Compensatory postural responses to backward loss of balance in patients with cerebellar disease

Abstract

Background: Impaired control of balance and coordinated reactions are a primary deficit of cerebellar dysfunction. As compared to other neurological patients with balance impairments, there has been little research assessing the characteristics of compensatory responses associated with falls in patients with cerebellar disease (CD).

Research question: The aim of this study was to examine the effects of cerebellar disease on compensatory balance control in response to postural perturbation. Do CD patients increase the number of steps when responding to instability because of inappropriate initial step reactions or poor control of trunk motion or both?

Methods: In this explorative study, 10 patients suffering from degenerative cerebellar ataxia and 10 age-matched healthy controls were examined. The balance recovery reactions were assessed using a lean-and-release postural perturbation method. Spatiotemporal characteristics of stepping movement and COM variables associated with torso motion were analyzed using 3D motion capture system.

Results: CD patients took multiple steps whereas matched controls generally took single steps to recover balance following perturbation. The characteristics of the initial step at the time of the fall revealed that foot reaction time, foot response time, and step distance of the initial step were similar between CD patients and matched controls. However, CD patients exhibited a shorter foot-to-COM distance, higher COM velocity, and less trunk flexion with which to attenuate their body momentum after the landing of the first step than did matched controls.

Significance: Although initial step responses were probably adequate, poor control of torso motion appears to be a particular problem that causes multiple-step reactions in CD patients. This observation would help to guide the development of tailored fall intervention strategies in CD patients aimed at promoting their recovery capacity in response to a pronounced balance challenge.

Keywords: Cerebellar ataxia; Compensatory balance strategy; Falls; Multiple step; Postural perturbation.