Falling Out of Postural Instability: Evaluating the Contribution of Somatosensation to Standing Balance in Parkinson's Disease
DOI:
https://doi.org/10.47611/jsrhs.v12i3.4914Keywords:
Parkinson's Disease, Somatosensory System, Falls, Postural InstabilityAbstract
People with PD (PwPD) experience a variety of motor symptoms, including postural instability, impaired gait, tremors, and falls. Falls among PwPD are especially debilitating, as they can result in fracture risk, increased progression of the disease, and even death. Previous research has demonstrated that the somatosensory system, consisting of tactile sensation (which is responsible for feelings of touch and pressure) and proprioceptive feedback (which is important in joint position sense), is crucial for reactive balance control. The primary goal of this project was to determine the unique contributions of the tactile and proprioceptive systems to standing balance control in PD. Participants at the Gait and Balance Disorders Lab at Arizona State University were asked to maintain their balance while experiencing 3 sensory vibration conditions from vibrotactile transducers 1) a control condition with no vibration, 2) vibration underneath the feet to disturb tactile sensation, and 3) vibration on top of their feet (dorsiflexor tendon) to manipulate proprioception. Another goal was to identify predictors of somatosensory impairment during standing balance (i.e., participants affected most by sensory vibration) by associating clinical characteristics with change scores in balance outcomes from the no vibration-control condition to the tactile and proprioceptive stimulation conditions. The results of this study indicate that vibrotactile stimulation had minimal impacts on standing balance responses. This study also found few predictors of somatosensory impairments. Further research is needed to enhance clinical efficiency in designing treatments that have the most impact on improving balance control and preventing falls.
Downloads
References or Bibliography
Albrecht, J. S., Al Kibria, G., Gruber-Baldini, A., & Magaziner, J. (2018). Risk of mortality in individuals with hip fracture and traumatic brain injury. Journal of the American Geriatrics Society, 67(1), 124–127. https://doi.org/10.1111/jgs.15661
Anastasopoulos, D. (2020). Tremor in parkinson’s disease may arise from interactions of central rhythms with spinal reflex loop oscillations. Journal of Parkinson's Disease, 10(2), 383–392. https://doi.org/10.3233/jpd-191715
APDM, Inc. (2016, March 22). Mobility Lab User's Guide. Retrieved May 2, 2023, from https://share2.apdm.com/documentation/MobilityLabv1UserGuide.pdf
Ator, G. A. (n.d.). The balance system. The University of Kansas Health System. Retrieved January 21, 2023, from https://www.kansashealthsystem.com/news-room/blog/0001/01/the-balance-system
Bronte-Stewart, H. M. (2002). Postural instability in idiopathic parkinson's disease: The role of medication and unilateral pallidotomy. Brain, 125(9), 2100–2114. https://doi.org/10.1093/brain/awf207
Centers for Disease Control and Prevention. (2021, August 6). Facts about falls. Retrieved December 5, 2022, from https://www.cdc.gov/falls/facts.html
Conte, A., Khan, N., Defazio, G., Rothwell, J. C., & Berardelli, A. (2013). Pathophysiology of somatosensory abnormalities in parkinson disease. Nature Reviews Neurology, 9(12), 687–697. https://doi.org/10.1038/nrneurol.2013.224
Federica, D. B., Eliana, F., Stefania, B., Gianpiero, G., Dario, A., & Antonio, C. (2009). The use of rubber foam pads and “sensory ratios” to reduce variability in static posturography assessment. Gait & Posture, 29(1), 158–160. doi:10.1016/j.gaitpost.2008.08.006
Fjeldstad, C., Pardo, G., Bemben, D., & Bemben, M. (2011). Decreased postural balance in multiple sclerosis patients with low disability. International Journal of Rehabilitation Research, 34(1), 53–58. https://doi.org/10.1097/mrr.0b013e32833d6ccb
Gaerlan, M.G. (2010). The role of visual, vestibular, and somatosensory systems in postural balance. UNLV Theses, Dissertations, Professional Papers, and Capstones. 357. http://dx.doi.org/10.34917/1598677
Gerards, M. H. G., McCrum, C., Mansfield, A., & Meijer, K. (2017). Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. Geriatrics & Gerontology International, 17(12), 2294–2303. https://doi.org/10.1111/ggi.13082
Gorst, T., Marsden, J., & Freeman, J. (2019). Lower limb somatosensory discrimination is impaired in people with parkinson's disease: Novel assessment and associations with balance, gait, and Falls. Movement Disorders Clinical Practice, 6(7), 593–600. https://doi.org/10.1002/mdc3.12831
Horak, F. B. (2006). Postural orientation and equilibrium: What do we need to know about neural control of balance to prevent falls? Age and Ageing, 35(suppl_2), ii7–ii11. https://doi.org/10.1093/ageing/afl077
Hospod, V., Aimonetti, J.-M., Roll, J.-P., & Ribot-Ciscar, E. (2007). Changes in human muscle spindle sensitivity during a proprioceptive attention task. The Journal of Neuroscience, 27(19), 5172–5178. https://doi.org/10.1523/jneurosci.0572-07.2007
Institute for Quality and Efficiency in Health Care. (2017, September 7). How does our sense of balance work? informedhealth.org. Retrieved January 6, 2023, from https://www.informedhealth.org/how-does-our-sense-of-balance-work.html
Kars, H. J., Hijmans, J. M., Geertzen, J. H., & Zijlstra, W. (2009). The effect of reduced somatosensation on standing balance: a systematic review. Journal of diabetes science and technology, 3(4), 931–943. https://doi.org/10.1177/193229680900300441
McKeon, P. O., & Hertel, J. (2007). Diminished plantar cutaneous sensation and postural control. Perceptual and Motor Skills, 104(1), 56–66. https://doi.org/10.2466/pms.104.1.56-66
McLellan, D. L. (1973). Dynamic spindle reflexes and the rigidity of parkinsonism. Journal of Neurology, Neurosurgery & Psychiatry, 36(3), 342–349. https://doi.org/10.1136/jnnp.36.3.342
Meyer, P. F., Oddsson, L. I., & De Luca, C. J. (2004). Reduced plantar sensitivity alters postural responses to lateral perturbations of balance. Experimental Brain Research, 157(4), 526–536. https://doi.org/10.1007/s00221-004-1868-3
Monaghan, A. S., Finley, J. M., Mehta, S. H., & Peterson, D. S. (2021-a). Assessing the impact of dual-task reactive step practice in people with Parkinson's disease: A feasibility study. Human Movement Science, 80, 102876. https://doi.org/10.1016/j.humov.2021.102876
Monaghan, A. S., Mansfield, A., Huisinga, J. M., & Peterson, D. S. (2022). Examining the relationship between reactive stepping outcomes and falls in people with multiple sclerosis. Physical Therapy, 102(6). https://doi.org/10.1093/ptj/pzac041
Monaghan, A. S., Monaghan, P. G., Richmond, S. B., Roper, J. A., & Fling, B. W. (2021-b). The effect of shoe cushioning on gait and balance in females with multiple sclerosis. Experimental Brain Research, 239(8), 2593–2603. https://doi.org/10.1007/s00221-021-06161-1
Monaghan, A. S., Huisinga, J. M., & Peterson, D. S. (2021-c). The relationship between plantar sensation and muscle onset during automatic postural responses in people with multiple sclerosis and healthy controls. Multiple Sclerosis and Related Disorders, 56, 103313. https://doi.org/10.1016/j.msard.2021.103313
National Institute on Aging. (2022, April 14). Parkinson's disease: Causes, symptoms, and treatments. U.S. Department of Health and Human Services, National Institutes of Health. Retrieved October 22, 2022, from https://www.nia.nih.gov/health/parkinsons-disease
Oddsson, L. I., De Luca, C. J., & Meyer, P. F. (2004). The role of plantar cutaneous sensation in unperturbed stance. Experimental Brain Research, 156(4), 505–512. https://doi.org/10.1007/s00221-003-1804-y
Parkinson's Foundation. (n.d.-a). Falls prevention. Retrieved November 4, 2022, from https://www.parkinson.org/library/fact-sheets/falls-prevention#:~:text=In%201817%2C%20when%20James%20Parkinson,the%20risk%20of%20their%20peers.
Parkinson's Foundation. (n.d.-b). Prevalence & Incidence. Retrieved December 17, 2022, from https://www.parkinson.org/understanding-parkinsons/statistics/prevalence-incidence#:~:text=Parkinson's%20Incidence,rate%20of%2060%2C000%20diagnoses%20annually
Parkinson's Foundation. (n.d.-c). Statistics. Retrieved October 22, 2022, from https://www.parkinson.org/understanding-parkinsons/statistics
Peterson, D. S., Dijkstra, B. W., & Horak, F. B. (2016). Postural motor learning in people with Parkinson's disease. Journal of Neurology, 263(8), 1518–1529. https://doi.org/10.1007/s00415-016-8158-4
Robertson, M. (n.d.). The postural control system. Physiopedia. Retrieved March 19, 2023, from https://www.physio-pedia.com/The_Postural_Control_System#:~:text=The%20somatosensory%20system%20plays%20a,the%20balance%20and%20postural%20control.
Shaffer, S. W., & Harrison, A. L. (2007). Aging of the somatosensory system: A translational perspective. Physical Therapy, 87(2), 193–207. https://doi.org/10.2522/ptj.20060083
U.S. Department of Veterans Affairs. (2007, January 11). UPDRS. Parkinson’s Disease Research, Education and Clinical Centers. Retrieved April 7, 2023, from https://www.parkinsons.va.gov/resources/UPDRS.asp#:~:text=1%20%3D%20Slight%20but%20definite%20excess,requires%20constant%20tissue%20or%20handkerchief.
Wiedenmann, T., Held, S., Rappelt, L., Grauduszus, M., Spickermann, S., & Donath, L. (2023). Exercise based reduction of falls in communitydwelling older adults: A network meta-analysis. European Review of Aging and Physical Activity, 20(1). https://doi.org/10.1186/s11556-023-00311-w
Published
How to Cite
Issue
Section
Copyright (c) 2023 Katherine Shi, Andrew Monaghan; Daniel Peterson
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.
