Objective: This prospective study aimed to evaluate the relationship between impaired trunk muscle function, segmental coordination and future falls in people with Parkinson’s disease (PD).

Background: Precisely timed muscle contractions are essential to effective locomotion, but the efficacy of such muscle synergies may be impaired in people with PD. The trunk accounts for approximately 50% of the body’s mass and plays a critical role in attenuating movement-related forces; hence effective trunk control appears fundamental to maintaining stability during gait. However, it remains unclear how the development of dopamine-resistant axial motor symptoms may influence trunk control and falls risk in people with PD.

Methods: Seventy-nine people with PD and 82 age- and gender-matched controls completed a series of validated questionnaires and clinical assessments to establish their medical history, balance confidence, history of falls and symptom severity. Gait characteristics and trunk muscle activation were assessed using 3D motion analysis and surface EMG while the participants completed a number of walking trials. Over the subsequent 12 months, participants prospectively recorded the incidence, cause and consequence of any falls experienced. During the 12-month follow-up, 48 PD participants (61%) reported at least one fall compared with 29 controls (35%).

Results: Despite individuals with PD and controls demonstrating similar patterns of trunk muscle activity during walking, PD fallers had greater peak activations for the lumbar and thoracic paraspinal muscles than controls. Also, PD fallers had significantly more baseline activity for the lumbar and thoracic paraspinal muscles than control participants. An ANCOVA indicated that while the higher lumbar multifidus activity was largely attributable to the more stooped posture adopted by the PD fallers, differences in thoracic erector spinae activity were not explained by trunk orientation. Furthermore, linear regression indicated that the greater baseline activity evident for the paraspinal muscles significantly contributed to increasing lateral head, trunk and pelvis movements in PD fallers, but not non-fallers or controls.

Conclusions: These results provide evidence of neuromuscular deficits for PD fallers that are independent of posture and contribute to the impaired head, trunk and pelvic control associated with falls in this population.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impairments-in-trunk-muscle-function-influence-head-and-trunk-stability-during-walking-in-parkinsons-disease-fallers/