Objective: To investigate the effectiveness of a non-linear index for identifying the decline in postural control associated with PD progression.

Background: Postural instability is a symptom of Parkinson’s disease that can significantly impact an individual’s ability to perform daily activities. This balance impairment often leads to disability and an increased risk of falls. Early detection of postural instability is crucial to prevent falls and their negative consequences. Low-cost technology may be used to evaluate balance and provide a non-linear index, which could be widely used in clinical practice.

Method: The study involved 55 individuals with Parkinson’s disease, out of which 37 were male. The participants were categorized into three stages based on the Hoehn and Yahr (H&Y) rating scale, with 11 in Stage I, 23 in Stage II, and 21 in Stage III. A static stance test was conducted on each participant, which was recorded by a two-dimensional movement analysis software. Additionally, three clinical balance tests – Timed Up and Go (TUG), Balance Evaluation Systems Test (BESTest), and Push and Release Test (PRT) – were performed by the participants. A Postural Instability Index (PII) was developed using the kinematic variables generated by the software. The results were analyzed using four one-way ANOVA tests – one for each balance measure – with H&Y stages (1-3) being the primary factors. The post-test was applied pairwise using Tukey’s test to compare the H&Y stages.

Results: The results of the one-way ANOVA indicate that the disease stage has a significant effect on all balance measures. Further analysis shows that BESTest, TUG, and PRT can distinguish patients in H&Y stages I-II from III. Additionally, PII is effective in differentiating patients in H&Y stages I from II (p<.03), I from III (p<00001), and II from III (p<.02).

Conclusion: The PII index can detect early postural instability that may not be noticeable through clinical tests. This study presents a promising opportunity to use a low-cost tool to identify subtle changes in postural control among individuals with Parkinson’s disease in clinical practice, which could help in assessing balance more accurately.

Flowchart of the study steps.

The two-dimensional balance assessment procedures

Pull Test differences in H&Y stages

TUG differences in H&Y stages

BESTest differences in H&Y stages I, II and II

PII in stages I, II and II

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-non-linear-index-can-detect-early-postural-instability-in-people-with-parkinsons-disease-enhancing-perspectives-on-the-utilization-of-cost-effective-technologies/