Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait

Balance control (the ability to maintain an upright posture) is asymmetrically controlled in a proportion of patients with Parkinson’s disease. Gait asymmetries have been linked to the pathophysiology of freezing of gait. We speculate that asymmetries in balance could contribute to freezing by a) ha...

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Main Authors:	Boonstra, Tjitske A., van Vugt, Jeroen P. P., van der Kooij, Herman, Bloem, Bastiaan R.
Format:	Online
Language:	English
Published:	Public Library of Science 2014
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102504/

id	pubmed-4102504
recordtype	oai_dc
spelling	pubmed-41025042014-07-21 Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait Boonstra, Tjitske A. van Vugt, Jeroen P. P. van der Kooij, Herman Bloem, Bastiaan R. Research Article Balance control (the ability to maintain an upright posture) is asymmetrically controlled in a proportion of patients with Parkinson’s disease. Gait asymmetries have been linked to the pathophysiology of freezing of gait. We speculate that asymmetries in balance could contribute to freezing by a) hampering the unloading of the stepping leg and/or b) leading to a preferred stance leg during gait, which then results in asymmetric gait. To investigate this, we examined the relationship between balance control and weight-bearing asymmetries and freezing. We included 20 human patients with Parkinson (tested OFF medication; nine freezers) and nine healthy controls. Balance was perturbed in the sagittal plane, using continuous multi-sine perturbations, applied by a motion platform and by a force at the sacrum. Applying closed-loop system identification techniques, relating the body sway angle to the joint torques of each leg separately, determined the relative contribution of each ankle and hip joint to the total amount of joint torque. We also calculated weight-bearing asymmetries. We determined the 99-percent confidence interval of weight-bearing and balance-control asymmetry using the responses of the healthy controls. Freezers did not have larger asymmetries in weight bearing (p = 0.85) nor more asymmetrical balance control compared to non-freezers (p = 0.25). The healthy linear one-to-one relationship between weight bearing and balance control was significantly different for freezers and non-freezers (p = 0.01). Specifically, non-freezers had a significant relationship between weight bearing and balance control (p = 0.02), whereas this relation was not significant for freezers (p = 0.15). Balance control is asymmetrical in most patients (about 75 percent) with Parkinson’s disease, but this asymmetry is not related to freezing. The relationship between weight bearing and balance control seems to be less pronounced in freezers, compared to healthy controls and non-freezers. However, this relationship should be investigated further in larger groups of patients. Public Library of Science 2014-07-17 /pmc/articles/PMC4102504/ /pubmed/25032994 http://dx.doi.org/10.1371/journal.pone.0102493 Text en © 2014 Boonstra et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Boonstra, Tjitske A. van Vugt, Jeroen P. P. van der Kooij, Herman Bloem, Bastiaan R.
spellingShingle	Boonstra, Tjitske A. van Vugt, Jeroen P. P. van der Kooij, Herman Bloem, Bastiaan R. Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait
author_facet	Boonstra, Tjitske A. van Vugt, Jeroen P. P. van der Kooij, Herman Bloem, Bastiaan R.
author_sort	Boonstra, Tjitske A.
title	Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait
title_short	Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait
title_full	Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait
title_fullStr	Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait
title_full_unstemmed	Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait
title_sort	balance asymmetry in parkinson’s disease and its contribution to freezing of gait
description	Balance control (the ability to maintain an upright posture) is asymmetrically controlled in a proportion of patients with Parkinson’s disease. Gait asymmetries have been linked to the pathophysiology of freezing of gait. We speculate that asymmetries in balance could contribute to freezing by a) hampering the unloading of the stepping leg and/or b) leading to a preferred stance leg during gait, which then results in asymmetric gait. To investigate this, we examined the relationship between balance control and weight-bearing asymmetries and freezing. We included 20 human patients with Parkinson (tested OFF medication; nine freezers) and nine healthy controls. Balance was perturbed in the sagittal plane, using continuous multi-sine perturbations, applied by a motion platform and by a force at the sacrum. Applying closed-loop system identification techniques, relating the body sway angle to the joint torques of each leg separately, determined the relative contribution of each ankle and hip joint to the total amount of joint torque. We also calculated weight-bearing asymmetries. We determined the 99-percent confidence interval of weight-bearing and balance-control asymmetry using the responses of the healthy controls. Freezers did not have larger asymmetries in weight bearing (p = 0.85) nor more asymmetrical balance control compared to non-freezers (p = 0.25). The healthy linear one-to-one relationship between weight bearing and balance control was significantly different for freezers and non-freezers (p = 0.01). Specifically, non-freezers had a significant relationship between weight bearing and balance control (p = 0.02), whereas this relation was not significant for freezers (p = 0.15). Balance control is asymmetrical in most patients (about 75 percent) with Parkinson’s disease, but this asymmetry is not related to freezing. The relationship between weight bearing and balance control seems to be less pronounced in freezers, compared to healthy controls and non-freezers. However, this relationship should be investigated further in larger groups of patients.
publisher	Public Library of Science
publishDate	2014
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102504/
_version_	1613115358039769088

Balance Asymmetry in Parkinson’s Disease and Its Contribution to Freezing of Gait

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