Multimodal mapping of balance dysfunction in Parkinson's disease: a consensus roadmap for research and intervention.
Multimodal mapping of balance dysfunction in Parkinson's disease: a consensus roadmap for research and intervention.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
US · Author affiliation · country only
Department of Neurology, University Hospitals, Cleveland, Ohio, USA.Location evidence
London, GB · Author affiliation
Department of Clinical and Movement Neuroscience, Queen Square Institute of Neurology, University College of London, London, UK.Location evidence
Nijmegen, NL · Author affiliation
Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.Location evidence
Ann Arbor, US · Author affiliation
University of Michigan Udall Center of Excellence in Parkinson's Research, University of Michigan, Ann Arbor, Michigan, USA.Location evidence
Vancouver, CA · Author affiliation
School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.Location evidence
Leuven, BE · Author affiliation
Research Group for Neurorehabilitation, University Paris, Leuven, Belgium.Location evidence
IE · Author affiliation · country only
School of Psychology, Queen's University Belfast, Belfast, Ireland.Location evidence
Atlanta, US · Author affiliation
Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.Location evidence
Milan, IT · Author affiliation
IRCCS Humanitas Research Hospital, Milan, Italy.Location evidence
Hamburg, DE · Author affiliation
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Location evidence
Tel Aviv, IL · Author affiliation
Center for the Study of Movement, Cognition, and Mobility (CMCM), Neurological Institute Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.Location evidence
Oregon, US · Author affiliation
Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.Location evidence
Faridabad, IN · Author affiliation
Department of Neurology, Amrita Hospital and Research Center, Faridabad, Haryana, India.Location evidence
Montréal, CA · Author affiliation
Faculty of Education, McGill University, Montreal, Quebec, Canada.Location evidence
Québec, CA · Author affiliation
Faculty of Education, McGill University, Montreal, Quebec, Canada.Location evidence
New York City, US · Author affiliation
Departments of Neurology and Ophthalmology, Grossman School of Medicine, New York University, New York, New York, USA.Location evidence
Little Rock, US · Author affiliation
Department of Neurology and Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.Location evidence
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Original abstract
PURPOSE OF REVIEW: Balance depends on accurate perception of self-motion and verticality and on multisensory integration for stance, and gait. In Parkinson's disease, balance is commonly impaired and variably affected by treatment. Although vestibular and multisensory contributions are increasingly recognized, progress is limited by fragmented evidence, inconsistent methods, and artifact-prone measures. We provide a consensus roadmap across four domains - video-oculography/vHIT, VEMPs, posturography, and perceptual paradigms - to improve clinical translation of balance research in Parkinson's disease. RECENT FINDINGS: An interdisciplinary taskforce conducted a comprehensive literature review and a modified Delphi process (≥80% agreement), using virtual meetings, surveys, and an in-person consensus session. Oculography/vHIT shows largely preserved aVOR in Parkinson's disease but is vulnerable to Parkinson's disease specific artifacts, requiring standardization. VEMPs relate to brainstem and non-motor features but are limited by EMG-dependent confounds. Posturography reveals impaired multisensory integration with visual dependence and cholinergic contributions; reactive-capacity measures outperform sway alone. Perceptual paradigms show task-specific distortions and increased variability linked to axial/postural syndromes. SUMMARY: This consensus offers a practical roadmap, de-emphasize aVOR/vHIT as primary unsteadiness outcomes; use VEMPs as ancillary measures; prioritize posturography probing adaptability and reactive stepping; integrate wearables and neurochemical imaging; and adopt consortium-level minimum datasets to enable reproducible, phenotype-aware advances in Parkinson's disease balance research.