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Turning Stability in Individuals With Parkinson Disease

Conradsson, David, PhD; Paquette, Caroline, PhD; Franzén, Erika, PhD

Journal of Neurologic Physical Therapy: October 2018 - Volume 42 - Issue 4 - p 241–247
doi: 10.1097/NPT.0000000000000242
Research Articles

Background and Purpose: Although instability during turning is a disabling feature of Parkinson disease (PD), little is known about the associated postural characteristics. Our goals were to compare turning stability between individuals with PD and healthy individuals and to investigate whether dopaminergic medication improves turning stability.

Methods: Nineteen older adults with mild to moderate PD and 19 healthy individuals walked straight or walked and turned 180° to the right or left. The turning direction was visually cued before (preplanned) or during (unplanned) straight walking. Participants with PD were assessed off and on medication. As a proxy for mediolateral stability, we calculated the difference between pelvis lateral displacement and the lateral edge of the support base.

Results: While healthy individuals regulated mediolateral stability in a steady-state manner during turning, mediolateral stability in PD was reduced for crossover steps (narrow steps by the foot contralateral to the turning direction) and increased for side steps (widening steps by the foot ipsilateral to the turning direction) (P ≤ 0.008). Individuals with PD turned with narrower step width (P ≤ 0.024) and smaller pelvis displacement than healthy individuals (P ≤ 0.002). Dopaminergic medication only improved mediolateral stability while using side steps to initiate unplanned turns (P < 0.001).

Discussion and Conclusions: Turning stability was compromised in PD, but only for crossover steps with a narrow support base. As dopaminergic medication showed limited effect on turning stability, rehabilitation plays an important role to promote safe turning strategies with a specific emphasis on sustainment of a wide support base.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at:

Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden (D.C., E.F.); Function Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden (D.C., E.F.); Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada (D.C., C.P.); and Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada (C.P.)

Correspondence: David Conradsson, PhD, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Alfred Nobels Allé 23, 23100 Huddinge, Sweden (

This work was supported by the Swedish Research Council, Swedish Parkinson's Foundation, the Karolinska Institutet Foundation, and the Natural Sciences and Engineering Research Council of Canada.

This study has previously been presented at the International Society for Posture and Gait Research, Ft. Lauderdale, Florida, 2017.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2018 Academy of Neurologic Physical Therapy, APTA