College of Health Solutions, Arizona State University, 425 N 5th St, Phoenix, AZ, 84005, USA.
College of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA.
J Neurol. 2018 May;265(5):1138-1144. doi: 10.1007/s00415-018-8821-z. Epub 2018 Mar 8.
Protective steps are critical for fall prevention and are altered in people with Parkinson's disease (PD). Previous work suggests that perturbation training, in which patients are exposed to repeated slips, may improve protective postural responses. However, these studies typically take the average performance of several postural responses before and after training. To reduce falls in the community, training must improve protective stepping after the first perturbation exposure. To date, no investigations have examined whether first-trial protective stepping is improved after training in people with PD.
First-trial protective stepping was measured in 14 people with PD and 9 healthy adults before and 24 h after 1 day of perturbation training. The primary outcome was margin of stability after a perturbation, a measure of protective stepping effectiveness.
Margin of stability for the first perturbation was significantly (p = 0.001) improved on day 2 compared to before perturbation practice (day 1) in both groups. Furthermore, improvement in margin of stability was correlated with age and baseline stepping performance, such that older individuals and people with worse baseline performance showed the most pronounced improvement.
Improving the first loss of balance after training is critical if such training is to reduce falls in people with PD. The observed improvement in first-trial protective stepping provides further support for perturbation training as a potential tool to improve protective steps and reduce falls in people with PD.
保护措施对于预防跌倒至关重要，而帕金森病（PD）患者的保护措施会发生改变。先前的研究表明，通过使患者反复经历滑倒，可以改善保护姿势反应，从而进行扰动训练。然而，这些研究通常会平均分析训练前后的多次姿势反应表现。为了减少社区中的跌倒，训练必须在第一次受到扰动后改善保护性的跨步反应。迄今为止，还没有研究调查过 PD 患者在接受训练后，第一次保护性跨步反应是否会得到改善。
在扰动训练的前一天和后 24 小时，我们测量了 14 名 PD 患者和 9 名健康成年人在受到扰动前和第一次受到扰动时的第一次保护性跨步反应。主要结果是在受到扰动后的稳定裕度，这是衡量保护性跨步反应效果的指标。
与扰动练习前（第 1 天）相比，两组患者在第 2 天首次受到扰动时的稳定裕度都显著提高（p=0.001）。此外，稳定裕度的改善与年龄和基线跨步反应表现相关，即年龄较大和基线表现较差的人改善幅度最大。
如果训练旨在减少 PD 患者跌倒，那么提高训练后的第一次平衡丧失至关重要。首次保护性跨步反应的改善为扰动训练作为改善保护步态和减少 PD 患者跌倒的潜在工具提供了进一步的支持。
