Anticipatory postural adjustments are unaffected by age and are not absent in patients with the freezing of gait phenomenon

In bipedal gait, the initiation of the first step is preceded by a complex sequence of movements which shift the centre of mass of the body towards the stance foot to allow for a step of the swing foot. These anticipatory postural adjustments (APAs) have been investigated in order to elucidate movement strategies in healthy and diseased persons. We studied the influence of several external parameters (age, type of step initiation) on APAs and investigated whether Parkinsonian patients may have different APAs. As a result, we found that externally elicited steps were preceded by faster and larger APAs than self-timed steps. Parkinsonian patients without the freezing of gait (FOG) phenomenon showed overall slightly reduced APAs but did not clearly differ from patients with FOG. Multiple APAs were seen in up to 25 % of the steps of the patients and in a much lower percentage of the steps of control subjects. The results indicate that APAs are significantly influenced by the timing of a step, i.e. are larger in externally elicited steps. The patients showed an overall preserved APA pattern but slowed movements and amplitude, indicating that increased bradykinesia due to progressive illness is a plausible explanation for these findings. The freezing phenomenon is not explained by a general absence or massive reduction in APA measures.