title: Impaired scaling of preparatory postural responses to repeated balance perturbations in Parkinsonian patients with comorbid white matter disease.
abstract: BACKGROUND
  Postural instability may result from altered sequencing of automatic motor programs for anticipatory postural corrections and/or impaired motor learning in Parkinson Disease (PD) patients. Comorbid white matter disease is a major determinant of axial motor impairment, leading to poorer stability than nigrostriatal dopaminergic denervation per se.
  
  
  OBJECTIVE
  To assess differences in anticipatory control of postural stability function between subjects affected by PD with comorbid leukoaraiosis (LPD), idiopathic Parkinson disease (IPD) and elderly healthy subjects (EHS) as control group.
  
  
  METHODS
  Eight patients with IPD, eight patients with LPD and eight age/weight matched elderly healthy subjects (EHS) were tested in standing position by measuring the Center of Pressure (CoP) along the anteroposterior axis (CoP-Y) while subjects were expecting three repeated backward surface translation.
  
  
  RESULTS
  LPD patients positioned the CoP-Y significantly backward while waiting for the second and third platform translations, with respect to their COP-Y position in preparation for the first translation. The IPD and EHS showed no significant differences in the COP-Y position among the repeated perturbation trials.
  
  
  CONCLUSIONS
  LPD patients show inability to rescale an effective preparatory postural pattern to known, repeated postural perturbations suggesting impaired sensory-motor strategies in anticipating perturbations. Anticipatory postural patterns remain effective in IPD patients.
authors.affiliation: U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Cioncoloni
authors.affiliation: U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Lodovica
authors.initials: L
authors.lastname: Martelli
authors.affiliation: Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università di Siena, Siena, Italy.
authors.forename: Deborah
authors.initials: D
authors.lastname: Rosignoli
authors.affiliation: Neurologia e Neurofisiologia Clinica, Dipartimento di Scienze Neurologiche e Neurosensoriali, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Mazzocchio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059031:Anticipation, Psychological / Q000502:physiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000453:epidemiology* / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology* / Q000503:physiopathology* / Q000523:psychology; D004856:Postural Balance / Q000502:physiology*; D011187:Posture / Q000502:physiology
keywords: Parkinson disease; leukoaraiosis; postural balance; prognosis; rehabilitation