Estudio del test del empujón ("Pull test") en sujetos sanos y en pacientes con enfermedad de Parkinsonanálisis cuantitativo de la fuerza desestabilizadora, análisis posturográfico y electromiográfico

Abstract

Postural instability and gait disorders are very invalidating symptoms for patients with advanced Parkinson´s disease (PD), so the main cause of falls and morbidity and mortality associated to them, originating an important dete-rioration in their quality of life, inpatient admissions and high social and health care economical costs. Postural Instability is characterized by an alteration in postural reflexes that impairs maintaining balance after an external postural perturbation or even spontaneously.The Pull Test (PT), translated into Spanish as “test del empujón” was described by S. Fahn et al and integrated in the Unified Parkinson´s Disease Rating Scale (UPDRS) in 1987 for evaluating the postural stability in PD patients. Its routine use was generalized in general clinical practice to detect abnormalities in postural stability and, therefore, of patients with high risk of suffering falls. Besides, it is the only item included in the motor part of the UPDRS to examine the postural stability in PD patients and indicates a change in the Hoehn y Yahr (H-Y) stages from II to III. This progression involves the start of imbalance and appearance of falls. Several studies have evidenced multiple clinical pitfalls and a great inter and intraobserver variability when performing the PT and interpreting its result, being the pull-force the mayor cause of variability between different examiners...