Performance on clinical tests of balance in Parkinson's disease

Research Unit, Kingston Centre, Cheltenham, Victoria, Australia.

BACKGROUND AND PURPOSE: Due to the high incidence of falls in people with idiopathic Parkinson's disease (PD), the assessment of standing balance is a key component of physical therapist evaluation. This study investigated performance on clinical tests of standing balance in subjects with and without PD. SUBJECTS: The subjects were 10 persons with PD who had a history of falls (age range = 60-80 years), 10 persons with PD who had no history of falls (age range = 63-79 years), and 10 persons with no known neurological impairment (age range = 60-78 years) who served as a comparison group. METHODS: Subjects were tested on their ability to maintain stability in 3 conditions: (1) steady standing (feet apart, feet together, tandem stance, step stance, and single-limb stance), (2) in response to perturbations generated by self-initiated movements (arm raise, functional reach, bend-reach, and step tests), and (3) in response to an external perturbation to upright stance (shoulder tug). Balance was measured at peak dosage in the levodopa medication cycle (in the morning) and 7 days later. RESULTS: The mean Hoehn and Yahr Disability Scale score was 3.0 for the fallers with PD and 2.5 for the nonfallers with PD. Performance on the tandem stance, single-limb stance, functional reach, and shoulder tug tests demonstrated differences between the subjects with PD and the comparison group and between the fallers and nonfallers with PD. The results of these tests were highly repeatable over 7 days (ICC = .61-.94). CONCLUSION AND DISCUSSION: Although there was a small sample size, performance was highly consistent across 7 days when testing occurred during peak dosage of levodopa. A small battery of tests were sensitive enough to discriminate between people with PD who fall and those with no history of falls.

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