Yang Wen-Chieh, Hsu Wei-Li, Wu Ruey-Meei, Lu Tung-Wu, Lin Kwan-Hwa
School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Gait Posture. 2016 Feb;44:83-8. doi: 10.1016/j.gaitpost.2015.10.023. Epub 2015 Nov 9.
Axial rigidity and postural instability in people with Parkinson's disease (PD) may contribute to turning difficulty. This study examined the rotation of axial segments and gait instability during turning in people with PD.
Thirteen PD and twelve age-matched healthy adults were recruited. Participants performed the timed Up-and-Go test and were recorded by a 3D motion capture system. Axial rotation was evaluated by the rotation onset of the head, thorax and pelvis. Gait stability was evaluated by the center of mass and center of pressure inclination angle. Turning performance was evaluated by turning time and turning steps.
During turning, PD adults rotated the head, thorax and pelvis simultaneously, whereas healthy adults rotated in a cranial to caudal sequence. Further, PD adults had a smaller sagittal inclination angle (p<0.001) but larger frontal inclination angle (p=0.006) than healthy adults. PD adults also turned slower (p=0.002) with a greater number of steps (p<0.001) than healthy adults. Last, PD adults showed a significant correlation between the sagittal inclination angle and turning steps (Spearman's ρ=-0.63), while healthy adults showed a significant correlation between frontal inclination angle and turning steps (Spearman's ρ=-0.67).
This study demonstrated the axial rigidity in PD adults during turning may reduce forward progression and increase lateral instability. The reduced progression is associated with extra turning steps and the increased lateral instability may result in great fall risk.
帕金森病（PD）患者的轴向僵硬和姿势不稳可能导致转身困难。本研究调查了PD患者转身时轴向节段的旋转情况和步态不稳情况。
招募了13名PD患者和12名年龄匹配的健康成年人。参与者进行了计时起立行走测试，并由三维运动捕捉系统进行记录。通过头部、胸部和骨盆的旋转起始来评估轴向旋转。通过重心和压力中心倾斜角度来评估步态稳定性。通过转身时间和转身步数来评估转身表现。
在转身过程中，PD成年患者同时旋转头部、胸部和骨盆，而健康成年人则按从头至尾的顺序旋转。此外，与健康成年人相比，PD成年患者矢状面倾斜角度更小（p<0.001），但额状面倾斜角度更大（p=0.006）。PD成年患者转身也比健康成年人更慢（p=0.002），步数更多（p<0.001）。最后，PD成年患者矢状面倾斜角度与转身步数之间存在显著相关性（斯皮尔曼ρ=-0.63），而健康成年人额状面倾斜角度与转身步数之间存在显著相关性（斯皮尔曼ρ=-0.67）。
本研究表明，PD成年患者在转身过程中的轴向僵硬可能会减少向前行进并增加侧向不稳。行进减少与额外的转身步数有关，而侧向不稳增加可能会导致更高的跌倒风险。
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