Skip Navigation
Skip to contents

JMD : Journal of Movement Disorders


Author index

Page Path
HOME > Browse Articles > Author index
Ye Eun Kim 1 Article
The Four Square Step Test for Assessing Cognitively Demanding Dynamic Balance in Parkinson’s Disease Patients
Jinhee Kim, Ilsoo Kim, Ye Eun Kim, Seong-Beom Koh
J Mov Disord. 2021;14(3):208-213.   Published online May 26, 2021
  • 3,405 View
  • 139 Download
  • 1 Citations
AbstractAbstract PDFSupplementary Material
The Four Square Step Test (FSST) is a tool that assesses dynamic balance during obstacle step-over. To date, few studies have used the FSST to measure balance in patients with Parkinson’s disease (PD). This study aimed to verify that patients with PD, even at the de novo early stage, take more time to perform the FSST and identify which factors, cognitive status or cardinal motor symptoms, are related most to FSST scores.
Thirty-five newly diagnosed drug-naïve patients with PD and 17 controls completed the FSST. The Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) stage, spatiotemporal gait parameters, and neuropsychological test battery were also assessed in the PD group.
Mean FSST performance time was 8.20 ± 1.61 seconds in patients with PD, which was significantly more than the control group (7.13 ± 1.10 seconds, p = 0.018). UPDRS part III total score and H&Y stage were not significantly associated with FSST, but among the UPDRS subscores, only the postural instability/gait disturbance subscore showed a significant association. Regarding the association between FSST and cognition, the Trail Making Test-B and the Color Word Stroop Test showed strongly inverse correlations with FSST (rho = -0.598 and -0.590, respectively). With respect to gait parameters, double support time was significantly associated with FSST score (rho = 0.342, p = 0.044); however, other parameters, including velocity and step length, were not associated with the FSST.
The FSST can be used in the clinic to assess dynamic balance with cognitive demands even in the early stages of PD.


Citations to this article as recorded by  
  • Relationship between parental history of dementia, motor-cognitive and executive function performance in African American women
    Allison A. Bay, Nicole Schindler, Whitney Wharton, Hayley Silverstein, Liang Ni, Todd A. Prusin, Madeleine E. Hackney
    Journal of the Neurological Sciences.2022; 439: 120305.     CrossRef

JMD : Journal of Movement Disorders