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Impairment of postural reflexes, termed postural instability, is difficult to quantify. Clinical assessments such as the pull test suffer issues with reliability and scaling. Here, we present an instrumented version of the pull test to objectively characterize postural responses.
Impairment of postural reflexes, termed postural instability, is a common and disabling deficit in Parkinson's disease. To assess postural reflexes, clinicians typically employ the pull test to grade corrective responses to a backward perturbation at the shoulders. However, the pull test is prone to issues with reliability and scaling (score/4). Here, we present an instrumented version of the pull test to more precisely quantify postural responses. Akin to the clinical test, pulls are manually administered except pull force is also recorded. Displacements of the trunk and feet are captured by a semi-portable motion tracking system. Raw data represent distance traveled (in millimeter units), making subsequent interpretation and analysis intuitive. The instrumented pull test also detects variabilities influencing pull test administration, such as pull force, thereby identifying and quantifying potential confounds that can be accounted for by statistical techniques. The instrumented pull test could have application in studies seeking to capture early abnormalities in postural responses, track postural instability over time, and detect responses to therapy.
Postural reflexes act to maintain balance and upright stance in response to perturbations1. Impairment of these postural responses in disorders such as Parkinson's disease results in postural instability, and commonly leads to falls, reduced walking confidence and diminished quality of life2,3,4. In clinical practice, postural reflexes are typically assessed with the pull test, where an examiner briskly pulls the patient backward at the shoulders and visually grades the response5,6,
All methods described were reviewed and approved by the local human research ethics committee at Melbourne Health. Informed consent was obtained from the participant prior to the study.
1. Equipment setup
The instrumented pull test (Figure 1) was used to investigate trunk and step responses in a young, healthy cohort23. Thirty-five trials were presented serially, with an auditory stimulus delivered concurrently with each pull (Figure 2). The auditory stimulus was either 90 dB (normal) or 116 dB (loud). The loud stimulus has been demonstrated as sufficient to trigger StartReact effects, where pre-prepared re.......
Here, we have demonstrated the protocol for instrumentation of the clinical pull test, taking a method widely used in clinical practice and yielding an objective measurement of postural responses in addition to the important aspect of the pull administration. Using semi-portable motion tracking, this method offers a means of measurement that is more accessible compared to conventional laboratory techniques28. Using this method, researchers can explore characteristics of postural responses to a top.......
We thank Angus Begg (The Bionics Institute) for his assistance in the video protocol. We acknowledge Dr. Sue Finch (Statistical Consulting Centre and Melbourne Statistical Consulting Platform, University of Melbourne) who provided statistical support. This work was supported by the funding through the National Health and Medical Research Council (1066565), the Victorian Lions Foundation, and The Victorian Government's Operational Infrastructure Support Program.
....Name | Company | Catalog Number | Comments |
Analog to Digital Convertor & Software | CED | Micro 1401-3 | Any suitable digital acquisition system can be used |
Load Cell | Omegadyne | LCM201-100N | |
MATLAB Software | MathWorks Inc. | NA | Any data science platform can be used |
Motion Sensor | Ascension | 6DOF, type-800 | |
Motion Tracker | Ascension | 3D Guidance trakSTAR | Mid-range transmitter |
S&F Technical Harness and Belt | Lowepro | LP36282 |
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