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Background: Balance disorders in patients diagnosed with Parkinson's disease (PD) are associated with a change in balance-keeping strategy and reflex disorders which regulate the maintenance of vertical body posture. Center of foot pressure (COP) displacement signals were analyzed during quiet standing experiments to define such changes. The research aimed to apply stock exchange indices based on the trend change analyses to the assessment of a level of the Parkinson disease progression on the grounds of the analysis of the COP signals., Methods: 30 patients in two stages of PD, 40 elderly participants, and 20 individuals at a young age were studied. Each person was subjected to 3 measurements with open and closed eyes. A technical analysis of the COP displacement signal was performed, and the following quantities were determined: indices related to the number of trend changes (TCI), indices defining a mean time (TCI&#95;dT), and mean displacement (TCI&#95;dS) and mean velocity (TCI&#95;dV) between such changes., Results: The results indicate a higher TCI value for PD than for aged-matched control group (p < 0.05). In the case of PD patients, there was also an increase in the TCI&#95;dS value by 2-5 mm, which mainly contributed to the increase in TCI&#95;dV. Statistically significant differences for the TCI&#95;dT values occurred between all groups in which differences in the average COP velocity were noted., Conclusions: The TCI and TCI&#95;dV results obtained for the healthy participants enabled the development of indices supporting PD diagnostics. The causes of the TCI&#95;dV changes in patients were determined, i.e., whether they resulted from an increase in the TCI&#95;dT or TCI&#95;dS between the moments of trend changes indicated by the developed algorithm. The developed methodology provides new information on the impact of PD on the strategy of maintaining balance, which was impossible to obtain using currently used analyses. Trial registration The conducted research is an observational study and does not include a health care intervention. Participants gave their consent to participate in the research and the procedure was approved by the Institutional Bioethics Committee., (© 2023. The Author(s).)

Introduction: Although previous studies have contributed to our understanding of the effects of implementing the virtual reality as a rehabilitation tool in patients with Parkinson's disease (PD), additional research is needed to examine the effects of applying balance-based exergaming training on quantitative biomechanical measures of balance., Research Question: To investigate the effects of balance-based conventional and exergaming training on posture parameters., Methods: The study involved 24 patients with PD (Hoehn and Yahr stages II-III).Participants underwent twelve training sessions during the 4-week training period. The experimental group (n=12) was trained with a custom-made exergaming balance based training system, the control group (n=12) underwent a conventional balance training. All objective outcomes were measured before intervention and the day after completion of training program. Postural stability was assessed using the quiet standing test, dynamic balance was assessed using limits of stability (LOS) and functional balance (FBT) tests., Results: After training, participants in both groups showed significantly better results in static balance performance. However, only exergaming training significantly improved LOS performance (higher values of Range of forward lean (p = 0.039, d z = 0.67) and leaning rate (p=0.007, d z =0.96). Also FBT test improved significantly only in experimental group (decrease in time to target hit (p=0.02, d z =0.76) and significant increase of average COP velocity (p=0.008, d z =0.93)., Conclusion: This study found that exergaming training created for patients with PD enhanced static and dynamic balance whereas conventional balance training improved static balance. Posturography is sensitive enough to reveal differential effects of training for both groups. These findings support the inclusion of our exergaming training in the exercise program for participants with PD., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Little is known about the early stage balance changes in PD. Many clinicians assume that there are no postural issues in early PD because of failure to identify them on bedside and clinical testing. Here, we quantify balance changes in early and moderate stage PD and compared these values to healthy controls (HC) using clinical assessments of balance and posturography., Methods: We compared 15 HC with 15 early PD (PD-II; Hoehn and Yahr stage II) and 15 moderate PD (PD-III; H&Y stage III). Participants performed various clinical tests of balance and a standing postural task on a force platform. We quantified the spatiotemporal parameters of the center of pressure (COP), the sample entropy and power spectral density (PSD) of the COP., Results: The PSD of the COP differentiated PD-II from HC from 0-0.5 Hz and PD-II from PD-III from 0.5-1 Hz. Specifically, PD-II and PD-III manifested greater power than HC from 0-0.5 Hz, whereas PD-III exhibited greater power than PD-II and HC from 0.5-1.0 Hz (p<0.05). However, there were no significant differences between PD-II and HC in all clinical tests and in spatiotemporal parameters of the COP (p>0.05). Although the sample entropy was significantly lower in the PD groups (p<0.05), entropy failed to differentiate PD-II from PD-III., Conclusion: The low-frequency modulation of the COP in this small cohort differentiated early PD from HC and from moderate PD. Clinicians should be aware that there are early balance deficits in PD. A larger sample size is needed to confirm these findings., Competing Interests: The authors have declared that no competing interests exist.

Falls pose a serious problem in elderly and clinical populations. Most often, they lead to a loss of mobility and independence. They might also be an indirect cause of death. The aim of this study was to determine an objective predictor of the fear of falling and falls in elderly subjects (ESs) and Parkinson's disease (PD) subjects. Thirty-two ESs were examined in this study, of whom sixteen were diagnosed with PD. The testing procedures comprised force plate measurements (limit of stability test-LOS test) and clinical tests (Berg Balance Scale, Functional Reach Test, Timed Up and Go test, Tinetti test). The Falls Efficacy Scale International (FES-I) was used to evaluate the fear of falling. The range of the maximum forward lean was normalized to the length from the ankle joint to the head of the first metatarsal bone and was named the functional forward stability indicator (FFSI). The FFSI, derived from the LOS test, allowed us to demonstrate the real deficit in functional stability and individual safety margins. Moreover, the FFSI was highly correlated with the FES-I score and almost all clinical test results in elderly subjects (r>0,6; p<0.05). In PD subjects, the FFSI was poorly correlated with the fear of falling, the BBS score and the FR distance; however, a high correlation with the Tinetii test (r>0,6, p<0.05) was noted. The PD subjects presented a different balance strategy when close to their stability limits, which was also reflected in the lower values of sample entropy (t = (-2.40); p<0.05; d = 0.87). The FFSI might be a good predictor of the fear of falling in the group of elderly people. Additionally, the FFSI allows us to show real balance deficits both in PD subjects and in their healthy peers without the need for a reference group and norms. In conclusion, it is postulated that the popular clinical assessments of postural balance in PD subjects should be accompanied by reliable posturography measurements., Competing Interests: The authors have declared that no competing interests exist.

Purpose: The aim of this study was to evaluate the reliability of the novel posturographic procedure and to investigate the relationships between parameters of this procedure and clinical tests. We hypothesised the proposed step initiation procedure to be reliable method of balance and motor disability assessment, especially in patients with neurological deficits. Also, we assumed high significant correlation between parameters of step initiation procedures and clinical tests., Methods: The 35 subjects with idiopathic PD and 35 agedmatched healthy controls participated in this study. The gait initiation was measured using two force platforms. The procedure consisted of three phases: (1) quiet standing on a first platform (2) crossing on the second platform, (3) quiet standing on a second platform. Testing was carried out in four conditions: unperturbed trial, obstacle crossing, step-up and step-down., Results: In the proposed gait initiation procedure, the vCOP, raCOP and rmsCOP showed an excellent reliability (ICC > 0.80). For transit phase, reliability of all variables in all conditions also was excellent (ICC = 0.8-0.9). There were only a few associations between Tinetti scores and posturographic variables in controls, but in PD patients the significant correlations were found between the proposed measures and the UPDRS, Tinetti, FRT, TUG and with the BBS., Conclusions: The proposed gait initiation procedure is reliable and very suitable for the assessment of patients with Parkinson's disease. It can be used as an objective assessment of the clinical condition and dynamic balance, and help in the designing and programming of the appropriate rehabilitation and treatment.

Postural instability is common in Parkinson's disease (PD), often contributing to falls, injuries, and reduced mobility. In the clinical setting, balance disorder is commonly diagnosed using clinical tests and balance scales, but it is suggested that the most sensitive measurement is the force platform. The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD. A systematic review was conducted of papers published from 2000 to 2017. Databases searched were PubMed and EBSCO. Studies must have involved patients with PD, used force platform or motion analysis system as a measurement tool, and described posturographic procedure. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. A total of 32 studies met the inclusion criteria. The PEDro scores ranged from 5 to 7 points. The analysis of the objective methods assessing balance disorders revealed a large discrepancy in the duration and procedures of measurements. The number of repetitions of each trial fluctuated between 1 and 8, and the duration of a single trial ranged from 10 to 60 seconds. Overall, there are many scales and tests used to assess the balance disorders and disabilities of people with PD. Although in many included studies the authors have used posturography as a method to evaluate the postural instability of PD patients, the results are contradictory. To solve this issue, it is indicated to establish a "gold standard" of procedures of measures of balance., Competing Interests: Disclosure The authors report no conflicts of interest in this work.