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. 2017 Mar 7;12(3):e0173351.
doi: 10.1371/journal.pone.0173351. eCollection 2017.

Impaired perception of surface tilt in progressive supranuclear palsy

Marian L Dale  1   2 , Fay B Horak  1   2 , W Geoffrey Wright  3 , Bernadette M Schoneburg  1 , John G Nutt  1 , Martina Mancini  1
Affiliations

Impaired perception of surface tilt in progressive supranuclear palsy

Marian L Dale et al. PLoS One. .

Abstract

Introduction: Progressive supranuclear palsy (PSP) is characterized by early postural instability and backward falls. The mechanisms underlying backward postural instability in PSP are not understood. The aim of this study was to test the hypothesis that postural instability in PSP is a result of dysfunction in the perception of postural verticality.

Methods: We gathered posturography data on 12 subjects with PSP to compare with 12 subjects with idiopathic Parkinson's Disease (PD) and 12 healthy subjects. Objective tests of postural impairment included: dynamic sensory perception tests of gravity and of surface oscillations, postural responses to surface perturbations, the sensory organization test of postural sway under altered sensory conditions and limits of stability in stance.

Results: Perception of toes up (but not toes down) surface tilt was reduced in subjects with PSP compared to both control subjects (p≤0.001 standing, p≤0.007 seated) and subjects with PD (p≤0.03 standing, p≤0.04 seated). Subjects with PSP, PD and normal controls accurately perceived the direction of gravity when standing on a tilting surface. Unlike PD and control subjects, subjects with PSP exerted less postural corrective torque in response to toes up surface tilts.

Discussion: Difficulty perceiving backward tilt of the surface or body may account for backward falls and postural impairments in patients with PSP. These observations suggest that abnormal central integration of sensory inputs for perception of body and surface orientation contributes to the pathophysiology of postural instability in PSP.

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Conflict of interest statement

Competing Interests: Yes. I have read the journal's policy and the authors of this manuscript have the following competing interests: FBH: OHSU and FH have a significant financial interest in APDM, a company that may have a commercial interest in the results of this research and technology. This potential institutional and individual conflict has been reviewed and managed by OHSU. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Perception of gravitational vertical and support surface orientation during platform oscillations.
Using an instrumented rod, healthy control subjects and iPD subjects similarly overestimated surface orientation, consistent with previous studies. In contrast, subjects with PSP showed reduced perception of surface movement and nearly absent perception of backward surface tilt. AP: anterior-posterior A) Rod range when indicating vertical in seated and standing conditions (difference from vertical) B) Rod range when indicating surface tilt in seated and standing conditions C) Rod maximum forward motion when indicating surface tilt in seated and standing conditions D) Rod minimum backward motion when indicating surface tilt in seated and standing conditions.
Fig 2
Fig 2. Postural motor control: Forward platform translation.
CoP displacement in response to forward platform translations. A) Group raw data mean±SEM B) Group mean±SEM. CoP: center of pressure, CoM: center of mass; AP: anterior-posterior.
Fig 3
Fig 3. Postural motor control: Toes-up platform rotation.
CoP: center of pressure displacement A) Group raw data mean±SEM and B) Group mean±SEM, CoM: center of mass.
See this image and copyright information in PMC

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