Lateral stepping for postural correction in Parkinson's disease
Lateral stepping for postural correction in Parkinson's disease
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DOI：
10.1016/j.apmr.2007.11.017
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发表时间：
2008-03-01
影响因子：
4.3
通讯作者：
Horak, Fay B.
中科院分区：
文献类型：
--
作者：
King, Laurie A.;Horak, Fay B.
目的：探讨帕金森病(PD)患者的侧步姿势矫正策略及其抗帕金森药物的治疗效果。设计：观察性研究。地点：门诊神经科学实验室。参与者：13例特发性帕金森病患者在开启(PD ON)和关闭(PD OFF)左旋多巴状态下和14名健康老年人对照。干预：活动平台以14.6 cm/S坡道速度侧移12 cm。主要观察指标：侧向侧步、交叉步和不步3种姿势策略的发生率和特点。矫正步进的特征是扰动开始后步进的潜伏期、步速、步长和预期姿势调整(APA)的存在。结果：老年对照组参与者从未摔倒，而PD参与者在服药和停药状态下分别有24%和35%的受试者摔倒。分别进行了分析。PD和对照组参与者最常使用侧步策略；在所有试验中，分别有70%(对照组)、67%(PD关闭)和73%(PD开启)。PD参与者在使用交叉策略(75%的交叉试验)或无步骤策略(100%的无步骤试验)时摔倒的频率最高。在停药状态下，帕金森病患者启动侧步策略的时间比对照组晚(370+/-37ms比280+/-10ms，P<；01)，步幅更小(254+/-20 mm比357±17 mm，P<；01)，步幅更慢(0.99+/-0.08nvs 1.20+/-0.07m/S，P<；0.05)。PD OFF和PD ON状态在校正步进特性上没有差异。与对照组参与者不同，帕金森病患者经常(56%的侧步策略试验)在踏步前未能激活APA，尽管他们的APA存在时，其潜伏期和大小与对照组参与者相似。左旋多巴开启或关闭状态对跌倒、APAS、侧步潜伏期、速度或幅度没有显著影响(P>；0.05)。结论：PD患者在需要对侧向不平衡进行姿势矫正时，姿势不稳定和跌倒明显多于年龄匹配的对照组。尽管帕金森病患者通常使用类似的侧向步进策略作为侧向平移的对照，但缺乏预期的侧向体重移动，以及步进反应的减速特征有助于解释患有帕金森氏症的患者跌倒的更高比率。在左旋多巴开启和关闭状态之间没有发现差异。结果提示，以改善帕金森病侧向稳定性为目的的康复治疗应包括在采用侧向步进策略之前，以更快、更大的步幅恢复平衡。
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 < 01), and steps were smaller (254 +/- 20mm vs 357 +/- 17mm, P < .01) and slower (0.99 +/- 0.08nVs vs 1.20 +/- 0.07m/s, P < .05). No differences were found between the PD off versus PD on state in the corrective stepping characteristics. Unlike control participants, PD participants often (56% of side-step strategy trials) failed to activate an APA before stepping, although their APAs, when present, were of similar latency and magnitude as for control participants. Levodopa on or off state did not significantly affect falls, APAs, or lateral step latency, velocity, or amplitude (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.