Department of Neurology, Oregon Health and Science University, Beaverton, OR, USA.
Arch Phys Med Rehabil. 2010 Sep;91(9):1332-8. doi: 10.1016/j.apmr.2010.05.013.
To characterize preparation for compensatory stepping in people with Parkinson's disease (PD) compared with healthy control subjects, and to determine whether levodopa medication improves preparation or the execution phases of the step.
Observational study.
Outpatient neuroscience laboratory.
Nineteen participants with idiopathic PD tested both in the on and off levodopa states and 17 healthy subjects.
Moveable platform with posterior translations of 24cm at 56cm/s.
Compensatory steps forward, in response to a backward surface translation (24cm amplitude at 56cm/s), were categorized according to the presence of an anticipatory postural adjustment (APA) before stepping: no APA, single APA, or multiple APAs. The following step parameters were calculated: step latency, step length, center of mass (CoM) average velocity, and CoM displacement at the step initiation.
Lateral APAs were evident in 57% and 42% of trials for people with PD in the off and on medication states, respectively, compared with only 10% of trials for control subjects. Compared with subjects with PD who did not have APAs, those subjects with PD who did make an APA prior to stepping had significantly later (mean +/- SEM, 356+/-16ms vs 305+/-8ms) and shorter (mean +/- SEM, 251+/-27mm vs 300+/-16mm) steps, their CoM was significantly farther forward (185+/-7mm vs 171+/-5mm) at foot-off, and they took significantly more steps to regain equilibrium. Levodopa did not affect the preparation or execution phase of compensatory stepping. Poor axial scores and reports of freezing in the United Parkinson's Disease Rating Scale were associated with use of 1 or more APAs before compensatory stepping.
Lateral postural preparation prior to compensatory stepping in subjects with PD was associated with inefficient balance recovery from external perturbations.
描述帕金森病（PD）患者与健康对照者在代偿性跨步中的准备情况，并确定左旋多巴药物是否改善了跨步的准备或执行阶段。
观察性研究。
门诊神经科学实验室。
19 名特发性 PD 患者，分别在服用和不服用左旋多巴状态下进行测试，以及 17 名健康受试者。
可移动平台，向后平移 24cm，速度为 56cm/s。
向前补偿跨步，以响应向后的表面平移（24cm 幅度，56cm/s），根据跨步前是否存在预期姿势调整（APA）进行分类：无 APA、单 APA 或多 APA。计算以下跨步参数：跨步潜伏期、跨步长度、质心（CoM）平均速度和跨步起始时的 CoM 位移。
与对照组相比，PD 患者在停药和服药状态下，分别有 57%和 42%的试验出现了侧向 APA，而对照组只有 10%的试验出现了 APA。与没有 APA 的 PD 患者相比，那些在跨步前有 APA 的 PD 患者的跨步明显更迟（平均 +/- SEM，356+/-16ms 比 305+/-8ms）和更短（平均 +/- SEM，251+/-27mm 比 300+/-16mm），他们的 CoM 在足离地时明显更靠前（185+/-7mm 比 171+/-5mm），并且他们需要采取更多的跨步来恢复平衡。左旋多巴并没有影响代偿性跨步的准备或执行阶段。在 United Parkinson's Disease Rating Scale 中，轴向评分较差和冻结报告与在代偿性跨步前使用 1 个或多个 APA 有关。
PD 患者在代偿性跨步前的侧向姿势准备与从外部干扰中恢复平衡的效率低下有关。
