Conceição Núbia Ribeiro da, Nóbrega de Sousa Priscila, Pereira Marcelo Pinto, Gobbi Lilian Teresa Bucken, Vitório Rodrigo
São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil.
São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil.
Hum Mov Sci. 2019 Aug;66:1-8. doi: 10.1016/j.humov.2019.03.010. Epub 2019 Mar 16.
Postural instability during walking and tripping over obstacles are the main causes of falls in people with Parkinson's disease (PD). Preliminary limited evidence suggests that the length of the prospective follow-up period affects falls prediction in PD, with shorter periods leading to more accurate prediction. Thus, the primary aim of the present study was to test the performance of center of pressure (CoP) variables during obstacle crossing to predict fall risk in people with PD during subsequent periods of four, six, and 12 months. We also compared CoP variables during obstacle crossing between fallers and non-fallers.
Forty-two individuals with PD, in mild to moderate stages, completed the baseline obstacle crossing assessment and reported falls for 12 months. Participants walked at their self-selected pace and were instructed to cross an obstacle (half knee height) positioned in the middle of an 8-m long pathway. A force platform was used to analyze CoP parameters of the stance phase of the trailing limb (most affected limb). The ability of each outcome measure to predict fall risk at four, six, and 12 months was assessed using receiver operating characteristic curve analyses.
Ten individuals (23.8%) were considered fallers at four months, twelve individuals (28.5%) at six months, and twenty-one individuals (50%) at 12 months. CoP amplitude and CoP velocity in the mediolateral direction significantly predicted fall risk at four, six, and 12 months. As judged by the area under the curve, mediolateral CoP velocity showed the best performance at four months, while mediolateral CoP amplitude showed the best performance at six months. Fallers presented greater values of mediolateral CoP velocity and amplitude than non-fallers.
These findings suggest that mediolateral CoP velocity and amplitude during obstacle crossing might be useful to predict fall risk in people with PD. Therefore, larger studies are encouraged.
行走时的姿势不稳和绊倒在障碍物上是帕金森病（PD）患者跌倒的主要原因。初步有限的证据表明，前瞻性随访期的长短会影响PD患者跌倒的预测，随访期较短时预测更准确。因此，本研究的主要目的是测试在跨越障碍物期间压力中心（CoP）变量的表现，以预测PD患者在随后4个月、6个月和12个月期间的跌倒风险。我们还比较了跌倒者和未跌倒者在跨越障碍物期间的CoP变量。
42名轻度至中度PD患者完成了基线障碍物跨越评估，并报告了12个月内的跌倒情况。参与者以自己选择的速度行走，并被指示跨过位于8米长路径中间的一个障碍物（半膝高）。使用测力平台分析后肢（受影响最严重的肢体）站立期的CoP参数。使用受试者工作特征曲线分析评估每个结果指标预测4个月、6个月和12个月跌倒风险的能力。
4个月时有10名个体（23.8%）被认为是跌倒者，6个月时有12名个体（28.5%），12个月时有21名个体（50%）。CoP在内外侧方向的幅度和速度在4个月、6个月和12个月时显著预测了跌倒风险。根据曲线下面积判断，内外侧CoP速度在4个月时表现最佳，而内外侧CoP幅度在6个月时表现最佳。跌倒者的内外侧CoP速度和幅度值高于未跌倒者。
这些发现表明，跨越障碍物期间的内外侧CoP速度和幅度可能有助于预测PD患者的跌倒风险。因此，鼓励开展更大规模的研究。
