Objective: The purpose of this study is to investigate different strategies of temporal coordination of the head and trunk in people with Parkinson’s disease(PD) while performing a turning-in-place task.

Background: Turning is involved in about 40% of daily activity, and most falls in people with PD occur during turning. Turning impairments in PD include 1) the ‘en bloc’ phenomenon where upper and lower body segments turn simultaneously, 2) a longer duration of turn and less accurate turn completion, 3) a narrower base of support, and 4) the use of ‘step turns’ rather than ‘pivot turns’ ¹. However, it isn’t clear which of these aspects is more related to fall risk or disease severity.

Method: 47 individuals with idiopathic PD (age=67±7 years, disease duration=8±5 years, MDS-UPDRS-III=32±10 score, MoCA=26±2 score) were assessed in the ON-medication state. The task was to make turn 360 degree turns in-place for 1 minute, alternating between right and left direction of turns. Turning was measured with 5 inertial sensors (head, sternum, lumbar, right foot, and left foot). Using gyroscope signals, particularly the yaw axis, we first estimated the period of motion of each segment using a threshold of the angular velocity of 0.6 rad/sec. Second, we selected the time when the head, sternum, and lumbar segments rested (combined resting). Third, we computed the onset times of all segments after the combined resting periods.

Results: People with and without a history of falls do not show significant differences in the head or lumbar leading metrics. The head-led turning was observed in 17 participants (36.1%), the lumbar segment led in 13 participants (27.6%), the sternum in 2 participants (4.2%), the ‘en bloc’ strategy in 8 participants (17%), and another 7 participants did not have a clear preference (14.8%). Disease progression is correlated with an increase in head onset leading to the turn and a decrease in the lumbar leading to the turn (r=0.6, p=0.01).

Conclusion: Turning variables were related to disease duration, suggesting that more severe motor symptoms of PD impact turning temporal coordination. Future analysis will include additional metrics and data from healthy control participants to understand better temporal coordination changes in Parkinson’s disease and its relation to fall risk.

References: 1. Morgan, C. et al. Understanding how people with Parkinson’s disease turn in gait from a real-world in-home dataset. Parkinsonism & Related Disorders 105, 114–122 (2022).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/temporal-coordination-of-head-and-trunk-during-360-degree-turning-in-parkinsons-disease/