatment arms : ( 1 ) worst side improvement ; ( 2 ) best side improvement ; ( 3 ) st and ard therapy . All study arms showed a significant improvement of the Tinetti and SPPB scores . BSI led to a greater improvement than ST in terms of UPDRS-III ( p = 0.01 ) ; Tinetti total score ( p = 0.05 ) and Tinetti gait subscore ( p = 0.01 ) . Our study confirms the efficacy of physical therapy in the treatment of PD and , more importantly , suggests that specific intervention tailored on individual feature ( e.g. , asymmetry of motor condition ) might be even more effective than st and ard rehabilitative programs Gait and balance disorders are the major source of motor disabilities in advanced forms of Parkinson ’s disease ( PD ) .  Low-frequency stimulation of the pedunculopontine nucleus area ( PPNa-DBS ) has been recently proposed to treat these symptoms with variable clinical results . To further underst and the effects of PPNa-DBS on resistant gait and balance disorders , we performed a r and omised double-blind cross-over study in six PD patients . Evaluation included clinical assessment of parkinsonian disability , quality of life and neurophysiological recordings of gait . Evaluations were done 1 month before , 4 and 6 months after surgery with four double-blinded conditions assessed : with and without PPNa-DBS , with and without levodopa treatment .  Four patients completed the study and two patients were excluded from the final analysis because of peri-operative adverse events ( haematoma , infection ) . Clinical ly , the combination of PPNa-DBS and levodopa treatment produced a significant decrease of the freezing episodes . The frequency of falls also decreased in three out of four patients . From a neurophysiological point of view , PPNa-DBS significantly improved the anticipatory postural adjustments and double-stance duration , but not the length and speed of the first step . Interestingly , step length and speed improved after surgery without PPNa-DBS , suggesting that the lesioning effect of PPNa-DBS surgery alleviates parkinsonian akinesia . Quality of life was also significantly improved with PPNa-DBS . These results suggest that PPNa-DBS could improve gait and balance disorders in well-selected PD patients . However , this treatment may be riskier than others DBS surgeries in these patients with an advanced form of PD
Overall , there are many scales and tests used to assess the balance disorders and disabilities of people with PD .
Postural instability is common in Parkinson ’s disease ( PD ) , often contributing to falls , injuries , and reduced mobility .
In the clinical setting , balance disorder is commonly diagnosed using clinical tests and balance scales , but it is suggested that the most sensitive measurement is the force platform .
The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD .