Identifying Falls Risk using an Instrumented Four-Square Stepping Test for Persons with Parkinson's Disease




Ogden, Bradley
Murray, Daniel
Ferguson, Albina
Blankenship, Seth
Gobert, Denise V.

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Problem: Although several assessments are available to document balance, only a limited number are able to sufficiently document multi-directional decline in dynamic balance in persons with Parkinson's Disease (PPD). Purpose: Identify clinical metrics to track changes in motor coordination over time using an instrumented Four-Square Stepping Test (iFSST) to document decomposition variables of performance for PPD. Design: Exploratory Case - Control Methods: Volunteers were PPD at least 18 years of age, a Hoehn Yahr stage 1-3, able to walk at least 10 meters with/without assistive device and perform a four-square stepping task using forward, sideways and backwards stepping into squares 1,2,3,4,1,4,3,2,1 on a computerized pressure mat while timed using the Prokinetic Zeno mat for 2 trials every 6-8 weeks up to 7 sessions. Data Analysis: Statistical analysis using SPSS (vs. 26.0, IBM, Inc.) provided descriptive statistical analysis including correlation coefficients with repeated measures MANOVA for group differences at p = 0.05. Results: 44 participants (F/M = 9/35) contributed to 244 completed iFSST trials over 18 months. Timed trials averaged 8.79 +/- 2.02 sec., Backward Transitions (sq3 - sq4) and (sq2 – sq1) indicated a significantly different strategy between fallers & non-fallers (p=0.028) with decreased efficiency (COPe) scores (< 50%). Conclusions: Preliminary results indicate a significant deficit in backwards stepping transitions for PPD with an identified history of falls compared to PPD without falls. Clinical Relevance: Results suggest that multi-directional step performance using iFSST can yield early detection of fall risk in persons with degenerative motor disorders. References: Winser SJ, Kannan P, Bello UM & Whitney SL. “Measures of balance and falls risk prediction in people with Parkinson’s disease: a systematic review of the psychometric properties.” Clinical Rehabilitation, 2019, Vol. 33(12) 1949 – 1962. Kim J, Kim I, Kim YE, Koh SB. “The Four-Square Step Test for Assessing Cognitively Demanding Dynamic Balance in Parkinson’s Disease Patient.” J Mov Disord 2021;14(3):208- 213. pISSN 2005-940X / eISSN 2093-4939. Gouelle A & Highsmith MJ. “Instrumented Four Square Step Test in Adults with Transfemoral Amputation: Test-Retest Reliability and Discriminant Validity Between Two Types of Microprocessor Knees”, Sensors 2020, 20, 4782; http://doi:10.3390/s20174782



balance, motor coordination, Four-Square Stepping Test, Parkinson's disease, iFSST


Ogden, B., Murray, D., Ferguson, A., Blankenship, S., & Gobert, D. (2022). Identifying falls risk using an instrumented four-square stepping test for persons with Parkinson's Disease. Poster presented at the International Research Conference for Graduate Students, San Marcos, Texas.


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