Balance Dysfunction in Parkinson’s Disease: Basic Mechanisms to Clinical Management

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

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 Parkinson’s 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 Parkinson’s 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 Parkinson’s 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.