Postural flexibility during quiet standing in healthy elderly and patients with Parkinson's disease

Postural instability is one of the predominant symptoms of Parkinson's disease (PD). Despite its significant impact on the deterioration in quality of life in PD patients, mechanistic causes of the instability have not been clarified. Joint inflexibility at ankle and hip joints might be such a major cause, leading to small variability in the center of pressure (CoP) during quiet stance. However, this conjecture is still controversial. Thus, quantitative characterization of CoP patterns during quiet stance in PD patients remains a matter of research. Here we performed a linear discriminant analysis for CoP data in PD patients and age-matched healthy elderly during quiet stance, and showed that CoP variations in PD patients and those in healthy elderly could be well distinguished with an accuracy of about 90%, to which appropriately selected sway indices characterizing aspects of power spectrum for the CoP variations contributed. Specifically, major factors responsible for the discrimination were all associated with increase in the power at a high-frequency band (near and over 1 Hz) along with reduction at the low-frequency regime (lower than about 0.7 Hz). Then, the power-ratio, defined as the relative spectral power in a band around 1 Hz, was examined, since the power in this band reflects postural sway with anti-phase coordinated motions of the ankle and hip joints. We showed that the power-ratio values were significantly smaller in the PD patients than those in the healthy subjects. This difference as well as the results of the linear discriminant analysis suggest joint inflexibility in PD patients, particularly at hip joint, which diminished anti-phase coordination between trunk and lower extremity, leading to postural instability in PD patients.