To assess the PANDA system's effectiveness in detecting early progression of postural instability in people with PD.
The prospective cross-sectional study was conducted according to STROBE guidelines. Fifty-five people with PD (mean age, 37 male) were categorized into three stages based on the Hoehn and Yahr (H&Y) rating scale, with 11 in Stage I, 23 in Stage II, and 21 in Stage III. The inclusion criteria were (1) a confirmed diagnosis of idiopathic PD; (2) they were capable of independent ambulation; and (3) they showed no signs of dementia (MoCA score above 21) or major depression (Geriatric Depression Scale score below 6). The exclusion criteria were (1) have other neurological diseases. The participants were asked to stay 30 seconds in an orthostatic position. A camera registered the oscillations in the sagittal and lateral plans. Afterward, the videos were analyzed by CvMOB, a free software for movement analysis. Additionally, all participants performed three clinical balance tests: Timed Up and Go (TUG), Balance Evaluation Systems Test (BESTest), and Push and Release Test (PRT). Using the kinematic variables generated by the software, a Postural Instability Index (PII) was developed. The results were analyzed using four one-way ANOVA tests—one for each balance measure—with H&Y stages (1-3) being the primary factors. The post-test was applied pairwise using Tukey's test to compare the H&Y stages.
The results of the one-way ANOVA indicate that the disease stage has a significant effect on all balance measures. Further analysis shows that BESTest, TUG, and PRT can distinguish patients in H&Y stages I-II from III. Additionally, PII is effective in differentiating patients in H&Y stages I from II (p.03), I from III (p00001), and II from III (p.02).
The PANDA system can detect early postural instability that clinical tests may not identify. This study shows a promising opportunity to use a low-cost tool to identify subtle changes in postural control among individuals with PD in clinical practice. This could help physiotherapists assess balance more accurately.
Early identification of postural instability opens new therapeutic windows for early physiotherapeutic intervention to minimize the progression of postural instability and reduce the risk of falls in people with PD. PANDA provides objective and quantitative data to guide clinical decision-making, improving treatment efficiency, and consequently, enhancing the quality of life for people with PD.
Quantitative assessment
Cost-effective technologies
