Impaired Weight-Shift Amplitude in People with Parkinson's Disease with Freezing of Gait

Bauke W. DIjkstra, Moran Gilat, L. Eduardo Cofré Lizama, Martina Mancini, Bruno Bergmans, Sabine M.P. Verschueren, Alice Nieuwboer

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: People with Parkinson's disease and freezing of gait (FOG; freezers) suffer from pronounced postural instability. However, the relationship between these phenomena remains unclear and has mostly been tested in paradigms requiring step generation. Objective: To determine if freezing-related dynamic balance deficits are present during a task without stepping and determine the influence of dopaminergic medication on dynamic balance control. Methods: Twenty-two freezers, 16 non-freezers, and 20 healthy age-matched controls performed mediolateral weight-shifts at increasing frequencies when following a visual target projected on a screen (MELBA task). The amplitude and phase shift differences between center of mass and target motion were measured. Balance scores (Mini-BESTest), 360° turning speed and the freezing ratio were also measured. Subjects with Parkinson's disease were tested ON and partial OFF (overnight withdrawal) dopaminergic medication. Results: Freezers had comparable turning speed and balance scores to non-freezers and took more levodopa. Freezers produced hypokinetic weight-shift amplitudes throughout the MELBA task compared to non-freezers (p = 0.002), which were already present at task onset (p < 0.001). Freezers also displayed an earlier weight-shift breakdown than controls when OFF-medication (p = 0.008). Medication improved mediolateral weight-shifting in freezers and non-freezers. Freezers decreased their freezing ratio in response to medication. Conclusion: Hypokinetic weight-shifting proved a marked postural control deficit in freezers, while balance scores and turning speed were similar to non-freezers. Both weight-shift amplitudes and the freezing ratio were responsive to medication in freezers, suggesting axial motor vigor is levodopa-responsive. Future work needs to test whether weight-shifting and freezing severity can be further ameliorated through training.

Original languageEnglish (US)
Pages (from-to)1367-1380
Number of pages14
JournalJournal of Parkinson's Disease
Issue number3
StatePublished - 2021


  • Parkinson disease
  • freezing of gait
  • levodopa
  • postural balance

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience


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