7. 0T ultrahigh-field MRI directly visualized the pedunculopontine nucleus in Parkinson's disease patients

OBJECTIVES: The pedunculopontine nucleus (PPN) is considered a promising new target for neurostimulation in Parkinson's disease (PD) patients with postural instability and gait disturbance that is refractory to other treatment modalities. However, the PPN is typically difficult to visualize with magnetic resonance imaging (MRI) at clinical field strengths, which greatly limits the PPN as a viable surgical target for deep brain stimulation (DBS). Thus, the aim of this study is to directly visualize the PPN based on 7.0T ultrahigh-field MRI. METHODS: Five PD patients were enrolled and scanned using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI scanner. Then, the MP2RAGE sequences were imported into a commercially available navigation system. The coordinates of the directly localized PPN poles were recorded in the navigation system relative to the anterior commissure-posterior commissure plane. RESULTS: Our results indicated that the PPN presented intermediate signal intensity in the 7.0T ultrahigh-field MR images in comparison with the surrounding structure, such as the hypo-intensity of the periaqueductal gray and the hyperintensity of the neighboring white matter tracts, in PD patients. The mean coordinates for the rostral and caudal poles of PPN were 6.50 mm and 7.20 mm lateral, 1.58 mm and 2.21 mm posterior, and 8.89 mm and 13.83 mm relative to the posterior commissure. CONCLUSION: Our findings provide, for the first time, direct visualization of the PPN using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI, which may improve the accuracy of stereotactic targeting of the PPN and improve the outcomes in patients undergoing DBS.

Alterations of brain activity in different motor subtypes of Parkinson disease based on regional homogeneity analysis / 中华放射学杂志

Objective@#To explore the changes and significance of local brain activity in different motor subtypes of Parkinson disease(PD) using resting-state functional MRI (rs-fMRI) based on regional homogeneity (ReHo) analysis.@*Methods@#A total of 84 PD patients and age-and gender-matched 29 healthy controls undergoing rs-fMRI were included. PD patients were divided into two groups of tremor dominant(TD) (n=45) and postural instability gait difficulty(PIGD) (n=39) according to the Unified Parkinson′s Disease Rating Scale (UPDRS) scores. Data processing assistant for resting-state fMRI (DPARSF) and resting-state fMRI data analysis Toolkit (REST) V1.8 based on MATLAB were used to calculate the ReHo which measured brain activity in different motor subtypes of PD. Analysis of covariance and post-hoc t-tests were performed to detect the differences of local brain activity among the three groups.Correlation analyses were performed between ReHo values of the regions showing group differences and TD and PIGD scores respectively.@*Results@#Compared to healthy controls, the TD group exhibited increased ReHo in the right superior and middle frontal gyrus, left cerebellum(13 to 21 voxels, P<0.05), while decreased ReHo in the left temporal lobule, left putamen, left paracentral lobule, and bilateral thalamus (12 to 91 voxels, P<0.05). The PIGD group showed increased ReHo in the right superior frontal gyrus, right middle frontal gyrus and anterior cingulate gyrus (ACC) (55 to 92 voxels, P<0.05), while decreased ReHo in the left putamen, left pallidum, left temporal lobule, right occipital lobule, bilateral thalamus, bilateral middle cingulate gyrus, bilateral supplementary motor area (SMA) (15 to 78 voxels, P<0.05). Compared with PIGD, the TD group showed increased ReHo in the left temporal lobule, left cerebellum, bilateral middle cingulate gyrus (19 to 51 voxels, P<0.05), whereas decreased ReHo in the left paracentral lobule, bilateral cuneus, right superior frontal gyrus, and right ACC (14 to 68 voxels, P<0.05). Additionally, ReHo in the left thalamus and left putamen negatively correlated with TD scores (r=-0.355 and -0.498, both P<0.05). ReHo in the left thalamus and right thalamus negatively correlated with PIGD scores (r=-0.478 and -0.397, both P<0.05).@*Conclusions@#The changes of brain activity in TD are located in the cerebello-thalamo-cortical (CTC) circuit and the striatal-thalamo-cortical (STC) loop while the changes in PIGD are largely located in the STC loop and visual network cortex. This specific pattern of intrinsic activity in TD and PIGD may provide insights into the neurophysiological mechanisms of PD with different motor subtypes.

Advance in Voluntary Postural Control Assessment (review) / 中国康复理论与实践

Postural control plays a crucial role in maintaining posture stability and improving performance efficiency. It involves involuntary and voluntary components. There is not a unified model for assessment of voluntary postural control. Based on the research framework of voluntary postural control, this paper reviewed three common voluntary postural control assessment tools (Timed "Up and Go" Test, Balance Evaluation System Test and Unified Balance Scale). The Timed “Up and Go” Test contains various capabilities which are recommended by the framework. There are few restrictions on the facilities and test circumstance, and it can be used in different populations. Balance Evaluation System Test consists of three different versions; each of them has high structure validity and shows different characteristics in the evaluation of voluntary postural control. The items of Unified Balance Scale also cover most of capabilities provided by the framework, and there are quality control methods in the scale. These tools would be selected according to purpose, occasion and time of study, or used in combination.

Alterations of brain activity in different motor subtypes of Parkinson disease based on regional homogeneity analysis / 中华放射学杂志

Objective To explore the changes and significance of local brain activity in different motor subtypes of Parkinson disease(PD) using resting-state functional MRI (rs-fMRI) based on regional homogeneity (ReHo) analysis. Methods A total of 84 PD patients and age-and gender-matched 29 healthy controls undergoing rs-fMRI were included. PD patients were divided into two groups of tremor dominant (TD) (n=45) and postural instability gait difficulty(PIGD) (n=39) according to the Unified Parkinson′s Disease Rating Scale (UPDRS) scores. Data processing assistant for resting-state fMRI (DPARSF) and resting-state fMRI data analysis Toolkit (REST) V1.8 based on MATLAB were used to calculate the ReHo which measured brain activity in different motor subtypes of PD. Analysis of covariance and post-hoc t-tests were performed to detect the differences of local brain activity among the three groups.Correlation analyses were performed between ReHo values of the regions showing group differences and TD and PIGD scores respectively. Results Compared to healthy controls, the TD group exhibited increased ReHo in the right superior and middle frontal gyrus, left cerebellum(13 to 21 voxels, P<0.05), while decreased ReHo in the left temporal lobule, left putamen, left paracentral lobule, and bilateral thalamus (12 to 91 voxels, P<0.05). The PIGD group showed increased ReHo in the right superior frontal gyrus, right middle frontal gyrus and anterior cingulate gyrus (ACC) (55 to 92 voxels, P<0.05), while decreased ReHo in the left putamen, left pallidum, left temporal lobule, right occipital lobule, bilateral thalamus, bilateral middle cingulate gyrus, bilateral supplementary motor area (SMA) (15 to 78 voxels, P<0.05). Compared with PIGD, the TD group showed increased ReHo in the left temporal lobule, left cerebellum, bilateral middle cingulate gyrus (19 to 51 voxels, P<0.05), whereas decreased ReHo in the left paracentral lobule, bilateral cuneus, right superior frontal gyrus, and right ACC (14 to 68 voxels, P<0.05). Additionally, ReHo in the left thalamus and left putamen negatively correlated with TD scores (r=-0.355 and －0.498, both P<0.05). ReHo in the left thalamus and right thalamus negatively correlated with PIGD scores (r=-0.478 and－0.397, both P<0.05). Conclusions The changes of brain activity in TD are located in the cerebello-thalamo-cortical (CTC) circuit and the striatal-thalamo-cortical (STC) loop while the changes in PIGD are largely located in the STC loop and visual network cortex. This specific pattern of intrinsic activity in TD and PIGD may provide insights into the neurophysiological mechanisms of PD with different motor subtypes.

Dynamic postural stability in patients with diabetic peripheral neuropathy and relationship to presence of autonomic neuropathy

@#Diabetic neuropathy is a common complication that can negatively influence balance and is a major cause of falls. We evaluated the association between postural sway and diabetic autonomic neuropathy (DAN) among patients with diabetic peripheral neuropathy (DPN). Patients with DPN documented by typical symptoms with abnormal results of nerve conduction study were included and postural stability was assessed using dynamic posturography. Composite autonomic scoring scale (CASS) score was calculated by evaluating sudomotor, cardiovagal, and adrenergic functions. CASS score ≥2 indicated DAN and the severity of DAN was indicated by the CASS scores divided into three subscales of 10-point total CASS: none or mild autonomic failure (0-3), moderate failure (4-6), and severe failure (7-10). A total of 34 patients comprised the DAN group (n=19) and non-DAN group (n=15). Patients with DAN had higher prevalence of diabetic retinopathy(p=0.011), higher urine albumin-creatinine ratio (p = 0.009), and lower HbA1c levels (p<0.001) than those with non-DAN. With regard to dynamic postural instability, the presence (p=0.025) as well as the severity of DAN (p<0.05) was associated with postural instability in the eyes-opencondition. Interestingly, the poorer dynamic postural instability in moderate/severe DAN compared to mild DAN was observed only in medio-lateral direction and this association remained significant after adjusting for age, sex, and glycemic control state (HbA1c). In patients with DAN accompanied by DPN, the dynamic postural instability was affected by visual feedback and medio-lateral directional instability was closely associated with the severity of DAN.

Clinical observation of polysomnographic in patients with different subtypes of Parkinson's disease / 临床神经病学杂志

Objective To evaluate the changes parameters of polysomnographic ( PSG) with different subtypes of primary Parkinson's disease ( PD ) and analyze the clinical characteristics of sleep disorders in PD patients. Methods Ninety patients with primary PD [ tremor-predominant PD group ( n = 40 ) , postural instability gait disorder ( PIGD )-predominant PD group ( n = 50 ) ] and 50 healthy controls were detected by full night PSG monitoring. And the results were compared. Results Compared with tremor-predominant PD group, the total sleep time, bed time, sleep wake-up times, sleep efficiency and rapid eye movement ( REM ) sleep time of PIGD-predominant PD group were significantly lower (all P0. 05). Compared with the controls, the total sleep time and bed time of tremor-predominant PD group were significantly lower (all P0. 05). Combined with video surveillance video observation,the abnormality of REM sleep behavior disorder ( RBD) was 70% with PIGD-predominant PD group, in which the abnormality of tremor-predominant PD group was 2. 5%. Conclusions The PIGD-predominant PD patients are more likely to appear sleep disorders and RBD than tremor-predominant PD patients. It may be related to clinical heterogeneity of different PD subtypes.

Can Postural Instability Respond to Galvanic Vestibular Stimulation in Patients with Parkinson's Disease?

OBJECTIVE: Galvanic vestibular stimulation (GVS) activates the vestibular afferents, and these changes in vestibular input exert a strong influence on the subject's posture or standing balance. In patients with Parkinson's disease (PD), vestibular dysfunction might contribute to postural instability and gait disorders. METHODS: Current intensity was increased to 0.7 mA, and the current was applied to the patients for 20 minutes. To perform a sham stimulation, the current intensity was increased as described and then decreased to 0 mA over the course of 10 seconds. The patient's status was recorded continuously for 20 minutes with the patient in the supine position. RESULTS: Three out of 5 patients diagnosed with PD with postural instability and/or abnormal axial posture showed a reduction in postural instability after GVS. The score for item 12 of the revised Unified Parkinson's Disease Rating Scale part 3 was decreased in these patients. CONCLUSIONS: The mechanism of postural instability is complex and not completely understood. In 2 out of the 5 patients, postural instability was not changed in response to GVS. Nonetheless, the GVS-induced change in postural instability for 3 patients in our study suggests that GVS might be a therapeutic option for postural instability.

Postural sway in diabetic peripheral neuropathy among Indian elderly.

Background & objectives: Diabetic peripheral neuropathy (DPN) is a major complication of type 2 diabetes and have long term complications on the postural control of the affected population. The objectives of this study were to evaluate postural stability in patients with DPN and to examine correlation of Michigan Neuropathy Screening Instrument (MNSI) with duration of diabetes, age and postural stability measures. Methods: Participants were included if they had clinical neuropathy which was defined by MNSI. Sixty one patients gave their consent to participate in the study and were evaluated on posturography for postural stability measures in four conditions. Repeated measures of analysis of variance (RANOVA) was used to analyze the changes in postural stability measures in different conditions. Results: An increase in mean value of postural stability measures was observed for velocity moment 20.4±1.3, 24.3±2.2, 42.3±20.7, 59±43.03, mediolateral displacement 0.21±0.10, 0.22±0.18, 0.03±0.11, 0.34±0.18, and anteroposterior displacement 0.39 ± 0.09, 0.45±0.12, 0.47±0.13, 0.51±0.20 from EO to EC, EOF, and ECF, respectively. There was a significant difference (P<0.05) in participants with DPN, with greater sway amplitude on firm and foam surface in all the conditions. Moderate correlation of MNSI with age (r=0.43) and postural stability measures were also observed. Interpretation & conclusions: Evaluation of postural stability in Indian DPN population suggests balance impairments on either firm and foam surfaces, with greater likelihood of fall being on foam or deformable surfaces among elderly adults with neuropathy (CTRI/2011/07/001884).

The effect of dual-task interference on postural sway and hand flexibility in early Parkinson's disease / 中华行为医学与脑科学杂志

Objective To observe the effect of dual-task interference on postural sway and hand flexibility of patients with early Parkinson's disease (PD).Methods Twenty-tree patients with early PD and twcnty-three healthy,sex-and age-matched control subjects were examined.Postural sway was measured with an accelerometer at the centre of mass at the lower spine.Two parameters of postural sway were computed from the acceleration signals including root mean square acceleration (RMS) and jerkiness of sway (JERK).Purdue pegboard test,single-task tests and dual-task test were performed respectively to record the numbers of nails inserted with left hand,right hand and both hands within 30 seconds.Results In the usual conditions,no significant differences of postural sway parameters were found between the control group and PD group in eye open and eye closed condition.In dualtask condition,PD patients showed an increase of RMS values (eye open conditions:PD group (0.156±0.112) m/s2,control group (0.086±0.026) m/s2;eye closed conditions:PD group (0.204±0.162)m/s2,control group (0.095±0.023)m/s2) of sway acceleration,compared with control subjects (P＜0.01).These differences reached significance during cognitive task performance in eye open and eye closed with dual task.PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance(P＜0.05).The number of pegs inserted within 30 s in patients with PD (17.33±4.87)was significantly lower than that in controls (20.77±4.13) (P＜0.05).Conclusion The hand flexibility of patients with early PD obviously decrease.The balance of patients with early PD may deteriorate when their attention is diverted or reduced because of attempting to perform cognitive tasks.

Postural instability in Parkinson?s disease ? 120 years after Charcot?s death / Instabilidade postural na doença de Parkinson ? 120 anos após Charcot

The authors present the original Charcot’s description of postural instability in Parkinson’s disease as well as the evolution of this sign after 120 years of Charcot’s death.

Os autores apresentam a descrição original de Charcot da instabilidade postural na doença de Parkinson, bem como a evolução deste sinal 120 anos após a morte de Charcot.

Pull test performance and correlation with falls risk in Parkinson?s disease / Performance e correlação do teste de retropulsão com o risco de quedas na doença de Parkinson

Postural instability (PI) and falls are major sources of disability in Parkinson’s disease (PD). Our objectives were to evaluate the correlation between the pull-test (PT) scores and falls. Patients underwent a standardized data collection including demographic, clinical data, and the UPDRS scores for falls and the PT. Cases with scores >1 for falls were considered frequent fallers. 264 patients were included with mean age 67.6±10 years, mean age of onset 59.1±10.7 years. Comparison between PT scores versus the proportion of frequent fallers and the mean score of the UPDRS for falls showed that for each increase in the PT score, both parameters were significantly worse, with positive linear relationship. For any abnormal PT score, sensibility and negative predictive value were excellent; specificity and positive predictive value improved with worse PT scores. In conclusion, the PT provides important and reliable information regarding PI and the risk of falls in PD.

Instabilidade postural (IP) e quedas são importantes fontes de incapacidade na doença de Parkinson (DP). Nossos objetivos foram avaliar a correlação dos escores do test de retropulsão (TR) com história de quedas. Pacientes foram submetidos a coleta de dados padronizada, incluindo dados demograficos, clinicos e escores da UPDRS para quedas e do TR. Escores >1 para quedas definiram casos com quedas freqüentes. 264 pacientes foram incluídos, idade média de 67,6±10 anos, idade média de início 59,1±10,7 anos. Comparação do escore do TR com a proporção de casos com quedas freqüentes e pontuação média para quedas mostrou que, para cada aumento na pontuação do TR, ambos os parâmetros pioraram significativamente, com relação linear. Para escores anormais no TR, sensibilidade e valor preditivo negativo foram excelentes; especificidade e valor preditivo positivo melhoraram com escores maiores. Conclusão: o TR fornece informações importantes e confiáveis sobre IP e risco de quedas em PD.

Analysis of dynamic posture in patients with early Parkinson disease / 中国神经精神疾病杂志

Objective To quantitatively analyze the dynamic posture in patients with early stage Pakinson disease (ESPD) by using dynamic posture equilibrium equipment. Method Thirty two ESPD patients were recruited in this study, in which, 10 was at Hoehn-Yahr stage 1, 9 at Hoehn-Yahr stage 1.5, 13 at Hoehn-Yahr stage 2. Thirty two age and gen?der matched healthy subjects served as a control group. The sensory organization test (SOT), motion coordination test (MCT), adaptive test (ADT), walk across were performed in those two groups using NeuroCom smart dynamic posture equipment. Results The average composite scores for SOT were 64 and 79 in ESPD patients and control group(P=0.032). The eqilibrium ratio of vision and vestibular sense were obviously lower in ESPD patients than in the control group ( 73.55±3.15 vs. 82.45±3.53, P=0.037;45.25±4.25 vs. 66.43±6.98, P=0.021). MCT showed that ESPD patients had a higher abnormality ratio of centre-of-gravity position compared with controls ( 70.3%vs. 7% )(P<0.001). ESPD pa?tients had 33% and 57% abnormality in ADT and Walk Across, which were obviously higher compared with control group (P<0.001). Conclusions ESPD patients have different degrees of posture disorders and posture equilibrium assess?ment at early stage is beneficial to rehabilitation training.

Redução do limite de estabilidade direção-específica em indivíduos leve a moderadamente afetados pela doença de Parkinson / Direction-specific limits of stability are reduced in mild to moderate Parkinson's disease individuals

A instabilidade postural na doença de Parkinson (DP) tem sido associada a uma diminuição do limite de estabilidade (LE) na direção ântero-posterior (AP). Entretanto, ainda que possíveis alterações do LE na direção látero-lateral (LL) tenham sido sugeridas, tal direção não tem sido avaliada nos estudos com DP, principalmente quando o teste de limite de estabilidade (TLE) envolve movimentos intencionais que deslocam o centro de massa corporal (CMC). O objetivo do presente estudo foi investigar o LE na postura de pé durante movimentos voluntários que promovem deslocamento do CMC nas direções AP e LL de indivíduos com e sem a DP. Doze indivíduos com DP (Hoehn & Yahr=II, III) e 12 sem a doença realizaram o TLE nos sentidos anterior, posterior, direito e esquerdo. A velocidade de movimento (VM), excursão máxima (EM) e o controle direcional (CD) do CMC foram avaliados em cada sentido. Os indivíduos com DP foram significativamente mais lentos em todos os sentidos de deslocamento do CMC (p<0,05). Não houve diferença significativa na EM e CD no sentido anterior entre os grupos (p>0,05). Por outro lado, a EM e CD do CMC foram menores para o grupo DP no sentido posterior (P) e na direção LL (p<0,05). Indivíduos leves a moderadamente afetados pela DP apresentaram redução do LE no sentido P e na direção LL quando comparados ao grupo controle. Os resultados sugerem que tal direção e sentido devam ser treinados em ortostatismo, com movimentos que deslocam voluntariamente o CMC, desde fases iniciais da DP.

Postural instability in Parkinson's disease (PD) has been associated with decreases of the limits of stability (LOS) in the anterior-posterior (AP) directions. Although LOS changes in the latero-lateral (LL) directions have been suggested, they have not been evaluated in studies with PD, especially when the LOS tests involve intentional displacements of the body center of mass (COM). The aim of this study was to investigate the LOS in standing posture during voluntary movements that promote movement of the COM in AP and LL directions of individuals with and without PD. Twelve subjects with PD (Hoehn & Yahr stages of II and III) and 12 without the disease performed the LOS tests in the anterior, posterior, right and left directions. The movement velocity (MV), maximum excursion (ME), and directional control (DC) of the COM were evaluated in all investigated directions. Individuals with PD demonstrated smaller COM displacements in all directions (p<0.05). There were no significant differences between the groups regarding the ME and DC in the anterior direction (p>0.05). However, the ME and DC of the COM were smaller for the PD group in the backward, right, and left directions (p<0.05). Individuals with mild to moderate PD demonstrated decreases in the LOS in the posterior and LL directions, when compared to individuals without the disease. These findings suggested that such directions should be trained in the standing position with voluntary movements of the COM from the early stages of PD.

Validation of the brazilian version of the berg balance scale for patients with parkinson's disease / Validação da versão brasileira da Escala de Equilíbrio de Berg para pacientes com a doença de Parkinson

Background: Changes in balance occur with the progression of Parkinson's disease (PD). OBJECTIVE: To validate the Brazilian version of the Berg Balance Scale (BBS) for PD patients, determining its reliability and internal consistency and correlating it with PD-specific instruments. METHOD: We evaluated 53 patients (M/F 37/16, mean age±SD, 62±7.9 years) with PD (mean±SD, 7.8±4.4 years). Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England Scale (S&E), Hoehn and Yahr Staging Scale (HY) and BBS were used to assess patients. Statistical analyses for inter-rater reliability, internal consistency and correlations among BBS, UPDRS, S&E and HY were performed. RESULTS: The mean scores±SD on UPDRS and BBS were, respectively, 41.6±17.8 and 47.2±8.2. The median on S&E and HY scales were 80 percent and 2.5, respectively. The BBS presented a high intra-class correlation coefficient (ICC=0.84) and internal consistency (Cronbrach's α=0.92). There was a statistically significant correlation between BBS and disease duration (r s= -0.520, p<0.001), UPDRS subscales II and III (r s= -0.467, p=0.011; r s= -0.374, p=0.046, respectively), stage of disease (HY; r s= -0.507, p<0.001) and the activities of daily living (S&E; r s=0.492, p<0.001). CONCLUSION: The BBS is a promising tool for the assessment of balance in PD, correlating with the stage of disease and the level of independence.

Alterações de equilíbrio ocorrem com a progressão da doença de Parkinson (DP). Objetivo: Validar a versão brasileira da Escala de Equilíbrio de Berg (EEB) para pacientes com DP, determinando a confiabilidade, a consistência interna e correlacionando com instrumentos específicos da DP. MÉTODO: Foram avaliados 53 pacientes (H/M 37/16, idade média±DP, 62±7,9 anos) com DP (media±DP, 7,8±4,4 anos). Escala de Graduação Unificada da Doença de Parkinson (UPDRS), Escala de Schwab e England (S&E), Escala de Estágios de Hoehn e Yahr (HY) e EEB foram utilizadas. Análise estatística para confiabilidade entre examinadores, consistência interna e correlações entre EEB, UPDRS, S&E e HY foram realizadas. RESULTADOS: Os escores médios±DP nas escalas UPDRS e EEB foram, respectivamente, 41,6±17,8 e 47,2±8,2. A mediana nas escalas S&E e HY foram 80 por cento e 2,5. A EEB mostrou ter alto coeficiente de correlação intraclasse (ICC=0,84) e consistência interna (α de Cronbach=0,92). Houve correlação estatisticamente significativa entre EEB e a duração da doença (r s= -0,520, p<0,001), sub-escalas II e III do UPDRS (r s= -0,467, p=0,011; r s= -0,374, p=0,046, respectivamente), estágio da doença (HY; r s= -0,507, p<0,001), com as atividades da vida diária (S&E; r s= 0,492; p<0,001). CONCLUSÃO: A EEB é um instrumento promissor para avaliar o equilíbrio na DP, correlacionando-se com o estágio da doença e o nível de independência.

Reabilitação vestibular no idoso com instabilidade postural / Vestibular rehabilitation in elderly patients with postural instability

As quedas constituem importante agravo à saúde do idoso, devido ao seu alto potencial de gerar traumas e condequente imobilidade. Figuram entre os chamados "gigantes da Geriatria". A imobilidade causada por sequelas da queda - sejam físicas ou psicológicas - pode acelerar o declínio funcional associado ao envelhecimento. Muitas das quedas inexplicáveis em idosos decorrem de instabilidade postural, que tem origem em alterações dos sistemas visual, proprioceptivo e vestibular, responsáveis pelo envio de informações ao sistema nervoso central para manter a estabilidade estática e dinâmica do corpo. As falhas do sistema vestibular, levando a tonteiras, desequilíbrio e vertigens, são responsáveis pela alta incidência de quedas em idosos. Os autores analisam o papel da reabilitação vestibular no tratamento da instabilidade postural dos idosos e, consequentemente, na prevenção das quedas. A literatura mostra que a reabilitação vestibular melhora o equilíbrio corporal, bem como alivia os sintomas vestibulares, melhorando a velocidade e a qualidade da marcha. Nos idosos, é necessário também abordar o descondicionamento físico geral, utilizando-se exercícios que trabalhem a força, a resistência muscular e a flexibilidade.

The falls are important problem for the elderly's health due their high potential to cause injuries and immobility, figuring as "geriatrics giants". The immobility occurs because physical or psychological sequels can to accelerate the functional decline associated with the aging. Great part of the inexplicable falls in the elderly happens due to the postural instability that has origin in visual, proprioceptive and vestibular system's faults. These systems send informations to the Central Nervous System for the maintaining of static and dynamic body stability. The vestibular system faults can cause symptoms such as dizzeness, imbalance and vertigo, being involved in the high falls incidence in the elderly. The aim of this study was to analyse the role of the vestibular rehabilitation in the treatment of the elderly's postural instability and in the falls prevention. Vestibular rehabilitation is efficient in the increasing body's balance and in the relief of the vertigo's symptoms, and still increases the gait's velocity and quality. However, in the elderly, it's necessary to increase the general physical conditions through exercises that work strength, muscle's resistance and flexibility.

Computerized Analysis of Postural Instability in Parkinson's Disease

OBJECTIVE: To evaluate and quantify the postural instability in patients with Parkinson's disease (PD) using computerized posturography. METHOD: Twenty subjects with PD group (10 men, 10 women) and 20 control group (10 men, 10 women) were matched for age and sex. Average Hoehn-Yahr stage of PD group was 2.3+/-0.3. Sensory dysfunction, voluntary motor impairments and functional limitation were measured by determining the subject's response to reduced or altered sensory and voluntary motor control of balance. RESULTS: PD subjects demonstrated wider area of sway (degrees) under eye closed condition in modified sensory organization test and lower directional control (%) in right/left rhythmic weight shift (p<0.05). No significant difference was observed for sit to stand. Wider area of turn sway (degrees) and longer turn time (sec) during left step/quick turn were demonstrated in PD subjects (p<0.05). CONCLUSION: Computerized posturography shows that sensory dysfunction scores, voluntary motor impairment scores and functional limitation test scores were reduced in patients with PD.