Background

Postural instability in Parkinson’s disease (PD) often is ill-responsive to drugs and DBS. Physiotherapy is recommended but practicability and cost effectiveness are debatable. Research question: Can a simple ‘plug and play’ posturography system produce clinically meaningful measures and elicit postural motor learning in PD patients?

Methods

40 moderately affected PD patients in a general neurology outpatient clinic who complained of postural instability were included to practice shifts and stabilization of the center of pressure (COP) in a low intensity (once weekly 20-25 minutes over 6 weeks) dynamic posturographic training using the Biodex balance system^TM. Average deviations from mean COP position and from the center of the base of support (BOS) with different degrees of visual feedback in static and dynamic posturographic tasks other than the training tasks, the Berg-Balance-Scale (BBS) and patient self-ratings (FES-I, ABC scale) were assessed before and after training.

Results

Posturographic performance was significantly better with eyes open than closed and more so with explicit visual feedback of COP position (p < 0.005). Only with this latter type of feedback and only the deviation form the BOS in dynamic and static posturography was significantly correlated with BBS and UPDRS III (p < 0.001). The deviation from the BOS under explicit visual feedback significantly improved after training (p < 0.005) whereas BBS, FES-I and ABC-scale did not.

Significance

Our posturography procedures were well applicable as a routine clinical tool. They yielded clinically valid measures when COP position was visible and directional shifts from the BOS centre were quantified. Our training was effective for this posturographic measure only. Its significance as a predictor for clinical efficacy of higher intensity and longer term training schedules is hypothesized and warrants further studies.

中文翻译：

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在常规临床情况下对帕金森氏病进行动态姿势描记和姿势描记训练

背景

帕金森氏病（PD）的姿势不稳定性通常对药物和DBS无效。建议进行物理治疗，但实用性和成本效益尚有争议。研究问题：一个简单的“即插即用”姿势成像系统能否产生具有临床意义的措施并引发PD患者的姿势运动学习？

方法

在普通神经科门诊就诊的40例中度受影响的PD患者，他们抱怨姿势不稳，以低强度（6周内每周20-25分钟一次）进行动态体位训练，以练习改变和稳定压力中心（COP） Biodex平衡系统^TM。在静态和动态姿势描记任务中，除了训练任务，Berg-Balance-Balance量表（BBS）和患者自评外，平均COP位置和支持底座中心（BOS）在不同视觉反馈下的平均偏差（FES-1，ABC量表）在训练前后进行了评估。

结果

闭眼时的姿势描记性能明显好于闭眼，并且在COP位置的明确视觉反馈下更明显（p <0.005）。仅在后一种类型的反馈中，并且在动态和静态姿势描记中只有BOS的偏差才与BBS和UPDRS III显着相关（p <0.001）。训练后，明显视觉反馈下BOS的偏差显着改善（p <0.005），而BBS，FES-1和ABC量表则没有。

意义

我们的体位检查程序非常适合作为常规临床工具。当COP位置可见并且从BOS中心的方向偏移被量化时，他们提供了临床有效的措施。我们的培训仅对这种姿势测量有效。可以推测其作为预测较高强度和长期培训计划的临床疗效的意义，值得进一步研究。