University of Nebraska Medical Center, Department of Neurological Sciences, 42nd and Emile, Omaha, NE 68198, USA.
University of Nebraska Medical Center, College of Allied Health Professions, 984035 Nebraska Medical Center, Omaha, NE 68198-4035, USA.
Parkinsonism Relat Disord. 2018 Feb;47:22-25. doi: 10.1016/j.parkreldis.2017.11.335. Epub 2017 Nov 16.
Orthostatic Tremor (OT) is a movement disorder characterized by a sensation of unsteadiness and tremors in the 13-18 Hz range present upon standing. The pathophysiology of OT is not well understood but there is a relationship between the sensation of instability and leg tremors. Despite the sensation of unsteadiness, OT patients do not fall often and balance in OT has not been formally assessed. We present a prospective blinded study comparing balance assessment in patients with OT versus healthy controls.
We prospectively enrolled 34 surface Electromyography (EMG)-confirmed primary OT subjects and 21 healthy controls. Participants underwent evaluations of balance by blinded physical therapists (PT) with standardized, validated, commonly used balance scales and tasks.
OT subjects were mostly female (30/34, 88%) and controls were majority males (13/20, 65%). The average age of OT subjects was 68.5 years (range 54-87) and for controls was 69.4 (range 32-86). The average duration of OT symptoms was 18 years. OT subjects did significantly worse on all the balance scales and on most balance tasks including Berg Balance Scale, Functional Gait Assessment, Dynamic Gait Index, Unipedal Stance Test, Functional Reach Test and pull test. Gait speed and five times sit to stand were normal in OT.
Common validated balance scales are significantly abnormal in primary OT. Despite the objective finding of impaired balance, OT patients do not commonly have falls. The reported sensation of unsteadiness in this patient population seems to be out of proportion to the number of actual falls. Further studies are needed to determine which components of commonly used balance scales are affected by a sensation of unsteadiness and fear of falling.
直立性震颤（OT）是一种运动障碍，其特征是在站立时出现 13-18Hz 范围内的不稳定感和震颤。OT 的病理生理学尚不清楚，但不稳定感与腿部震颤之间存在关系。尽管存在不稳定感，但 OT 患者并不经常跌倒，OT 中的平衡尚未得到正式评估。我们提出了一项前瞻性、盲法研究，比较了 OT 患者与健康对照组的平衡评估。
我们前瞻性纳入了 34 名经表面肌电图（EMG）证实的原发性 OT 患者和 21 名健康对照者。参与者接受了由经过盲法训练的物理治疗师（PT）进行的平衡评估，使用了标准化、经过验证的、常用的平衡量表和任务。
OT 患者主要为女性（30/34，88%），对照组主要为男性（13/20，65%）。OT 患者的平均年龄为 68.5 岁（范围 54-87 岁），对照组为 69.4 岁（范围 32-86 岁）。OT 患者的平均 OT 症状持续时间为 18 年。OT 患者在所有平衡量表和大多数平衡任务上的表现明显较差，包括 Berg 平衡量表、功能性步态评估、动态步态指数、单足站立测试、功能性伸展测试和拉力测试。OT 患者的步态速度和五次坐立时间正常。
常见的经验证的平衡量表在原发性 OT 中明显异常。尽管存在客观的平衡障碍，但 OT 患者通常不会跌倒。在该患者群体中，报告的不稳定感似乎与实际跌倒次数不成比例。需要进一步的研究来确定常用平衡量表的哪些成分受到不稳定感和跌倒恐惧的影响。
