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Acute effects of a lateral postural assist on voluntary step initiation in patients with Parkinson's disease

Authors

  • Marie-Laure Mille PhD,

    1. Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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  • Marjorie Johnson Hilliard MS, PT,

    1. Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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  • Katherine M. Martinez MA, PT,

    1. Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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  • Tanya Simuni MD,

    1. Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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  • Mark W. Rogers PhD, PT

    Corresponding author
    1. Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
    2. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
    • Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 1100, Chicago, IL 60611
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Abstract

Anticipatory postural adjustments (APAs) for lateral weight transfer and stability precede and accompany voluntary stepping. Patients with Parkinson's disease (PD) show delays in step initiation with altered APA characteristics that may reflect impaired interactions between posture and locomotion. The purpose of this study was to examine the influence of a lateral postural assist on step initiation in patients with early stage PD while off medication and healthy controls. Subjects performed self-paced rapid forward steps. In one condition (ASSIST), the APA was assisted at onset with a lateral pull applied to the pelvis by a motor-driven robotic system. Ground reaction forces and whole body kinematics were recorded to characterize the APA and step characteristics. Overall, PD subjects had a longer APA duration (P < 0.01) and longer first step duration (P < 0.027) than Control subjects. With the ASSIST, the APA duration for both groups was shorter (P < 0.001), the step onset time was earlier (P < 0.001), and the speed of the first step became faster for PD subjects. Postural assistance affecting the interaction between posture and locomotion may have therapeutic potential for improving movement function in patients with PD. © 2006 Movement Disorder Society

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