title: Postural control and freezing of gait in Parkinson's disease.
abstract: BACKGROUND
  The relationship between freezing of gait (FOG) and postural instability in Parkinson's disease (PD) is unclear. We analyzed the impact of FOG on postural control.
  
  
  METHODS
  31 PD patients with FOG (PD+FOG), 27 PD patients without FOG (PD-FOG) and 22 healthy control (HC) were assessed in the ON state. Postural control was measured with the Fullerton Advanced Balance (FAB) scale and with center of pressure (COP) analysis during quiet stance and maximal voluntary forward/backward leaning.
  
  
  RESULTS
  The groups were balanced concerning age, disease duration and disease severity. PD+FOG performed significantly worse in the FAB scale (21.8 ± 5.8) compared to PD-FOG (25.6 ± 5.0) and HC (34.9 ± 2.4) (mean ± SD, p < 0.01). PD+FOG had impaired ability to voluntary lean forward, difficulties to stand on foam with eyes closed and reduced limits of stability compared to PD-FOG (p < 0.05). During quiet stance the average anterior-posterior COP position was significantly displaced towards posterior in PD+FOG in comparison to PD-FOG and HC (p < 0.05). The COP position correlated with severity of FOG (p < 0.01). PD+FOG and PD-FOG did not differ in average COP sway excursion, sway velocity, sway regularity and postural control asymmetry.
  
  
  CONCLUSIONS
  PD+FOG have reduced postural control compared to PD-FOG and HC. Our results show a relationship between the anterior-posterior COP position during quiet stance and FOG. The COP shift towards posterior in PD+FOG leads to a restricted precondition to generate forward progression during gait initiation. This may contribute to the occurrence of FOG or might be a compensatory strategy to avoid forward falls.
authors.affiliation: Department of Neurology, Christian-Albrechts-University, Kiel, Germany; Department of Sport Science, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlenstedt
authors.affiliation: Department of Neurology, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Muthuraman
authors.initials: M
authors.lastname: Muthuraman
authors.affiliation: Department of Neurology, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Witt
authors.affiliation: Department of Sport Science, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Weisser
authors.affiliation: Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.affiliation: Department of Neurology, Christian-Albrechts-University, Kiel, Germany. Electronic address: g.deuschl@neurologie.uni-kiel.de.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D004856:Postural Balance / Q000502:physiology*; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000209:etiology*; D012720:Severity of Illness Index
keywords: Asymmetry; Freezing of gait; Fullerton advanced balance scale; Parkinson's disease; Postural balance; Postural control; Posture