Objective: The objective of the study is to compare single-limb stance test performance between tremor dominant (TD) and akinetic rigid dominant (ARD) Parkinson’s disease patients.

Background: The patients with PD can be classified into the Akinetic Rigid(AR) subtype and Tremor Dominant(TD) subtype based on predominant motor signs. Pathophysiological study model has proved the difference in patterns of intrinsic brain activity between two sub types. Jiang et al has proved that TD Parkinson’s involves more of Cerebello-Thalamo-Cortical loop whereas ARD Parkinson’s involves more of Striatal-Thalamo-Cortical loop. This can explain the clinical differences in loss of postural reflexes early in ARD Parkinson’s than TD Parkinson’s. Poor balance is one of the major contributor to falls in Parkinson’s disease. Single limb stance test (SLST) is a simple static test done in the elderly. There are numerous studies done on balance in Parkinson’s patients. However, there are not many studies reporting on the sub types of Parkinson’s disease (TD and ARD) and their differences in balance performance.

Methods: This is a cross-sectional study design done in the physiotherapy unit of a tertiary care hospital. 9 patients (4 TD and 5 ARD) with idiopathic Parkinson’s disease diagnosed according to the UK Parkinson’s Society Brain Bank clinical diagnostic criteria were enrolled in the study.The baselin1e measures – Mini mental status examination, Modified Hoehn & Yahr scale, Unified Parkinson’d Disease Rating Scale (UPDRS). The patients were asked to perform Single Limb Stance Test (SLST), Timed Up and Go test (TUG), Mini BESTest. The performance of patients in these tests between TD and ARD groups were analyzed using median (Inter quartile range) difference.

Results: The median score of SLST of TD and ARD Parkinson’s disease are 27 seconds (IQR 6.75, 54.75) and 5 seconds (IQR 3.5, 8) respectively. The TUG scores TD and ARD Parkinson’s disease are 16 seconds (IQR 10.5, 44) and 20 seconds (IQR 16.5, 34) respectively. The MiniBESTest score of TD and ARD Parkinson’s disease are 19.5 (IQR 9.75, 27.75) and 13 (IQR 12, 17) respectively. The TD Parkinson’s patients seemed to demonstrate better performance in balance measures.

Conclusions: The Single Limb Stance Test (SLST) performance seem to better in patients with tremor dominant (TD) than akinetic rigid dominant (ARD) Parkinson’s disease. Similarly, tremor dominant Parkinson patients performed better in TUG and BESTest than akinetic rigid dominant Parkinson’s disease.

References: 1. Zhang J-R, Feng T, Hou Y-N, Chan P, Wu T. Functional Connectivity of Vim Nucleus in Tremor- and Akinetic-/Rigid-Dominant Parkinson’s Disease. CNS Neurosci Ther. 2016 Feb 5. 2. Jiang S, Wang M, Zhang L, Yuan Y, Tong Q, Ding J, et al. Regional homogeneity alterations differentiate between tremor dominant and postural instability gait difficulty subtypes of Parkinson’s disease. J Neural Transm Vienna Austria 1996. 2016 Mar;123(3):219–29. 3. Almeida LRS, Valenca GT, Negreiros NN, Pinto EB, Oliveira-Filho J. A Comparison of Self-report and Performance-based Balance Measures to Predict Recurrent Falls in People With Parkinson Disease: A Cohort Study. Phys Ther. 2016 Jan 28. 4. Almeida, L. R. S., Valenca, G. T., Negreiros, N. N., Pinto, E. B., & Oliveira-Filho, J. (2016). A Comparison of Self-report and Performance-based Balance Measures to Predict Recurrent Falls in People With Parkinson Disease: A Cohort Study. Physical Therapy. http://doi.org/10.2522/ptj.20150168. 5. Jiang, S., Wang, M., Zhang, L., Yuan, Y., Tong, Q., Ding, J., … Zhang, K. (2016). Regional homogeneity alterations differentiate between tremor dominant and postural instability gait difficulty subtypes of Parkinson’s disease. Journal of Neural Transmission (Vienna, Austria: 1996), 123(3), 219–229. http://doi.org/10.1007/s00702-015-1490-5. 6. King, L. A., Priest, K. C., Salarian, A., Pierce, D., & Horak, F. B. (2012). Comparing the Mini-BESTest with the Berg Balance Scale to Evaluate Balance Disorders in Parkinson’s Disease. Parkinson’s Disease, 2012, 375419. http://doi.org/10.1155/2012/375419.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/single-limb-stance-test-performance-difference-between-tremor-dominant-and-akinetic-rigid-dominant-parkinsons-disease-a-pilot-study/