ORIGINAL RESEARCH article
Front. Hum. Neurosci.
Sec. Motor Neuroscience
Dopamine-mediated improvements of the step threshold task in Parkinson's disease: validation against clinical measures of motor and cognitive function
Provisionally accepted
Alyson Moll1*
Harrison Carroll Walker2
Noah J Rosenblatt3
Daniel Kuhman1Jaden Adams1
Victor Del Bene2Roy C Martin2
Sarah A Brinkerhoff2
Christopher P Hurt1- 1The University of Alabama at Birmingham, Birmingham, United States
- 2University of Alabama at Birmingham Department of Neurology, Birmingham, AL, United States
- 3Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, United States
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Introduction: Standardized treadmill-based balance disturbances have potential to improve assessments of dynamic balance control in individuals with Parkinson's disease. Here we examined the validity of a step threshold task to measure dynamic balance control in patients with Parkinson's disease. Methods: Thirty-nine participants with idiopathic Parkinson's disease underwent clinical testing and performed a dynamic balance assessment both OFF and ON dopaminergic medication. For the assessment, participants were instructed to avoid stepping in response to progressively larger postural perturbations applied via treadmill translations. The step threshold was defined as the perturbation magnitude that resulted in a stepping response on four consecutive trials. Validity was assessed by correlating medication-mediated changes in gold standard clinical measures and medication-mediated changes in stepping. Results: Medication-mediated changes in step threshold correlated with changes in MDS-UPDRS part III (p<0.01), with change in MDS-UPDRS 3.12 postural instability (p<0.05), and with measures of executive function: CPT-3 Omission T-score (p=0.013), the CPT-3 Commission T-score (p=0.019), and the CPT-3 Variability T-score (p=0.040). Discussion: Our results validate step threshold task as a measure of dynamic balance control in patients with Parkinson's disease. Correlations with gold standard assessments of motor and executive function suggest that the step threshold task can serve as a comprehensive measure of dynamic balance control.
Keywords: Parkinson's disease1, Balance2, step threshold3, postural instability4, Validation5
Received: 16 Jun 2025; Accepted: 30 Oct 2025.
Copyright: © 2025 Moll, Walker, Rosenblatt, Kuhman, Adams, Del Bene, Martin, Brinkerhoff and Hurt. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alyson Moll, alymoll@gmail.com
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