Comparison of forward and backward postural perturbations in mild-to-moderate Parkinson's disease

Chiahao Lu, Sommer L Amundsen-Huffmaster, Kenneth H Louie, Robert Lowe, Reme Abulu, Robert A McGovern, Jerrold L Vitek, Colum D MacKinnon, Scott E Cooper

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Assessing postural stability in Parkinson's disease (PD) often relies on measuring the stepping response to an imposed postural perturbation. The standard clinical technique relies on a brisk backwards pull at the shoulders by the examiner and judgement by a trained rater. In research settings, various quantitative measures and perturbation directions have been tested, but it is unclear which metrics and perturbation direction differ most between people with PD and controls.

OBJECTIVES: (1) Use standardized forward vs. backward perturbations of a support surface to evaluate reactive stepping performance between PD and control participants. (2) Evaluate the utility of using principal components analysis to capture the dynamics of the reactive response and differences between groups.

METHODS: Sixty-two individuals participated (40 mild-to-moderate PD, off medication). Standardized rapid translations of the support surface were applied, requiring at least one step, backward or forward, to restore balance. The number of steps taken and the projection of the first principal component (PC1) of the center of pressure (COP) time series were entered in linear repeated-measures mixed effect models.

RESULTS: Forward falls required significantly fewer steps to recover than backward falls. PC1 captured more than half of the variance in the COP trajectory. Analysis of the PC1 projection revealed a significant interaction effect of group (PD vs. controls) by direction, such that there was a group difference in forward stepping, but not backward.

SIGNIFICANCE: Forward reactive stepping in PD differed from controls more than backward-stepping. PC1 projections of the COP trajectory capture the dynamics of the postural response and differ between PD and controls.

Original languageEnglish (US)
Pages (from-to)205-208
Number of pages4
JournalGait & posture
Early online dateDec 23 2020
StatePublished - Feb 1 2021

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health [grant numbers: P50NS098573 , R01NS088679 , R01NS081118 , R01NS094206 ] and the State of Minnesota’s MnDRIVE Brain Conditions Initiative .

Publisher Copyright:
© 2020 Elsevier B.V.


  • Center of pressure
  • Parkinson's disease
  • Postural instability
  • Principal component analysis
  • Reactive stepping

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


Dive into the research topics of 'Comparison of forward and backward postural perturbations in mild-to-moderate Parkinson's disease'. Together they form a unique fingerprint.

Cite this