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Balance and Gait Represent Independent Domains of Mobility in Parkinson Disease

Fay B. Horak, Martina Mancini, Patricia Carlson-Kuhta, John G. Nutt, Arash Salarian
DOI: 10.2522/ptj.20150580 Published 1 September 2016
Fay B. Horak
F.B. Horak, PT, PhD, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; Department of Neurology, Oregon Health & Science University, Portland, Oregon.
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Martina Mancini
M. Mancini, PhD, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Rd, Portland, OR 97239 (USA).
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Patricia Carlson-Kuhta
P. Carlson-Kuhta, PhD, Department of Neurology, Oregon Health & Science University.
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John G. Nutt
J.G. Nutt, MD, Department of Neurology, Oregon Health & Science University.
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Arash Salarian
A. Salarian, PhD, Department of Neurology, Oregon Health & Science University.
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Figures

Figure 3.
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Figure 3.

Effect of Parkinson disease (PD) and levodopa replacement on each domain. Participants with PD in the off-levodopa state (PD-OFF group) are represented by the blue dotted line. Participants with PD in the on-levodopa state (PD-ON group) are represented by the light gray arrows, and the control group is represented by the dark gray arrows. Freq=frequency, Asym=asymmetry.

Figure 2.
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Figure 2.

Exploratory factor analysis of 30 measures performed during the Instrumented Stand and Walk Test (ISAW) test in 100 people with Parkinson disease in the off-levodopa state. Six independent domains of gait and balance were identified: sway area, sway frequency (freq), gait speed, gait trunk, gait timing, and arm asymmetry (asym). The percentage of variance explained by each factor and the total variance is given at right, as well as the loading of each measure. RMS=root mean square, CoM=center of mass, Dis=distance, RoM=range of motion, Horiz=horizontal, Acc=acceleration, Vert=vertical, Vel=velocity, ML=mediolateral, AP=anteroposterior, Asym=asymmetrical, SSI=Symbolic Symmetry Index.

Figure 1.
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Figure 1.

Visualization of the covariance structure of the Instrumented Stand and Walk Test (ISAW) measures in participants with Parkinson disease in the off-levodopa state (PD-OFF group). Blue indicates positive, and red indicates negative correlation. Higher color saturation indicates higher correlation. Gait metrics start with G_, turning metrics start with T_, anticipatory postural adjustments metrics start with A_, and postural sway metrics start with S_. RoM=range of motion, Horiz=horizontal, Acc=acceleration, Vert=vertical, Vel=velocity, ML=mediolateral, AP=anteroposterior, Asym=asymmetrical, SSI=Symbolic Symmetry Index, Freq=frequency, CoM=center of mass, RMS=root mean square, Dis=distance.

Figure 4.
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Figure 4.

Correlation between the gait trunk domain and the Postural Instability and Gait Disability (PIGD) subscale (from the Unified Parkinson's Disease Rating Scale [UPDRS] motor subscale) in participants with Parkinson disease.

Tables

Table 2.
Table 2.

Severity of Parkinson Disease in the On- and Off-Levodopa Statesa

  • ↵a UPDRS=Unified Parkinson's Disease Rating Scale, PIGD=Postural Instability and Gait Disability subscale of the UPDRS.

Table 1.
Table 1.

Characteristics of the Control and Parkinson Disease Groups

Supplementary Data

eTables and eFigure

Files in this Data Supplement:

  • eTables and eFigure (PDF) (58 KB) - This PDF contains the following supplements:
    • eTable 1. All Metrics Used in the Study
    • eTable 2. Difference in Mobility Factors Between the PDF OFF Group and the PD-ON and Control Groups
    • eFigure. Scree Plot of Eigenvalues Used to Determine How Many Factors to Use in Factor Analysis
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Vol 96 Issue 9 Table of Contents
Physical Therapy: 96 (9)

Issue highlights

  • Experiences of Physical Therapists Working in the Acute Hospital Setting: Systematic Review
  • Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive, Comparative Analysis Over Time
  • Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis
  • Physical Therapists' Perceptions and Use of Exercise in the Management of Subacromial Shoulder Impingement Syndrome: Focus Group Study
  • Balance and Gait Represent Independent Domains of Mobility in Parkinson Disease
  • Client Perspectives on Reclaiming Participation After a Traumatic Spinal Cord Injury in South Africa
  • Inpatient Rehabilitation Outcomes in Patients With Stroke Aged 85 Years or Older
  • Physical Activity Levels and Their Associations With Postural Control in the First Year After Stroke
  • Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain
  • Effectiveness of Global Postural Re-education in Patients With Chronic Nonspecific Neck Pain: Randomized Controlled Trial
  • Development and Integration of Professional Core Values Among Practicing Clinicians
  • Translation, Validation, and Reliability of the Dutch Late-Life Function and Disability Instrument Computer Adaptive Test
  • Coactivation During Dynamometry Testing in Adolescents With Spastic Cerebral Palsy
  • Cohort Study Comparing the Berg Balance Scale and the Mini-BESTest in People Who Have Multiple Sclerosis and Are Ambulatory
  • Use of Six-Minute Walk Test to Measure Functional Capacity After Liver Transplantation
  • Feasibility of the Six-Minute Walk Test for Patients Who Have Cystic Fibrosis, Are Ambulatory, and Require Mechanical Ventilation Before Lung Transplantation
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Balance and Gait Represent Independent Domains of Mobility in Parkinson Disease
Fay B. Horak, Martina Mancini, Patricia Carlson-Kuhta, John G. Nutt, Arash Salarian
Physical Therapy Sep 2016, 96 (9) 1364-1371; DOI: 10.2522/ptj.20150580

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Balance and Gait Represent Independent Domains of Mobility in Parkinson Disease
Fay B. Horak, Martina Mancini, Patricia Carlson-Kuhta, John G. Nutt, Arash Salarian
Physical Therapy Sep 2016, 96 (9) 1364-1371; DOI: 10.2522/ptj.20150580
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More in this TOC Section

  • Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease
  • Predictors of Reduced Frequency of Physical Activity 3 Months After Injury: Findings From the Prospective Outcomes of Injury Study
  • Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury
Show more Neurology

Subjects

  • Examination/Evaluation
    • Tests and Measurements
  • Musculoskeletal System/Orthopedic
    • Kinesiology/Biomechanics
    • Gait Disorders
  • Neurology/Neuromuscular System
    • Parkinson Disease and Parkinsonian Disorders
    • Balance

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