Journal of Movement Disorders

Original Articles

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; DOI: https://doi.org/10.14802/jmd.20146

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Objective
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.
Methods
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.
Results
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.
Conclusion
The FSST can be used in the clinic to assess dynamic balance with cognitive demands even in the early stages of PD.

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Validity and Reliability Study of the Korean Tinetti Mobility Test for Parkinson’s Disease: Jinse Park, Seong-Beom Koh, Hee Jin Kim, Eungseok Oh, Joong-Seok Kim, Ji Young Yun, Do-Young Kwon, Younsoo Kim, Ji Seon Kim, Kyum-Yil Kwon, Jeong-Ho Park, Jinyoung Youn, Wooyoung Jang; J Mov Disord. 2018;11(1):24-29. Published online January 23, 2018; DOI: https://doi.org/10.14802/jmd.17058

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Abstract PDF Supplementary Material

Objective
Postural instability and gait disturbance are the cardinal symptoms associated with falling among patients with Parkinson’s disease (PD). The Tinetti mobility test (TMT) is a well-established measurement tool used to predict falls among elderly people. However, the TMT has not been established or widely used among PD patients in Korea. The purpose of this study was to evaluate the reliability and validity of the Korean version of the TMT for PD patients.
Methods
Twenty-four patients diagnosed with PD were enrolled in this study. For the interrater reliability test, thirteen clinicians scored the TMT after watching a video clip. We also used the test-retest method to determine intrarater reliability. For concurrent validation, the unified Parkinson’s disease rating scale, Hoehn and Yahr staging, Berg Balance Scale, Timed-Up and Go test, 10-m walk test, and gait analysis by three-dimensional motion capture were also used. We analyzed receiver operating characteristic curve to predict falling.
Results
The interrater reliability and intrarater reliability of the Korean Tinetti balance scale were 0.97 and 0.98, respectively. The interrater reliability and intra-rater reliability of the Korean Tinetti gait scale were 0.94 and 0.96, respectively. The Korean TMT scores were significantly correlated with the other clinical scales and three-dimensional motion capture. The cutoff values for predicting falling were 14 points (balance subscale) and 10 points (gait subscale).
Conclusion
We found that the Korean version of the TMT showed excellent validity and reliability for gait and balance and had high sensitivity and specificity for predicting falls among patients with PD.

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Review Article

What Is Wrong with Balance in Parkinson’s Disease?: Jeong-Ho Park, Yeo-Jeong Kang, Fay Bahling Horak; J Mov Disord. 2015;8(3):109-114. Published online September 10, 2015; DOI: https://doi.org/10.14802/jmd.15018

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Abstract PDF

Postural instability and resulting falls are major factors determining quality of life, morbidity, and mortality in individuals with Parkinson’s disease (PD). A better understanding of balance impairments would improve management of balance dysfunction and prevent falls in patients with PD. The effects of bradykinesia, rigidity, impaired proprioception, freezing of gait and attention on postural stability in patients with idiopathic PD have been well characterized in laboratory studies. The purpose of this review is to systematically summarize the types of balance impairments contributing to postural instability in people with PD.

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Case Report

Psychogenic Balance Disorders: Is It a New Entity of Psychogenic Movement Disorders?: Jong Sam Baik, Myung Sik Lee; J Mov Disord. 2012;5(1):24-27.; DOI: https://doi.org/10.14802/jmd.12007

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Abstract PDF

The various reported psychogenic dyskinesias include tremor, dystonia, myoclonus, gait disorder, Parkinsonism, tics, and chorea. It is not easy to diagnose psychogenic movement disorders, especially in patients with underlying organic disease. We describe three patients with balance and/or posture abnormalities that occur when they stand up, start to move, or halt from walking, although their gaits are normal. One had an underlying unilateral frontal lobe lesion. All patients improved dramatically after receiving a placebo-injection or medication. These abnormal features differ from the previously reported features of astasia without abasia and of psychogenic gait disorders, including recumbent gait. We describe and discuss the patients’ unique clinical characteristics.

Citations

Citations to this article as recorded by

Somatization in Parkinson's Disease: A systematic review
Danilo Carrozzino, Per Bech, Chiara Patierno, Marco Onofrj, Bo Mohr Morberg, Astrid Thomas, Laura Bonanni, Mario Fulcheri
Progress in Neuro-Psychopharmacology and Biological Psychiatry.2017; 78: 18. CrossRef
Functional movement disorders
Anita Barbey, Selma Aybek
Current Opinion in Neurology.2017; 30(4): 427. CrossRef

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