BJMB
Brazilian Journal of Motor Behavior
Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
Santos et al.
2024
VOL.18
https://doi.org/10.20338/bjmb.v18i1.372
1 of 8
Additional visual information on postural control mechanisms in Parkinson's disease: a
pilot study
LUCAS H. C. C. SANTOS
1,2
| RAFAELA B. S. C. GARBUS
1,2
| CAMILA M. AQUINO
3
| SANDRA M. S. F. FREITAS
1,2
1
Graduate program in Physical Therapy, University of São Paulo City (UNICID), São Paulo, SP, Brazil
2
Motion Analysis Laboratory (LAM-I), University of São Paulo City (UNICID), São Paulo, SP, Brazil
3
Undergraduate program in Medicine, Anhembi-Morumbi University, São José dos Campos, SP, Brazil
Correspondence to: Sandra M. S. F. Freitas
Graduate Program in Physical Therapy - City University of São Paulo - Rua Cesário Galeno, 448/475 Tatuapé -03071-000 São Paulo - SP - Brazil
Phone: +55 11 2178-1565 / orcid.org/0000-0003-1973-9019
email: sandra.freitas@unicid.edu.br / smsf.freitas@gmail.com
https://doi.org/10.20338/bjmb.v18i1.372
HIGHLIGHTS
Changes in postural control mechanisms due to
Parkinson’s disease were assessed.
Sway controlled by central and peripheral mechanisms
increased without vision.
Visual feedback reduced both postural control
mechanisms only in healthy adults.
• Visual feedback affected the peripheral postural control
in Parkinson’s disease.
ABBREVIATIONS
AP Anterior-posterior
COP Center of pressure
CE Closed Eyes
IEPs Instant Equilibrium Points
OE Open Eyes
ML Mediolateral
UPDRS Unified Parkinson’s Disease Rating Scale
PD Parkinson’s disease
VF Visual Feedback
PUBLICATION DATA
Received 19 06 2023
Accepted 31 10 2023
Published 12 05 2024
BACKGROUND: Individuals with Parkinson’s disease (PD) have sensorimotor deficits that
affect the mechanisms of postural control. Additional visual information effects on postural
control mechanisms in PD were unknown.
AIM: To examine the effects of visual information on postural control mechanisms in
individuals with PD.
METHOD: Seven individuals with PD and five healthy adults (controls) stood, as quiet as
possible, on a force plate for 35 seconds with eyes open, eyes closed, or with additional visual
feedback [VF] of the center of pressure (COP). The COP trajectories were calculated in
anterior-posterior and mediolateral directions and then decomposed to assess two postural
control mechanisms: Rambling (i.e., supraspinal) and Trembling (i.e., peripheral). The
amplitude and velocity of COP and Rambling and Trembling components were compared
between groups for each visual condition.
RESULTS: The amplitude and velocity of COP and its components were greater in individuals
with PD than controls. They increased under closed eyes condition for PD group, but only the
Rambling velocity increased in anterior-posterior direction for controls. When additional VF of
the COP was provided, individuals with PD presented increased COP and Trembling velocity
in mediolateral direction, while healthy individuals presented reduced sway in both directions.
CONCLUSION: Individuals with PD showed greater postural sway and were more affected
without visual information than controls. They were not able to use the additional VF to reduce
their postural sway as healthy individuals due to changes in sensory integration, causing
possible overload in supraspinal processes and compensatory effects in the peripheral
postural control mechanisms.
KEYWORDS: Parkinson Disease | Visual information | Feedback visual | Postural control |
Sensory feedback
INTRODUCTION
Postural instability affects more than 80% of individuals with Parkinson’s disease (PD)
1
and is the main symptom that leads to
increased risk of falls
2
. Individuals in early stages of PD already showed postural control impairments, such as larger postural sway in
quiet standing than healthy individuals
3,4
, although the postural instability is not the initial symptom of PD
5,6,7
. The postural control is
assured by an adequate functioning of nervous, sensory (mainly somatosensory, visual, and vestibular systems), and motor systems
8
.
Therefore, increased postural sway observed in individuals with PD could be related to impairments in one or more of these systems
9
. In
addition, according to a widely accepted theory of postural control, when sensory conditions change, other sensory inputs are
dynamically re-weighted, and adequate postural control is a result of a complex multi-sensory integration
9,10
. Hence, it can be
hypothesized that individuals with PD also have sensorimotor deficits that affect the mechanisms of postural control
11
. On the other hand,
it was suggested that the postural control impairments could be related to a delay in integrating the information from different sensory
systems when the condition of one of them is changed
12
. For example, it has been shown that individuals with PD needed more time to
change and adjust their postural muscles synergies when the sensory information were manipulated (e.g., closed eyes and additional
BJMB
Brazilian Journal of Motor Behavior
Santos et al.
2024
VOL.18
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2 of 8
Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
visual information)
13,14
.
Several studies reported that individuals with PD have increased dependence on the visual information for postural control
15,16
.
Compared to healthy individuals, increased postural sway of individuals with PD was more evident when they stood with eyes closed,
mainly in the mediolateral (ML) direction
16
and for postural sway velocity than amplitude
16
. Individuals with PD were also more affected
by the visual manipulation when stood inside of a moving room while the ground remained fixed
17
. They showed greater postural sway
amplitude in the anterior-posterior (AP) direction, compared to healthy individuals in stationary room condition
17
. These findings
suggested that individuals with PD have greater reliance on visual information for postural control and, when absent or unreliable, the
other sensory systems have some deficits into compensating it or solving the sensory conflicts in a similar way as healthy individuals. On
the other hand, individuals with PD improved their balance (i.e., decreased their postural sway) when real-time, visual feedback (VF) of
the trunk and head was provided to them
18
. They also reduced their postural sway when VF of the Center of Pressure (COP) was
presented on a monitor screen
19
. Overall, individuals were asked to stay as still as possible while the VF was presented to them. Despite
improving the balance, how the information provided by VF affected the postural control mechanisms of individuals with PD is not fully
understood.
The VF effects on the postural control mechanisms were only investigated when healthy individuals were asked to stay as still
as possible using the visual information of the COP position
20
. For this, a stabilogram decomposition method, called Rambling-Trembling,
was used
21,22
. Based on this method, the COP trajectory is decomposed in two components: one is the Rambling, which is associated
with central processes of postural control, while the second is the Trembling, which is associated with the peripheral mechanisms
21,22,23
.
Both components of postural sway were affected by the VF of COP, but while the Rambling increased when VF was provided, the
Trembling reduced. According to the authors
20
, these findings suggested that an increase in muscle activation level is due to associated
mechanical factors and segmental reflex effects
20
. Recently, this method was used to examine the postural control mechanisms in
individuals with PD during quiet standing under open eyes condition
11
. The results revealed that individuals with PD present greater
amplitude and velocity of COP, Rambling, and Trembling than healthy individuals, mainly for AP amplitude and AP and ML velocity. The
authors suggested that the changes in postural control in individuals with PD were related to both central and peripheral control
mechanisms
11
. In particular, the effects on Rambling trajectory may be related to impaired sensory integration while the effects on
Trembling could be due to delayed sensorimotor feedback process needed to stabilize the upright posture
11
. However, the participants
were assessed only with eyes open and changes on the postural control mechanisms due to PD may be more evident in the absence of
visual information (i.e., closed eyes). The effects of additional VF on the postural control mechanisms may contribute to the
understanding about the sensorimotor deficits, such as delayed sensory integration and increased visual reliance, to maintain the upright
standing in individuals with PD.
Therefore, the current study aimed to examine the effects of visual information on the trajectory of COP, and two components
of postural control mechanisms, Rambling, and Trembling, in individuals with PD. The visual information was manipulated in three
conditions asking participants to fix their gaze to a stationary target, close their eyes, or try to minimize the movement of the target
representing the VF of the COP. Our first hypothesis was that the amplitude and velocity of the COP, Rambling, and Trembling would
increase when the visual information was absent (i.e., closed eyes condition) and would reduce with VF compared to open eyes
condition. A second hypothesis was that Rambling would be more affected than Trembling, mainly in VF condition, because PD affects
the sensory integration
13
. The results of this study will contribute with the understanding about the postural control mechanisms of
individuals with PD and the influence of the visual information in the sensory integration for postural control. The findings of the current
study may give support for future interventions with the aim of manipulating the postural control mechanisms for the balance rehabilitation
of individuals with PD.
METHOD
Participants
Twelve individuals, 4579 years old, participated in this study. Seven of them were PD individuals (3 females) assessed in ‘On
phase of their medication. The PD group presented the following characteristics: mean age (±S.D.) of 64.86 11) years, height of 1.62
(± 0.11) m, and body mass of 73 (± 9.3) kg. The PD individuals were assessed using the Unified Parkinson’s Disease Rating Scale part
III (UPDRS-III)
24
and had an average score of 38.50 12.13). The control group was composed by five individuals without known
neurological disorders or musculoskeletal and joint disorders [all females, 60.8 (± 9.34) years; height of 1.59 0.08) m; and body mass
71.20 2.19) kg]. All individuals participated voluntarily and gave written informed consent according to the protocol approved by the
local ethics committee prior their participation.
Experimental Procedures
Participants were instructed to stand, barefoot, in a comfortable position, with the feet approximately at shoulder width on a
force plate (AMTI OR6-7, Watertown-MA, OR6-7, 50.8 cm x 46.4 cm). The feet position was marked on the force plate to be reproduced
across trials. The force plate data were acquired at a sampling frequency of 100 Hz using a custom code written in LabView 2010
(National Instruments Corp., Norman, OK, USA). Participants were asked to stay as still as possible, for 35 seconds, in three visual
BJMB
Brazilian Journal of Motor Behavior
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2024
VOL.18
https://doi.org/10.20338/bjmb.v18i1.372
3 of 8
Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
conditions: a) keeping their eyes closed (closed eyes condition, CE); b) fixing their gaze to a stationary target (open eyes condition, OE);
and c) trying to minimize the movement of a target by reducing their body sway (explicit information of it was provided in this additional
visual feedback condition, VF). In OE and VF trials, the target was presented as a black, 1-cm diameter circle on a white background in
the center of the 32" touchscreen monitor (ELO, Milpitas-CA) positioned at participant eye's height and 1m in front of the participant
(Figure 1). The VF condition was like that used in previous studies
25,26,27
. In this condition, the target could move up or down according to
the real-time instantaneous changes of the COP position in the AP direction. There was no magnification factor added to the target
movements and participants were aware that the target motion was related to their body sway. They also had one minute of practice in
the VF on the screen before the beginning of the experimental trials. Participants performed six trials, two trials for each condition, in a
randomized order and rest intervals between two trials were allowed.
Figure 1. Participants’ position on the force plate. Note: VF: Visual Feedback; COP: Center of Pressure.
Data Analyses
Data analyses were developed in a Matlab R2022b routine. First, forces and moments of force data were filtered with a low-
pass Butterworth filter of 10Hz and then used to calculate the COP trajectories in AP and ML directions (COP
AP
and COP
ML
, respectively)
as:
𝐶𝑂𝑃
𝐴𝑃
=
(−ℎ 𝐹𝑥) 𝑀𝑦
𝐹𝑧
𝐶𝑂𝑃
𝑀𝐿
=
(−ℎ 𝐹𝑦) 𝑀𝑥
𝐹𝑧
where h is the height of the base of support, F
x
, the horizontal force in AP direction, F
y
, the horizontal force in ML direction, M
y
,
the ML moment, M
x
, the AP moment, and F
z
, the vertical reaction force. Next, five seconds of the trials were excluded by removing the
first and last 2.5 seconds of the trial. Analysis of postural control mechanisms was performed by decomposing COP trajectory in
Rambling and Trembling components
21,22
. First, the instant equilibrium points (IEPs) were identified when the horizontal force was zero.
Then, COP position was determined in these IEPs and Rambling and Trembling trajectories were calculated based on these values.
Rambling trajectory was defined by the interpolation of these COP values using a cubic spline function. Trembling trajectory was
calculated by the difference between Rambling and COP trajectories. Mean amplitude of COP, Rambling, and Trembling were calculated
as the root mean square of each time-series. COP, Rambling, and Trembling mean velocity were computed dividing the path length by
the time-series duration (here 30s as we removed 5s of the analysis). The mean amplitude and velocity were calculated for each trial and
averaged across trials for the statistical analyses.
Statistical Analyses
Statistical analyses were performed using IBM SPSS software, version 21 for Windows. Considering the sample size, non-
parametric tests were used for data analysis. First, group comparisons were run for the OE condition. Then, changes on the CE and VF
conditions related to OE condition were computed and compared between groups. All group comparisons were run using Mann-Whitney
test. Microsoft Excel® was used to calculate the effect size. The effect size (r) was calculated by following formula:
𝑟 =
|𝑧|
𝑛
. The Z score
is mapping the data in a distribution, and the N value represents the number of participants. A small effect was considered less than 0.3,
a medium effect for values between 0.3 to 0.5, and a larger effect for greater than 0.5
28
. To test our hypothesis, the Wilcoxon test was
also run comparing the values under CE or VF conditions normalized by OE condition with a single value of 100% (considered the OE
condition). The significance level was set at p < 0.05.
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2024
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Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
RESULTS
All participants were able to stand under OE, CE, and VF conditions. The results of amplitude and velocity of COP, Rambling,
and Trembling trajectories in AP and ML directions in the OE condition are presented in figure 2. In this condition, individuals with PD
presented a greater COP and Rambling amplitude than controls only in ML direction [U=4, p=0.03; r=0.63 and U=4, p=0.03; r=0.63,
respectively]. The velocity was greater for individuals with PD for COP in AP direction [U=3, p=0.018; r=0.68] and for Rambling in AP
[U<0.001, p=0.003; r=0.82] and ML [U=2, p=0.010; r=0.73] directions compared to control individuals. There was a trend (p=0.073) of
increased COP amplitude in AP direction and increased velocity for COP and Trembling components in both directions.
Effect of absent visual information
To verify whether the absence of visual information affected the amplitude and velocity of COP, Rambling, and Trembling in the
CE condition, the values were normalized by the OE condition. The results in percentage are presented in table 1. When the visual
information was removed (i.e., CE condition) the COP velocity increased for both directions for PD (p=0.018 and p=0.043, respectively,
AP and ML directions) and controls (p=0.043 and p=0.043, respectively, AP and ML directions) compared to 100% (representing OE
condition). In addition, the increase in the amplitude of COP was greater in individuals with PD than controls in the ML direction (p=0.043)
and a trend in AP direction (p=0.063).
Table 1. Median and median deviations of both groups for AP and ML directions, amplitude, and velocity of COP, Rambling, and
Trembling.
Note: PD: Parkinson’s disease; AP: anterior-posterior; ML: mediolateral; COP: Center of pressure. *p<0.05 for group comparison.
&
p<0.05 for comparison with 100%.
The CE condition also affected the Rambling and Trembling amplitudes (p=0.018 and p=0.028, respectively) in AP direction for
individuals with PD. The Trembling velocity in AP direction also increased in the CE condition (p=0.018). For controls, only the Rambling
velocity in AP direction (p=0.043) was affected by the absence of the visual information. There was only significant difference between
groups in the Rambling amplitude in AP direction [U=2, p=0.01; r=0.73]. Individuals with PD increased more the Rambling amplitude with
CE than controls (table 1).
Conditions
PD group (n=7)
Control group (n=5)
Closed Eyes
AP
ML
AP
ML
COP
Amplitude (cm)
141.2 (17.4)
155.8 (26.3)*
128.7 (32.1)
149.6 (29.5)
Velocity (cm/s)
139.5 (19.7)
&
114.6 (52.9)
&
149.7 (27.9)
&
138.7 (25.1)
&
Rambling
Amplitude (cm)
147.1 (14.7)
&,
*
129.1 (23.3)
119.2 (11.2)
127 (40.3)
Velocity (cm/s)
124.4 (27.9)
124 (37.9)
147 (25.7)
&
124.9 (32.6)
Trembling
Amplitude (cm)
134.8 (29.1)
&
122.1 (50.6)
132.7 (32.1)
120.6 (41.5)
Velocity (cm/s)
166.1 (19.7)
&
127.1 (56.2)
146.2 (30.1)
132.1 (36.4)
VF
AP
ML
AP
ML
COP
Amplitude (cm)
118.8 (28.4)
108.7 (24.2)
79.1 (16.4)
110.3 (23.3)
Velocity (cm/s)
107 (6.7)
116.8 (9.5)
&,
*
97.5 (4.1)
90.2 (1.4)
&
Rambling
Amplitude (cm)
112.8 (20.2)
101.3 (22.9)
81.5 (14.8)
86.7 (8.4)
Velocity (cm/s)
91.6 (14.7)
116.8 (16.9)
109.6 (9.7)
88.5 (5.8)
&
Trembling
Amplitude (cm)
109.5 (21.3)*
115 (30)
89.5 (7.8)
&
85.4 (6.3)
Velocity (cm/s)
98.4 (21.7)
117.3 (10.6)
&,
*
91.9 (8.9)
91 (5.2)
&
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Manipulation of sensory information on postural control
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Effect of additional visual information
When additional visual information was provided, individuals with PD increased the COP and Trembling velocity in ML direction
(p=0.028 and p=0.028, respectively). Individuals of the control group reduced the velocity of COP and its components in the ML direction
and the Trembling amplitude in AP direction in the VF condition (all p=0.043). Individuals with PD had greater COP and Trembling
velocity in ML direction [all U<0.001, p=0.003; r=0.82] and Trembling amplitude in AP direction [U=4, p=0.03; r=0.63] compared to control
group.
Figure 2. Boxplot with values of amplitude and velocity of COP, Rambling and Trembling for AP and ML directions, of the OE condition for both groups. Note: COP: Center
of pressure; PD: Parkinson’s disease; AP: Anterior-posterior; ML: Mediolateral. * p<0.05.
DISCUSSION
Individuals with PD present sensorimotor deficits
9
that can impair their postural control. It has also been suggested that they
have increased reliance on the visual information
15,16
during upright standing. We examined how the visual information (when it is absent
or when additional VF of COP is provided) affects the postural control mechanisms in individuals with PD. Overall, individuals with PD
presented greater COP amplitude and velocity, mainly in ML direction and with eyes closed. These results support part of our first
hypothesis and corroborate with previous studies
15,16,29
that observed greater effect of absent visual information on the COP variables in
individuals with PD. They also confirm previous findings that the increased postural sway in individuals with PD is due to impairments in
both supraspinal and peripheral postural sway mechanisms (respectively, observed by changes in Rambling and Trembling components
of COP)
11
. We extended the findings from Costa and collaborators
11
showing increased Rambling component when the visual
information was removed (CE condition) and increased Trembling component with additional visual information of the COP (VF condition)
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Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
for individuals with PD compared to controls. Interestingly, this later effect was observed because, contrary to healthy individuals, those
with PD were not able to use the VF of the COP to reduce their postural sway. They showed greater COP velocity in the VF condition
than when they did not receive it (i.e., OE condition). Healthy individuals, however, presented a COP velocity approximately 10% smaller
than in OE condition, corroborating with a previous study that they take advantage of the VF
27
.
Based on previous studies, we expected that if individuals with PD are more dependent on visual information to maintain the
posture
15,16
, their postural stability should increase in the VF condition. This hypothesis was based on the fact that VF of the COP has
been described as a strategy to improve balance
19
and gait
30
of individuals with PD. Our results were opposite to our expectations and
went against, in part, the predictions of our first hypothesis. Individuals with PD increased the COP velocity when they received the VF
compared to the OE condition corroborating with previous study that also observed that PD did not use the real-time VF to reduce their
sway
31
. There is a two-fold explanation for the increased postural sway in our study: a difficulty in integrating the information provided by
the VF
9,32
or a delay in the sensory integration as reported in previous study
13
. Regarding the first explanation, it was observed that when
visual information was restored after a period of time with it removed, individuals with PD did not improve their postural stability during
quiet standing. This finding suggested the existence of central deficits to reorganize the sensory information to control their postural sway
32
. If that is the case in our study, increased amplitude and velocity of the Rambling component should be observed under VF compared
to OE condition. However, the VF effects were observed mainly in the Trembling component of postural sway, which is related to the
changes in the properties of the mechanical and neural structures implementing the supraspinal control signals
20
. Hence, the hypothesis
of difficulty in integrating the information provided by the VF may be refuted and corroborates with previous study
13
.
It is possible that an overload in supraspinal postural control mechanisms
31
had cause a delay to integrate the information
provided by the VF and then compensatory effects are required by the peripheral postural control mechanisms. A delay in compensating
the postural changes in different visual conditions has been reported
12
. For example, when visual condition changed from EC to EO
individuals with PD showed a delay in changing their balance strategy
12
. Individuals with PD also showed impaired neuromuscular
adaptation and a delayed ability to become accustomed to the postural response
33
after repeated exposure to postural perturbation.
The current findings showed that, although previous studies reported that individuals with PD have increased dependence on
the visual information for postural control
15,16
, they also have sensory integration deficits that may be responsible for the inability of taking
advantage of VF
9,32
. Because PD is characterized by dopamine deficiency in substantia nigra, and the substantia nigra with caudate
nucleus have the vestibular, visual, and somatosensory neurons
34
, it was assumed that the velocity of the integration of the sensory
information is impaired
12,13
.
Furthermore, another alternative hypothesis is that the VF effects can be influenced by task instruction. In the current study, the
target motion was associated with individual’s body sway. The instruction for maintaining the target position as still as possible may
require the cognitive component (i.e., language and attentional component)
35
, which is processed by supraspinal systems and can
contribute to the overload mentioned earlier. In fact, it has been suggested that cognitive disorder is associated with increased postural
sway and, consequently, increased risk of falls
36
. Based on these facts, our second hypothesis that Rambling should be more affected
than Trembling, mainly in VF condition, was refuted. The additional visual information provided by VF did not affect the Rambling
trajectory in individuals with PD; but increased the COP and Trembling variables mainly in the ML direction. The influence of VF of COP
on the Trembling component suggests that peripheral rather than suprapostural mechanisms were changed in PD. It is possible to relate
this with increased muscle contraction, hypertonicity, or rigidity
37
, due to the task instruction to stay as still as possible, influencing more
the peripheral postural control mechanisms
38
. Overall, these findings corroborate with the information that individuals with PD have
difficulty to use the additional visual information to improve postural stability
31,33
. Future studies should investigate whether individuals
with more advanced PD and with different clinical characteristic (e.g., freezing of gait) have different responses to VF of the COP.
Study limitation
The analysis of the present study was performed from previous collected data with limited number of participants. Future
studies are needed to examine the additional visual information effects in a larger sample of individuals with PD, with possible influence
of disease stage and different clinical characteristics. Because only few trials were assessed, it is possible that individuals with PD
needed more trials to adequately take advantage of the VF
13,14
.
CONCLUSION
In summary, individuals with PD oscillate more than healthy individuals. With the absence of visual information, both groups
increased their postural sway. On the other hand, the postural control mechanisms of healthy individuals were positively affected with
additional VF, but not individuals with PD. VF increased the Trembling component related to the peripheral control mechanisms in
individuals with PD. This indicated that when sensory information is manipulated, individuals with PD may need more time to reorganize
the sensory information and compensate the effects in peripheral mechanisms.
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BJMB
Brazilian Journal of Motor Behavior
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2024
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performance of children, young and older adults
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BJMB
Brazilian Journal of Motor Behavior
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VOL.18
https://doi.org/10.20338/bjmb.v18i1.372
8 of 8
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Manipulation of sensory information on postural control
performance of children, young and older adults
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ACKNOWLEDGMENTS
The authors are thankful for all the participants for this study, for Chiarioni L.A. to be the model for the figure, and Gobbi, L.T.B.
to all contribution to motor behavior area.
Editor-in-chief: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil.
Associate editors: Dr José Angelo Barela - São Paulo State University (UNESP), Rio Claro, SP, Brazil; Dr Natalia Madalena Rinaldi - Federal University of Espírito Santo
(UFES), Vitória, ES, Brazil; Dr Renato de Moraes University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
Guest editors: Dr Paula Favaro Polastri Zago - São Paulo State University (UNESP), Bauru, SP, Brazil; Dr Daniela de Godoi Jacomassi Federal University of São Carlos
(UFSCAR), São Carlos, SP, Brazil.
Copyright:© 2024 Santos, Garbus, Aquino and Freitas and BJMB. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non
Commercial-No Derivatives 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source
are credited.
Funding: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001 and São Paulo
Research Foundation (FAPESP- grant 2022/14200-0) (Santos, L.H.C.C).
Competing interests: The authors have declared that no competing interests exist.
DOI: https://doi.org/10.20338/bjmb.v18i1.372
Citation: Santos LHCC, Garbus RBSC, Aquino CM, Freitas SMSF. (2024). Additional visual information on postural control mechanisms in Parkinson's disease: a pilot
study. Brazilian Journal of Motor Behavior, 18(1):e372.