Compensatory postural adjustments in Parkinson's disease assessed via a virtual reality environment

Abstract

Postural control is a complex dynamic mechanism, which integrates information from visual, vestibular and somatosensory systems. Idiopathic Parkinson's disease (IPD) patients are unable to produce appropriate reflexive responses to changing environmental conditions. Still, it is controversial what is due to voluntary or involuntary postural control, even less what is the effect of levodopa. We aimed to evaluate compensatory postural adjustments (CPA), with kinematic and time-frequency analyzes, and further understand the role of dopaminergic medication on these processes. 19 healthy subjects (Controls) and 15 idiopathic Parkinson's disease (IPD) patients in the OFF and ON medication states, wearing IMUs, were submitted to a virtual reality scenario with visual downward displacements on a staircase. We also hypothesized if CPA would involve mechanisms occurring in distinct time scales. We subsequently analyzed postural adjustments on two frequency bands: low components between 0.3 and 1.5 Hz (LB), and high components between 1.5 and 3.5 Hz (HB). Vertical acceleration demonstrated a greater power for discriminating IPD patients from healthy subjects. Visual perturbation significantly increased the power of the HB in all groups, being particularly more evident in the OFF state. Levodopa significantly increased their basal power taking place on the LB. However, controls and IPD patients in the ON state revealed a similar trend of the control mechanism. Results indicate an improvement in muscular stiffness provided by levodopa. They also suggest the role of different compensatory postural adjustment patterns, with LB being related to inertial properties of the oscillating mass and HB representing reactions to the ongoing visual input-changing scenario.