Objective: To identify the clinical features of postural instability by PD patients.

Background: Postural instability (PI) to maintain body balance while walking. The causes of PI are still not clearly understood. PI develops in the dysfunction of the basal ganglia (Kerr G. K.), has a noradrenergic mechanism (Narabayashi H),associates with akinesia in the ankle joint (Fay B. Horak, John G. Nutt), depends on the visual analyzer (Azulay J.).

Methods: We tested 38 patients with PD (23 men and 15 women) aged from 60 to 75 years. Disease duration was 4-7 years. There were identified three forms of patients: akinetic-rigid (AR) 18 pts, the mixed form (MF) 10 pts, shaking form (SF) 10 pts. Stage II-15 pts, stage III -23 pts. PI was determined using modificated Tavener probe (TP): push trial bag, without warning, with warning forward with open eyes, with closed eyes, toward the side. The PI were valued in points scale UPDRS.

Results: PI patients: 1 point – 10 people, 2 points – 13 p., 3 points – 10 p., 4 points -5 p.. The severity of PI depends on the form of the disease. In AR 3,2 ± 0,6 points, MF 2,4±0,3 points, SF 1.2 ± 0,4 points. PI depends on the debut of the disease: in cases with stiffness and movement disorder (n=19), PI 2,6±0,4, debut with stiffness and tremor (n=10), PI 2,3±0,3, debut with tremor (n=9 people), PI 1,2 ± 0,6. Debut with stiffness quickly leads to the development of PI. It was analyzed correlation of PI with the UPDRS score (tremor, hypokinesia, axial tone).PI dependence on the abnormal gait (R = 0.63, p<0.05). The most clear relationship was PI with the tone of lower limbs(R =0.56, p<0.05). In the group with camptocormia and SPT (n=18), PI was 2,6±0,7 and in the group without these symptoms (n=20) PI 1,5 people± 0,3. The following results were obtained in TP with. PI bag without warning is with for more than warning by 1-2 points. Thus the central mechanisms of regulation of PI is broken. While carrying out samples forward with closed eyes and backwards, load factors coincided (R=0.9, p =0,92). In conducting push tests forward with open eyes and bag, PI forward is less than backward (R = 0,62, p<0.05).

Conclusions: Debut PD with stiffness leads to quick PI. The central mechanism plays role in development of PI. In the mechanism of development of PI postural strategy play the role, it means the ankle strategy. The elevated muscle tone of the lower limbs causes a PI. In PI plays role visual control.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-aspects-of-postural-instability-in-parkinsons-disease/