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Do Clinical Scales of Balance Reflect Turning Abnormalities in People With Parkinson's Disease?

King, Laurie A. PT, PhD; Mancini, Martina PhD; Priest, Kelsey BA; Salarian, Arash PhD; Rodrigues-de-Paula, Fatima PT, PhD; Horak, Fay PT, PhD

Journal of Neurologic Physical Therapy: March 2012 - Volume 36 - Issue 1 - p 25–31
doi: 10.1097/NPT.0b013e31824620d1
Research Articles

Background and Purpose: It is well known that people with Parkinson's disease (PD) have significant difficulty turning, and that such difficulty is related to freezing episodes and falls. However, it is unclear how clinicians should evaluate turning. The purpose of this exploratory study was to determine whether the common clinical assessment instruments reflect turning deficits in persons with PD compared with an instrumented measure.

Methods: Forty-six participants with PD (23 with mild PD, and 23 with severe PD), and 40 healthy controls were assessed using the Berg Balance Scale (Berg), Tinetti Mobility Test (Tinetti), Activities-Specific Balance Confidence Scale, and the new instrumented Timed Up & Go test using wearable inertial sensors.

Results: Turns during the instrumented Timed Up & Go test showed significant differences among groups (χ2 = 43.6, P < 0.0001). Specifically, controls and mild PD (P < 0.001) and controls and severe PD (P < 0.00001). The number of steps (χ2 = 32.1; P < 0.0001) and peak speed (χ2 = 31.9; P < 0.0001) during turning were significantly different among all groups. Clinical scales were less likely to detect these differences. Of the clinical scales, the Berg was best able to detect differences between control and mild PD groups. Correlations between clinical measures of balance and instrumented turning were moderate but significant.

Conclusions: We show evidence that turning is impaired, even in mildly impaired participants with PD and that this deficit is not obviously reflected in common clinical scales of balance such as the Berg or Tinetti. It may be more useful for a clinician to examine particular items within the Berg or the turning component of the TUG if turning difficulty is suspected.

Balance Disorders Laboratory, Department of Neurology (L.A.K., M.M., K.P., A.S., F.H.), Balance Disorders Laboratory, Department of Physiology and Pharmacology (F.H.), and Department of Biomedical Engineering (F.H.), School of Medicine, Oregon Health & Science University, Portland, Oregon; and Department of Physical Therapy, Universidade Federal de Minas Gerais Belo Horizonte, Minas Gerais, Brazil (F.P.).

Correspondence: Laurie A. King, PT, PhD, Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (

This study was previously presented at Combined Sections Meeting, American Physical Therapy Association, San Diego, 2010.

Disclosure of funding: National Institutes of Health (Bethesda, Maryland) and Kinetics Foundation (Los Altos, California).

Drs. Horak and Salarian have a significant financial interest in and/or are employees of ADPM, a company that may have a commercial interest in the results of this research and technology. This potential institutional and individual conflict has been reviewed and managed by Oregon Health & Science University. All other authors declare no conflict of interest.

© 2012 Neurology Section, APTA