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E-raamat: Balance Dysfunction in Parkinson's Disease: Basic Mechanisms to Clinical Management

(Balance Disorders Laboratory, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA), (Director of Balanc), (Oregon Health and Science University, Parkinson Center for Health and Healing, Portland, OR, USA)
  • Formaat: EPUB+DRM
  • Ilmumisaeg: 14-Sep-2019
  • Kirjastus: Academic Press Inc
  • Keel: eng
  • ISBN-13: 9780128138755
  • Formaat - EPUB+DRM
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  • Formaat: EPUB+DRM
  • Ilmumisaeg: 14-Sep-2019
  • Kirjastus: Academic Press Inc
  • Keel: eng
  • ISBN-13: 9780128138755

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Balance Dysfunction in Parkinson’s Disease: Basic Mechanisms to Clinical Management presents the most updated information on a variety of topics. Sections help clinicians evaluate the types of balance control issues, dynamic balance dysfunction during turning, and the effects of medication, deep brain stimulation, and rehabilitation intervention on balance control. This book is the first to review the four main postural control systems and how they are affected, including balance during quiet stance, reactive postural adjustments to external perturbations, anticipatory postural adjustments in preparation for voluntary movements, and dynamic balance control during walking and turning.

In addition, the book's authors summarize the effects of levodopa, deep brain stimulation, and rehabilitation intervention for each balance domain. This book is recommended for anyone interested in how and why balance control is affected by PD.

  • Provides the first comprehensive review of research to date on balance dysfunctions in Parkinson's disease
  • Discusses how to translate current neuroscience research into practice regarding neural control of balance
  • Provides evidence on the effects of current interventions on balance control
About the authors xi
Acknowledgments xv
Introduction xvii
1 How is balance controlled by the nervous system?
A What is balance control?
1(2)
B What are the critical properties of balance control?
3(3)
C What are the main balance domains to assess?
6(7)
D What parts of the brain are involved in balance control?
13(3)
E What is the role of the basal ganglia in balance control?
16(4)
F Balance is a complex sensorimotor task that can be improved with practice
20(1)
Highlights
21(1)
References
21(4)
2 Why is balance so important in Parkinson disease?
A How common are balance disorders in PD?
25(1)
B How important are balance and gait to the wellbeing of a person with PD?
25(1)
C When do balance problems emerge?
26(1)
D Why does Parkinson disease affect balance?
26(2)
E How does dopaminergic replacement therapy work?
28(2)
F Do dopaminergic mechanisms explain all the balance deficits of parkinsonism?
30(1)
G How is balance affected in Parkinson-Plus syndromes?
31(2)
H Do nonmotor signs affect balance control in PD?
33(1)
Highlights
34(1)
References
34(3)
3 How is balance during quiet stance affected by PD?
Clinical case
37(1)
A How does PD affect postural alignment?
37(4)
B How are limits of stability impaired in PD?
41(2)
C What is the contribution of axial tone to standing balance?
43(2)
D Why is postural sway important?
45(1)
E Does PD affect sensory integration for balance?
46(2)
F Does levodopa improve standing balance?
48(2)
G Do other medications influence balance?
50(1)
H What are the effects of deep brain stimulation on standing posture?
51(2)
I Can rehabilitation improve standing posture?
53(1)
Highlights
54(1)
References
55(8)
4 How are postural responses to external perturbations affected by PD?
Clinical case
63(1)
A How are retropulsion and propulsion related to impaired postural responses?
63(2)
B Why do patients with PD show more abnormalities in their postural responses in the backward direction than other directions (or do they?)
65(3)
C What are the major postural responses deficits in PD?
68(3)
D How does PD affect adaptation of postural responses to changes in environmental context?
71(2)
E Does levodopa improve postural responses?
73(3)
F Does deep brain stimulation improve postural responses?
76(2)
G Does rehabilitation improve postural responses?
78(2)
Highlights
80(1)
References
80(3)
5 How are anticipatory postural adjustments in preparation for voluntary movements affected by PD?
Clinical case
83(1)
A Are APAs hypometric in PD?
83(4)
B Are APAs context-dependent?
87(1)
C Does levodopa improve APAs?
88(2)
D What are the effects of deep brain stimulation on APAs?
90(2)
E Can rehabilitation affect APAs?
92(2)
Highlights
94(1)
References
94(5)
6 How is dynamic balance during walking affected by PD?
Clinical case
99(1)
A How does impaired balance affect gait and impaired gait affect balance in PD?
99(11)
B How is predictive and reactive obstacle avoidance during walking affected by PD?
110(2)
C How does levodopa and deep brain stimulation affect dynamic balance, as well as gait?
112(2)
D Rehabilitation and exercise improve gait but do they also improve dynamic balance control during walking?
114(3)
Highlights
117(1)
References
117(6)
7 How and why is turning affected by Parkinson disease?
Clinical case
123(1)
A Why is turning a difficult dynamic balance task?
123(1)
B PD affects many sensorimotor control systems important for controlling a turn
124(7)
C Turning impairments are sensitive to early disease, falls, and freezing of gait
131(2)
D Can levodopa, deep brain stimulation, or exercise improve turning?
133(1)
Highlights
134(1)
References
134(5)
8 Is freezing of gait a balance disorder?
Clinical case
139(1)
A What is freezing of gait and why it is associated with falls
139(3)
B Do freezers have more balance disorders than nonfreezers?
142(8)
C Do brain circuitry abnormalities in freezers suggest causes for FoG?
150(3)
D How can FoG be treated with medication?
153(1)
E Does deep brain stimulation improve FoG?
153(1)
F Does rehabilitation improve FoG?
154(2)
Highlights
156(1)
References
156(7)
9 How should the clinician approach imbalance in PD?
A When in the course of PD should clinicians address balance issues?
163(1)
B When is exercise helpful for balance disorders?
163(4)
C Does levodopa, dopamine replacement therapy, improve balance?
167(2)
D What considerations should a history of falls trigger?
169(4)
E How will deep brain stimulation affect balance?
173(1)
F How can freezing of gait be treated?
174(2)
G How should advanced PD incapable of independent ambulation be treated?
176(1)
Highlights
177(1)
References
178(3)
10 Future perspectives on balance disorders in PD
A How can wearable technology improve assessment of balance?
181(3)
B How will wearable or embedded technology improve mobility in daily life?
184(2)
C How could new technologies improve rehabilitation of balance disorders?
186(4)
D Will future medications likely improve balance in PD?
190(1)
E Could different electrical stimulation targets improve balance in PD?
191(3)
References
194(7)
Index 201
Dr. Mancini received her PhD in bioengineering at University of Bologna in Italy, and completed a postdoctoral fellowship in the Department of Neurology at OHSU. Her translational biomedical research focuses on objectively characterizing, understanding and monitoring mobility impairments in patients with neurological disorders with wearable sensors in order to develop tailored rehabilitation intervention, such as biofeedback-based solutions. She has presented at national and international meetings on topics related to balance and gait impairments in subjects with Parkinsons disease and Parkinsonism, as well as fall risk in healthy elderly subjects. She received an NIH K99-R00 award from the National center for Medical Rehabilitation Research to characterize the physiology of gait disturbances during locomotion with body-worn sensors, and to determine whether vibrotactile biofeedback improves gait disturbances in Parkinsons disease in laboratory and home environments. I have two main research areas. The first theme is the pharmacology of movement disorders. My studies have largely been proof of principle clinical trials of dopaminergic therapies. I have developed protocol using 2-hour levodopa infusions and four simple clinical tests (tapping speed, timed up and go tremor score and dyskinesia score) for investigating pharmacodynamics of levodopa and interactions between levodopa and other interventions. The second theme is gait and balance dysfunction with clinical interests in gait disorders and interests in the physiology of gait and balance in neurological disorders. David Marsden, Phillip Thompson and I introduced the concept of lower, middle and higher level gait disorders that is widely accepted today. Dr. Horak, with whom I have collaborated for over 30 years, and I have investigated the physiology of balance and gait disorders that characterizes Parkinsons disease. Dr. Horak holds a PhD in Physiology and Biophysics, an MS in Neurophysiology from University of Minnesota, and a BS in Physical Therapy from University of Wisconsin. Her background is in neural control of balance and gait and the effects of neurological disorders on motor control. She has received the prestigious MERIT award from the NIH, a rare Mary McMillan Research Award from the American Physical Therapy Association, and many national and international honorary research awards. She is past-president of the International Society of Posture and Gait Research and past-editor of Gait and Posture. She has over 250 peer-reviewed publications.