ArticlePloS one2015
StartReact effects support different pathophysiological mechanisms underlying freezing of gait and postural instability in Parkinson's disease.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 51 citations in OpenAlex.
- What Is the StartReact Effect?Acta physiologica (Oxford, England) · 2026Review
- Feasibility and preliminary effectiveness of a 2-week in-place reactive balance training program in people with multiple sclerosis.Multiple sclerosis and related disorders · 2025Article
- Personalized auditory cues improve gait in patients with early Parkinson's disease.Frontiers in neurology · 2025Article
- Unraveling the threads of stability: A review of the neurophysiology of postural control in Parkinson's disease.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2024Review
- Remotely prescribed and monitored home-based gait-and-balance therapeutic exergaming using augmented reality (AR) glasses: protocol for a clinical feasibility study in people with Parkinson's disease.Pilot and feasibility studies · 2024Article
- Remotely prescribed, monitored, and tailored home-based gait-and-balance exergaming using augmented reality glasses: a clinical feasibility study in people with Parkinson's disease.Frontiers in neurology · 2024Article
- Relating Parkinson freezing and balance domains: A structural equation modeling approach.Parkinsonism & related disorders · 2020Article
- Focus on the pedunculopontine nucleus. Consensus review from the May 2018 brainstem society meeting in Washington, DC, USA.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2019Review
- Startle evokes nearly identical movements in multi-jointed, two-dimensional reaching tasks.Experimental brain research · 2019Article
- Balance control systems in Parkinson's disease and the impact of pedunculopontine area stimulation.Brain : a journal of neurology · 2018Article
- Anticipatory postural responses prior to protective steps are not different in people with PD who do and do not freeze.Gait & posture · 2018Article
- Adaptations to Postural Perturbations in Patients With Freezing of Gait.Frontiers in neurology · 2018Article
- Low to moderate relationships between gait and postural responses in Parkinson disease.Journal of rehabilitation medicine · 2017Article
- Physical Fitness and Serum Vitamin D and Cognition in Elderly Koreans.Journal of sports science & medicine · 2015Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe pathophysiology underlying postural instability in Parkinson's disease is poorly understood. The frequent co-existence with freezing of gait raises the possibility of shared pathophysiology. There is evidence that dysfunction of brainstem structures contribute to freezing of gait. Here, we evaluated whether dysfunction of these structures contributes to postural instability as well. Brainstem function was assessed by studying the StartReact effect (acceleration of latencies by a startling acoustic stimulus (SAS)).
methodsWe included 25 patients, divided in two different ways: 1) those with postural instability (HY = 3, n = 11) versus those without (HY<3, n = 14); and 2) those with freezing (n = 11) versus those without freezing (n = 14). We also tested 15 matched healthy controls. We tested postural responses by translating a balance platform in the forward direction, resulting in backward balance perturbations. In 25% of trials, the start of the balance perturbation was accompanied by a SAS.
resultsThe amplitude of automatic postural responses and length of the first balance correcting step were smaller in patients with postural instability compared to patients without postural instability, but did not differ between freezers and non-freezers. In contrast, the StartReact effect was intact in patients with postural instability but was attenuated in freezers. DISCUSSION: We suggest that the mechanisms underlying freezing of gait and postural instability in Parkinson's disease are at least partly different. Underscaling of automatic postural responses and balance-correcting steps both contribute to postural instability. The attenuated StartReact effect was seen only in freezers and likely reflects inadequate representation of motor programs at upper brainstem level.
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