[Diagnosis of pathological and adaptive balance changes in Parkinson's disease to select a rehabilitation program]

To assess static and dynamic balance in Parkinson's disease (PD) to select a rehabilitation program using group-based and group-inclusive methods.

A comparative non-randomized study included 50 female patients with Hoehn and Yahr stage 2-3 PD (65.73±7.19 years); the control group was 25 females without PD (67.86±6.12 years). Study subjects were interviewed about the presence of pain and impaired function of the lower extremities, examined for scoliosis, and subjected to stabilometry on the ST-150 platform, the «stand up and go» test, a Short Physical Performance Battery (SPPB), hand dynamometry, and an orthostatic test; PD patients were assessed for motor function using the MDS UPDRS scale - Part III.

Indicators of displacement of the pressure center in the sagittal plane of patients with PD in the European and American feet stand with open and closed eyes were less than the values of subjects in the control group. In PD patients, the rate of displacement of the pressure center in the European stand correlated with the points of the MD UPDRS scale (Part III). The symptoms of impaired lower limb function and the dynamometry results were not correlated with the displacement of the pressure center in the frontal plane in both groups. The frequency of scoliosis did not differ in persons with or without PD, and the presence of scoliosis was not correlated with stabilometry. The characteristics of the SPPB static balance (standing time in the «foot together», in the longitudinal «half-tandem», and in the longitudinal «tandem» stands) were within the reference range (>10 s) and did not differ between the groups. The indicators were correlated with the age of PD patients and subjects in the control group.

The «stand up and go» test time was normal, did not differ in PD patients and the control group, and was correlated with the points of MDS UPDRS score (Part III) (R=0.45; p<0.05) and age (R=0.43; p<0.05). The time of the «5 Times Sit to Stands» of the SPPB was within the normal range and did not differ between the groups.

The frequency of orthostatic hypotension did not differ between groups. In PD patients with orthostatic hypotension, the «stand up and go» test time was longer than in those without orthostatic hypotension.

Based on the observed changes, a program for the rehabilitation of balance in the group of patients and an inclusive program with subjects without PD are proposed, including strength exercises, stretching, orthostatic response training if necessary, weight shift, and dynamic balance exercises.

Changes in static and dynamic balance in PD patients are due to complex sensory and motor integration disorders beyond the dopaminergic pathway and age-related changes. These changes are both pathological and adaptive, and they must be considered when developing a rehabilitation program using group-based and group-inclusive methods.