Falls when standing, falls when walking: different mechanisms, different outcomes in Parkinson disease
Lieberman A, Deep A, Olson MC, Smith Hussain V, Frames CW, McCauley M, Lockhart TE. Cureus 2019; 11(8): e5329.
Biomedical Engineering, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, USA.
(Copyright © 2019, Curēus)
DOI 10.7759/cureus.5329 PMID 31598436
Our retrospective study of falls and resultant trauma in consecutive Parkinson disease (PD) patients seen in one year at the Muhammad Ali Parkinson Clinic found that multiple-fallers could be divided into patients who fell mainly when walking or those who fell mainly when standing. Patients who fell when walking were more likely to visit an emergency room or be admitted to a hospital. Of 455 consecutive patients who were evaluated over a one-year period, 51 were excluded because they had atypical Parkinson disorders, had multiple risk factors for falling, or were demented. Unified Parkinson Disease Rating Scales and Zeno Walkway results were compared among non-fallers, single-fallers, and multiple-fallers.
Among multiple-fallers, comparisons were made between patients who fell mainly when standing and those who fell mainly when walking. Most patients (197, 49%) did not fall, 142 (35%) fell once, and 65 (16%) fell more than once. Multiple-fallers differed significantly from single-fallers and non-fallers: they had PD significantly longer (p<0.001), were more severely affected (p<0.001), and took shorter steps (p<0.001). Of 65 multiple-fallers, 26 (40%) fell mainly when standing, 28 (43%) fell mainly when walking, and 11 (17%) fell equally often when standing or walking. Falls when walking resulted in more severe injuries. Patients who fell mainly when standing did not realize they could fall when standing; engaged in inappropriate weight shifting, bending, reaching, and multitasking; and failed to use their assistive devices. Such patients would benefit from being counseled about falling when standing. Patients who fell mainly when walking were aware they could fall, despite using an assisted device, and were more likely to have freezing of gait (FOG). They were more likely to sustain a severe injury, and were more likely to be admitted to an emergency room or hospital. Such patients would benefit from reducing, if possible, FOG.
Keywords falls when standing; falls when walking; locomotion; parkinson disease; postural stability
Fractures in Parkinson’s Disease: injury patterns, hospitalization, and therapeutic aspects
Mühlenfeld N, Söhling N, Marzi I, Pieper M, Paule E, Reif PS, Strzelczyk A, Verboket RD, Willems LM. Eur. J. Trauma Emerg. Surg. 2019; ePub(ePub): ePub.
Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany.
(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)
DOI 10.1007/s00068-019-01240-z PMID 31608417
AIM: The primary aim of this study was to analyze the frequency and characteristic patterns of fall-related fractures as well as consecutive hospitalization and management relating to such fractures. In addition, important pathognomonic and therapeutic aspects are discussed.
METHODS: This retrospective mono-center study was conducted at the University Hospital Frankfurt am Main, Germany. Between 2007 and 2017, a total of 145 PD patients with fall-related fractures were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G20.0-G20.9. Patients with unclear or falsely coded PD were strictly excluded.
RESULTS: The mean age of the cohort was 77.7 years (± 7.5, median 77.) and 57.9% of the cohort were females (n = 84). A total number of 151 fractures were reported, with 140 patients (96.6%) suffering from one, four patients from two (2.8%), and one patient from three fractures (0.6%) at a time. For 43.9% (n = 65) of the cohort, fractures concerned lower extremities (LE) followed by trunk (38.1%, n = 58) and upper extremities (UE, 17.9%, n = 27). Most common fracture types in LE were femoral neck fractures (52.3%, n = 34). Mean length of hospital stay (LOS) was 13.6 days (95% CI 12.4-14.7). In 43.4% (n = 63) of cases, an interim admission to an intensive-care unit (ICU) was necessary. Mean ICU LOS was 2.3 days (95% CI 1.5-3.0), and mean LOS for normal care unit was 10.5 days (95% CI 10.3-12.4). Surgical treatment was necessary in 75.9% of the cases (n = 110). Patients undergoing surgical treatment showed significantly longer LOS compared to conservatively treated patients (p < 0.001). Moreover, fractures of the LE (p = 0.018) and UE (p = 0.010) were associated with a significant longer LOS.
CONCLUSION: Fall-related fractures are a common and relevant complication in PD patients leading to increased immobility, frequent hospitalization, and immediate surgical care. Fractures of the lower extremities and trunk were the most common in the cohort for this study. A PD patient presenting to the emergency room or at the general practitioner with a fracture should always be checked for osteoporosis and a fall-related injury should be seen as a red flag for reviewing a patient’s individual therapeutic regime.
Keywords Fall; Idiopathic parkinson syndrome; Injury; Quality of life
Measures of balance and falls risk prediction in people with Parkinson’s disease: a systematic review of psychometric properties
Winser SJ, Kannan P, Bello UM, Whitney SL. Clin. Rehabil. 2019; ePub(ePub): ePub.
Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
(Copyright © 2019, SAGE Publishing)
DOI 10.1177/0269215519877498 PMID 31571503
OBJECTIVE: To investigate the psychometric properties of measures of balance and falls risk prediction in people with Parkinson’s disease (PD). DATA SOURCES: PubMed, Embase, CINAHL, Ovid Medline, Scopus, and Web of Science were searched from inception to August 2019. REVIEW METHOD: Studies testing psychometric properties of measures of balance and falls risk prediction in PD were included. The four-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) assessed quality.
RESULTS: Eighty studies testing 68 outcome measures were reviewed; 43 measures assessed balance, 9 assessed falls risk prediction, and 16 assessed both. The measures with robust psychometric estimation with acceptable properties were the (1) Mini-Balance Evaluation Systems Test (Mini-BEST), (2) Berg Balance Scale, (3) Timed Up and Go test, (4) Falls Efficacy Scale International, and (5) Activities-Specific Balance Confidence scale. These measures assess balance and falls risk prediction at the body, structure and function level, falls risk and balance, and falls risk at the activity level. The motor examination of the Unified Parkinson’s Disease Rating Scale (UPDRS-ME) with robust psychometric analysis is a condition-specific measure with acceptable properties. Except the UPDRS-ME and Mini-BESTest, the responsiveness of the other four measures has yet to be established.
CONCLUSION: Six of the 68 outcome measures have strong psychometric properties for the assessment of balance and falls risk prediction in PD. Measures assessing balance and falls risk prediction at the participatory level are limited in number with a lack of psychometric validation.
Parkinson’s disease; balance and falls; falls risk; reliability; validity
Economic evaluation of exercise-based fall prevention programs for people with Parkinson’s disease: a systematic review
Winser SJ, Paul LF, Magnus LKL, Yan S, Shenug TP, Sing YM, Cheing G. J. Altern. Complement. Med. 2019; ePub(ePub): ePub.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
(Copyright © 2019, Mary Ann Liebert Publishers)
DOI 10.1089/acm.2019.0148 PMID 31556689
Objectives: Falls are common in Parkinson’s disease (PD). Exercise interventions can prevent falls. This review aims to (1) explore the existing evidence regarding the cost-effectiveness of exercise-based fall prevention programs for people with PD and (2) discuss the implications of the review findings for future research and clinical practice.
Design: Databases AMED Allied and Complementary Medicine, CINAHL, CRD, EBSCO, EMBASE, MEDLINE, PubMed, Scopus, and Web of Science were searched from their inception until June 2019. Randomized and nonrandomized trials that included an economic evaluation of fall prevention programs for people with PD were considered. Quality of the economic evaluation was assessed using the Consensus on Health Economic Criteria list (CHEC-list), and the methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk of bias tool.
Results: Nine hundred and sixty-five studies were screened to include three studies involving 556 participants. Quality of economic evaluation assessed using CHEC-list was high. The methodological quality was high for two studies and low for one study. Tested interventions included Tai Ji Quan, physiotherapist-led, supervised, weekly and monthly balance, and strengthening exercises. The duration of the interventions ranged from 10 weeks to 6 months, while the intervention frequency ranged from two sessions per week to one session per month. Treatment sessions lasted for 60 min in all three studies. One high economic and methodological quality study comparing Tai Ji Quan with resistance and stretching exercises reported least cost resource use among Tai Ji Quan group (USD 80,441) and greater incremental number of falls prevented. All three tested interventions had an 80% probability of being cost-effective with the corresponding country-specific threshold incremental cost-effectiveness ratio values.
Conclusions: The findings provide some evidence for exercise-based intervention as a cost-effective treatment option for preventing falls in PD; however, due to the limited number of available studies, heterogeneity of the interventions, and diversity of assessment settings, a firm conclusion cannot be established. Additional studies evaluating the cost-effectiveness of fall prevention programs involving larger samples and using different treatment parameters in various settings are warranted.
Keywords: Parkinson’s disease; Tai Ji Quan; cost-effectiveness; economic evaluation; exercise; fall prevention
Multimodal training reduces fall frequency as physical activity increases in individuals with Parkinson’s disease
Penko AL, Barkley JE, Rosenfeldt AB, Alberts JL. J. Phys. Act. Health 2019; ePub(ePub): ePub.
(Copyright © 2019, Human Kinetics Publishers)
DOI 10.1123/jpah.2018-0595 PMID 31648204
BACKGROUND: Parkinson’s disease (PD) results in a global decrease in information processing, ultimately resulting in dysfunction executing motor-cognitive tasks. Motor-cognitive impairments contribute to postural instability, often leading to falls and decreased physical activity. The aim of this study was to determine the effects of a multimodal training (MMT) versus single-modal (SMT) training on motor symptoms, fall frequency, and physical activity in patients with PD classified as fallers.
METHODS: Individuals with PD were randomized into SMT (n = 11) or MMT (n = 10) and completed training 3 times per week for 8 weeks. The SMT completed gait and cognitive training separately, whereas MMT completed gait and cognitive training simultaneously during each 45-minute session. Physical activity, 30-day fall frequency, and PD motor symptoms were assessed at baseline, posttreatment, and during a 4-week follow-up.
RESULTS: Both groups exhibited significant (P <.05) improvements in clinical ratings of motor function, as symptoms improved by 8% and 15% for SMT and MMT, respectively. Physical activity significantly increased (P <.05) for both groups from baseline (mean steps 4942 ) to posttreatment (mean steps 5914 ). The MMT resulted in a significant 60% reduction in falls.
CONCLUSIONS: Although SMT and MMT approaches are both effective in improving physical activity and motor symptoms of PD, only MMT reduced fall frequency after the intervention.
dual task; exercise; gait; neurology
Parkinson’s disease and symptomatic osteoarthritis are independent risk factors of falls in the elderly
Teder-Braschinsky A, Märtson A, Rosenthal M, Taba P. Clin. Med. Insights Arthritis Musculoskelet. Disord. 2019; 12: e1179544119884936.
Neurology Clinic, Tartu University Hospital, Tartu, Estonia.
(Copyright © 2019, Libertas Academica)
DOI 10.1177/1179544119884936 PMID 31700249
OBJECTIVES: Deteriorating functionality and loss of mobility, resulting from Parkinson’s disease, may be worsened by osteoarthritis, which is the most common form of joint disease causing pain and functional impairment. We assessed the association between symptomatic hip or knee osteoarthritis, falls, and the ability to walk among patients with Parkinson’s disease compared to a control group.
METHODS: A total of 136 patients with Parkinson’s disease in Southern Estonia and 142 controls with an average age of 76.8 and 76.3 years, respectively, were enrolled in a retrospective case-control study. Information on falls and related fractures during the previous year was collected from the patients with Parkinson’s disease and controls. Covariates included gender, age, mobility, duration of Parkinson’s disease, and fractures.
RESULTS: Patients with Parkinson’s disease were at an increased risk of falls compared to the control group, and for the higher risk of fractures. Symptomatic knee or hip osteoarthritis was a significant independent predictor of falls in both patients with Parkinson’s disease and controls. The higher risk for fractures during the previous year was demonstrated in symptomatic osteoarthritis. Risk factors for falls included also female gender, use of sleep pills, and the inability to walk 500 m.
CONCLUSIONS: Symptomatic hip and knee osteoarthritis are risk factors for falls and related fractures among the elderly population with and without Parkinson’s disease. The inability to walk 500 m could be used as a simple predictive factor for the increased risk of falls among elderly populations.
Keywords Parkinson’s disease; elderly; falls; osteoarthritis; risk factors
Towards a wearable system for predicting the freezing of gait in people affected by Parkinson’s disease
Demrozi F, Bacchin R, Tamburin S, Cristani M, Pravadelli G. IEEE J. Biomed. Health Inform. 2019; ePub(ePub): ePub.
(Copyright © 2019, Institute of Electrical and Electronics Engineers)
DOI 10.1109/JBHI.2019.2952618 PMID 31715577
Some wearable solutions exploiting on-body acceleration sensors have been proposed to recognize Freezing of Gait (FoG) in people affected by Parkinson Disease (PD). Once a FoG event is detected, these systems generate a sequence of rhythmic stimuli to allow the patient restarting the march. While these solutions are effective in detecting FoG events, they are unable to predict FoG to prevent its occurrence. This paper fills in the gap by presenting a machine learning-based approach that classifies accelerometer data from PD patients, recognizing a pre-FOG phase to further anticipate FoG occurrence in advance. Gait was monitored by three tri-axial accelerometer sensors worn on the back, hip and ankle. Gait features were then extracted from the accelerometer’s raw data through data windowing and non-linear dimensionality reduction. A k-nearest neighbor algorithm (k-NN) was used to classify gait in three classes of events: pre-FoG, no-FoG and FoG. The accuracy of the proposed solution was compared to state of-the-art approaches. Our study showed that: (i) we achieved performances overcoming the state-of-the-art approaches in terms of FoG detection, (ii) we were able, for the very first time in the literature, to predict FoG by identifying the pre-FoG events with an average sensitivity and specificity of, respectively, 94.1% and 97.1%, and (iii) our algorithm can be executed on resource-constrained devices. Future applications include the implementation on a mobile device, and the administration of rhythmic stimuli by a wearable device to help the patient overcome the FoG.
Does a sway-based mobile application predict future falls in people with Parkinson disease?
Fiems CL, Combs-Miller SA, Buchanan N, Knowles E, Larson E, Snow R, Moore ES. Arch. Phys. Med. Rehabil. 2019; ePub(ePub): ePub.
University of Indianapolis College of Health Science and School of Nursing, 1400 East Hanna Ave, Indianapolis, IN 46227.
(Copyright © 2019, Elsevier Publishing)
DOI 10.1016/j.apmr.2019.09.013 PMID 31669299
OBJECTIVE: To determine whether a sway-based mobile application (SWAY) predicts falls and to evaluate its discriminatory sensitivity and specificity relative to other clinical measures in identifying fallers in individuals with Parkinson disease (PD).
DESIGN: Observational cross-sectional study SETTING: Community PARTICIPANTS: A convenience sample of 59 subjects with idiopathic PD in Hoehn & Yahr levels I-III. INTERVENTIONS: Participants completed a balance assessment using SWAY, the Movement Disorders Systems-Unified PD Rating Scale motor exam, Mini-BESTest, Activities-specific Balance Confidence (ABC) Scale and reported 6 month fall history. Participants also reported falls for each of the following 6 months. Binomial logistic regression was used to identify significant predictors of future fall status. Cutoff scores, sensitivity and specificity were based on receiver operating characteristic plots. MAIN OUTCOME MEASURES: SWAY score RESULTS: The most predictive logistic regression model included fall history, ABC, and SWAY (P <.001). This model explained 61% (Nagelkerke R2) of the variance in fall prediction and correctly classified 85% of fallers. However, only fall history and ABC were statistically significant (P <.02). Using this model, participants were 32 times more likely to fall in the future if they fell in the past. The ABC and Mini-BESTest demonstrated greater accuracy than SWAY (AUC =.76,.72 and.65 respectively). Cutoff scores to identify fallers were 85% for the ABC and 21/28 for the Mini-BESTest.
CONCLUSION: SWAY did not improve the accuracy of predicting future fallers beyond common clinical measures and fall history.
Balance; Parkinson disease; Postural Sway; Technology Assessment
A turn for the worse: turning performance in Parkinson’s disease and Essential tremor
Baudendistel ST, Schmitt AC, Rodriguez AV, McFarland NR, Hass CJ. Clin. Biomech. 2019; 70: 245-248.
Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA.
(Copyright © 2019, Elsevier Publishing)
DOI 10.1016/j.clinbiomech.2019.09.008 PMID 31669958
BACKGROUND: Turning is an activity of daily living known to elicit falls in older adults and particularly in persons with movement disorders. Specifically, those with Parkinson’s disease have marked impairments in forward walking and turning. Although recent work has identified gait impairment in those with Essential tremor, turning has not been extensively evaluated. As the cerebellum is key in the pathophysiology of Essential tremor, complex tasks like turning, may be impaired for this population. The purpose of this study was to investigate turning behavior and falls in those with Essential tremor and Parkinson’s disease.
METHODS: 15 persons with Essential tremor and 15 persons with Parkinson’s disease performed forward walking and turns on an instrumented walkway. t-tests compared groups and a regression was performed to predict fall frequency.
FINDINGS: During turning, those with Essential tremor had lower cadence (p = .042) and took more time (p = .05). No other variables, including forward walking variables, differed between groups. When pooling groups, the significant fall frequency predictor model (p = .003) included decreased forward cadence, increased turning cadence, and female sex. Overall, the model explained 40.7% of the variance.
INTERPRETATION: While forward gait performance was similar between groups, those with Essential tremor had increased turn time, a measure often associated with turning impairment. Together, these results suggest overall gait impairment in Essential tremor is more prevalent than recognized. Walking performance, both turning and forward, and sex were predictive of fall frequency. Therapeutic interventions in these populations should include both forward walking and turns to mitigate fall risk.
Essential tremor; Falls; Gait; Parkinson’s disease; Turns
Perception of whole-body motion during balance perturbations is impaired in Parkinson’s disease and is associated with balance impairment
Bong SM, McKay JL, Factor SA, Ting LH. Gait Posture 2019; 76: 44-50.
Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, Georgia, USA; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: email@example.com.
(Copyright © 2019, Elsevier Publishing)
DOI 10.1016/j.gaitpost.2019.10.029 PMID 31731133
BACKGROUND: In addition to motor deficits, Parkinson’s disease (PD) may cause perceptual impairments. The role of perceptual impairments in sensorimotor function is unclear, and has typically been studied in single-joint motions. RESEARCH QUESTION: We hypothesized that perception of whole-body motion is impaired in PD and contributes to balance impairments. We tested (1) whether directional acuity to whole body perturbations during standing was worse in people with PD compared to neurotypical older adults (NOA), and (2) whether balance ability, as assessed by the MiniBESTest, was associated with poor directional acuity in either group.
METHODS: Participants were exposed to pairs of support-surface translation perturbations in a two-alternative forced choice testing paradigm developed previously in a young healthy population. The first perturbation of each pair that was to be judged by participants was directly backward, and the second perturbation deviated from the left or right from the backward direction by 1°-44°. Participants reported whether the perturbations in each pair were in the “same” or “different” direction. Judgements from 24 to 67 perturbation pairs were used to calculate directional acuity thresholds corresponding to “just-noticeable differences” in perturbation direction. Linear mixed models determined associations between directional thresholds and clinical variables including MDS-UPDRS-III score, age, and MiniBESTest score.
RESULTS: 20 PD (64 ± 7 y, 12 male, ≥12 h since last intake of antiparkinsonian medications) and 12 NOA (64 ± 8, 6 male) were assessed. Directional thresholds were higher (worse) among PD participants (17.6 ± 5.9° vs. 12.8 ± 3.3°, P < 0.01). Linear mixed models further showed that higher thresholds were associated with MDS-UPDRS-III score (P < 0.01), and were associated with poorer balance ability among PD participants (P < 0.01), but not among NOA participants (P = 0.40). SIGNIFICANCE: Perception of whole-body motion is impaired in PD and may contribute to impaired balance and falls.
Balance; Parkinson’s disease; Perception; Posture
Argentine tango reduces fall risk in Parkinson’s patients
Peter S, Crock ND, Billings BJ, Wu R, Sterling S, Koul S, Taber WF, Pique K, Golan R, Maitland G. J. Am. Med. Dir. Assoc. 2019; ePub(ePub): ePub.
Florida State University College of Medicine, Tallahassee, FL, USA.
(Copyright © 2019, Lippincott Williams and Wilkins)
DOI 10.1016/j.jamda.2019.10.009 PMID 31780412
Argentine tango (tango) is a partnered dance focused on walking and balance dynamics. Partners learn correct posture and the ability to use the floor as a walking aid. For example, a forward step is broken down into multiple aspects: weight shifting, knee and hip positions, torso dissociation from hips, and gradual foot placement onto the floor again. Literature reports that tango significantly improves Unified Parkinson Disease Rating Scale (UPDRS) motor scores in patients with Parkinson’s disease (PD) compared to no intervention …
Falling among people with Parkinson’s disease: motor, non-motor, or both?
Silva de Lima AL, Borm C, Vries NM, Bloem BR. Arq. Neuropsiquiatr. 2019; 77(11): 759-760.
Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center of Expertise for Parkinson & Movement Disorders; Department of Neurology, Nijmegen, The Netherlands.
(Copyright © 2019, Associacao Arquivos De Neuro-Psiquitria)
DOI 10.1590/0004-282X20190164 PMID 31826130
Falling is common among people with Parkinson’s disease (PD). Because of a common amnesia for falls, capturing falls in real-life is challenging. Despite this challenge, we estimate that about 70% of PD patients experience at least one fall per year, which – according to objective measurements using wearable falls detectors – is about 1.8 times more often than age matched controls. Established risk factors for falling in PD include particularly motor features, such as freezing of gait or balance impairment. The contribution of non-motor symptoms, such as autonomic failure, ophthalmological problems or depression, can be suspected, but is to date much less clear.
In this current edition, Alvarado-Bolaños and colleagues report on the association between non-motor symptoms and fall risk in people with PD. Using a cross-sectional design, they collected retrospective data from a convenience sample of 179 people with PD attending a Movement Disorders clinic in Mexico City. Thirty of these were self-reported fallers (16 of whom were recurrent fallers), and their profile was fairly representative (19 men; mean age 66.7 years), although 13 were surprisingly mildly affected (Hoehn & Yahr stage 1 or 2). Baseline data included presence and severity of motor symptoms (Movement Disorder Society – Unified Parkinson’s Disease Rating Scale – MDS-UPDRS) and non-motor symptoms (non-motor symptoms scale – NMSS; and relevant sections of the UPDRS). Bivariate analyses showed that fallers had more non-motor symptoms (mainly in the urinary and miscellaneous domains of the NMSS) compared to non-fallers. However, in a multivariate analysis, non-motor symptoms were no longer predictive of falling; only disease duration and the Postural Imbalance and Gait Disorder (PIGD) type of PD persisted as predictors of falls …
Falls in persons with Parkinson’s disease: do non-motor symptoms matter as much as motor symptoms?
Alvarado-Bolaños A, Cervantes-Arriaga A, Arredondo-Blanco K, Salinas-Barboza K, Isais-Millán S, Rodríguez-Violante M. Arq. Neuropsiquiatr. 2019; 77(11): 761-767.
Instituto Nacional de Neurología y Neurocirugía, Clínica de Trastornos del Movimiento, Mexico City, Mexico.
(Copyright © 2019, Associacao Arquivos De Neuro-Psiquitria)
DOI 10.1590/0004-282X20190148 PMID 31826131
INTRODUCTION: Falls are common among persons with Parkinson’s disease (PD). On the other hand, predicting falls is complex as there are both generic and PD-specific contributors. In particular, the role of non-motor symptoms has been less studied.
OBJECTIVE: The objective of this study was to identify the role of non-motor predictors of falling in persons with PD (PwP).
METHODS: A cross-sectional study was carried out in PwP recruited from a movement disorders clinic. Clinical and demographical data were collected. All PwP were assessed using the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Variables were assessed at the bivariate level. Significant variables were put into a logistic regression model.
RESULTS: A total of 179 PwP were included. Overall, 16.8% of PwP had fallen in the past 12 months, with 53.3% of them being recurrent fallers. The mean number of monthly falls was 2.5 ± 3.3. Factors associated with falling in the bivariate analysis included the disease duration, Hoehn and Yahr stage, MDS-UPDRS part I and II, postural instability/gait disturbance (PIGD) subtype, NMSS urinary domain, NMSS miscellaneous domain, and non-motor severity burden (all p-values < 0.05). After multivariate analysis, only the disease duration (p = 0.03) and PIGD (p = 0.03) remained as independent risk factors.
CONCLUSION: Disease duration and the PIGD subtype were identified as relevant risk factors for falls in PwP Non-motor symptoms appear to have a less important role as risk factors for falls.
Geriatric rehabilitation: gait in the elderly, fall prevention and Parkinson disease
Swanson R, Robinson KM. Med. Clin. North Am. 2020; 104(2): 327-343.
Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3800 Woodland Avenue, Philadelphia, PA 19104, USA. Electronic address: Keith.Robinson@va.gov.
(Copyright © 2020, Elsevier Publishing)
DOI 10.1016/j.mcna.2019.10.012 PMID 32035572
Aging-associated anatomic and physiologic decline begins during the fourth decade of life and progresses over the ensuing decades sometimes to a state of frailty, with the decline amplified when there is deconditioning. Aging-related gait and balance disorders leading to an increased risk of falling can be compensated for with the use of exercise interventions, durable medical equipment, and environmental modifications. Caregiver training is an essential component of geriatric rehabilitation.
Aging; Caregivers; Deconditioning; Durable medical equipment; Geriatrics; Parkinsonism; Rehabilitation