Objective: To characterize sensory modulation of postural control in Huntington’s disease (HD); and to identify postural metrics that are sensitive in the prodromal stage of HD.

Background: In manifest HD (mHD), there is progressive decline of postural control. The Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is a common bedside balance test for postural control. In prodromal HD (pHD), the root mean square (RMS) is sensitive in revealing postural deficits. It is unclear whether other postural metrics are sensitive in pHD and mHD during mCTSIB.

Methods: Our sample included 10 control (mean age: 43.7y), 14 pHD (mean age: 46.38 y), and 10 mHD (mean age: 50.5 y). Subjects performed the mCTSIB: eyes open-firm surface; eyes closed-firm surface; eyes open-foam surface; and, eyes closed-foam surface. An accelerometer collected data in anteroposterior (AP) and mediolateral (ML) directions. Postural sway was assessed based on sway jerkiness, time-based, and frequency-based domains. To examine within-group differences across conditions, Friedman’s ANOVA with multiple comparisons was used. To examine between-group differences and to identify metrics sensitive to pHD, Kruskal-Wallis test was used.

Results: Sensory modulation of postural control differed significantly in all groups across sensory conditions as measured by sway jerkiness domain (jerk), time-based domain (total sway area, RMS sway, mean distance, and mean velocity), and frequency-based domain (frequency, and total power) in both AP and ML directions, but with exceptions: mean velocity in ML (mHD); mean frequency in AP (mHD) and in ML (all groups). Generally, the greatest decrements were observed during standing with eyes closed on foam for all groups. To maximize the potential in revealing postural deficits in pHD, between-group analysis focused on standing eyes closed-foam surface. Both pHD and mHD had significantly worse sway than controls in AP and ML directions based on jerk, all time-based domain measures (except for mean velocity in ML direction), and one frequency-based domain measure (total power). Mean frequency was not a sensitive metric of postural deficit for HD.  

Conclusions: Manipulation of sensory input during mCTSIB reveals postural control deficits in pHD and mHD. Metrics that are sensitive to pHD are jerk, several time-based domain measures, and total power; thus suggests multiple independent balance constructs may be impaired early in the course of HD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sensory-modulation-of-postural-control-in-huntingtons-disease/