Trunk Accelerometry Reveals Postural Instability in Untreated Parkinson's Disease

While several studies have shown that subjects with advanced Parkinson's disease (PD) exhibit abnormalities in sway parameters during quiet standing, abnormalities of postural sway associated with untreated PD have not been reported. Although not clinically apparent, we hypothesized that spontaneous sway in quiet stance is abnormal in people with untreated PD. We examined 13 subjects, recently diagnosed with PD, who were not yet taking any anti-parkinsonian medications and 12 healthy, age-matched control subjects. Postural sway was measured with a linear accelerometer on the posterior trunk (L5 level) and compared with traditional force plate measures of sway. Subjects stood for 2 min under two conditions: eyes open (EO) and eyes closed (EC). One of the most discriminative measures of postural changes in subjects with untreated PD was the increased 'JERK' of lower trunk in the EO condition, measured with the accelerometer. Root mean square and the frequency dispersion of postural sway in the EO condition also discriminated sway in untreated PD subjects compared to control subjects. We conclude that accelerometer-based sway metrics could be used as objective measures of postural instability in untreated PD. Accelerometer-based analysis of spontaneous sway may provide a powerful tool for early clinical trials and for monitoring the effects of treatment of balance disorders in subjects with PD.