scholarly journals The Effect of Parkinson’s Disease on the Step Response to a Backwards Pull

2008 ◽  
Author(s):  
Molly A. McVey ◽  
Antonis P. Stylianou ◽  
Carl W. Luchies ◽  
Kelly E. Lyons ◽  
Rajesh Pahwa ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Economic Impacts ◽  
Postural Instability ◽  
Step Response ◽  
Risk Of Falling ◽  
Effective Interventions ◽  
Increased Risk

Postural instability is one of the most disabling symptoms of Parkinson’s disease (PD) and often leads to falls. Falls can have severe physical, psychological, and economic impacts including fractures, fear of falling, and loss of independence [1]. Effective interventions to reduce fall risk exist [2, 3] and would be most effective if they could be implemented prior to a fall occurring. Unfortunately, the current methods to evaluate postural instability in PD are not sensitive enough to predict those who are at an increased risk of falling so it is difficult to identify the best time to begin fall interventions.

Postural instability and falls in Parkinson’s disease

2016 ◽  
Vol 27 (5) ◽  
pp. 549-555 ◽  
Author(s):  
Jacob J. Crouse ◽  
Joseph R. Phillips ◽  
Marjan Jahanshahi ◽  
Ahmed A. Moustafa
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Fear Of Falling ◽  
Brain Regions ◽  
Postural Instability ◽  
Delayed Effect ◽  
Increased Risk ◽  
Deep Brain

AbstractPostural instability (PI) is one of the most debilitating motor symptoms of Parkinson’s disease (PD), as it is associated with an increased risk of falls and subsequent medical complications (e.g. fractures), fear of falling, decreased mobility, self-restricted physical activity, social isolation, and decreased quality of life. The pathophysiological mechanisms underlying PI in PD remain elusive. This short review provides a critical summary of the literature on PI in PD, covering the clinical features, the neural and cognitive substrates, and the effects of dopaminergic medications and deep brain stimulation. The delayed effect of dopaminergic medication combined with the success of extrastriatal deep brain stimulation suggests that PI involves neurotransmitter systems other than dopamine and brain regions extending beyond the basal ganglia, further challenging the traditional view of PD as a predominantly single-system neurodegenerative disease.

scholarly journals The Role of Architecture and Design in the Management of Parkinson’s Disease: A Systematic Review

2020 ◽  
Vol 10 (4) ◽  
pp. 1301-1314
Author(s):  
Joana Beisl Ramos ◽  
Gonçalo S. Duarte ◽  
Raquel Bouça-Machado ◽  
Margherita Fabbri ◽  
Tiago A. Mestre ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Fear Of Falling ◽  
Experimental Studies ◽  
Postural Instability ◽  
Functional Mobility ◽  
Housing Type ◽  
Architecture And Design ◽  
The Impact

Background: Parkinson’s disease (PD) is a neurological condition characterized by the development of daily disabling symptoms. Although the architecture and design of a PD patient’s environment can hinder or facilitate full participation in daily activities, their putative role in the management of these patients has received little attention to date. Objective: We conducted a systematic review to evaluate the evidence of architectural and design features in the management of people with PD. Methods: An electronic database search of observational and experimental studies was conducted in MEDLINE and Embase from inception to May 2020, with two independent reviewers identifying the studies. Falls, fear of falling, postural instability, gait impairment/disability, and functional mobility were our outcomes of interest. Results: Thirty-six studies were included, among which nineteen were observational and seventeen were experimental studies (overall participants = 2,965). Pavement characteristics, notably unstable surfaces and level differences, were found to be a major cause of falling. Ground-based obstacles and confined/narrowed spaces were found to disturb gait, increase postural instability, and decrease functional mobility. Housing type did not appear to increase risk of falling, nor to significantly explain concerns about falling. Conclusion: Findings suggest a need to adjust architectural features of the surrounding space to ensure appropriate care and provide a safe environment to PD patients. More evidence about the impact of such modifications on PD outcomes is needed.

scholarly journals Assessment of Risk Factors for Falls among Patients with Parkinson’s Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jacek Wilczyński ◽  
Magdalena Ścipniak ◽  
Kacper Ścipniak ◽  
Kamil Margiel ◽  
Igor Wilczyński ◽  
...  
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
High Risk ◽  
Fear Of Falling ◽  
External Factors ◽  
Low Risk ◽  
Risk Of Falling ◽  
Risk Of Falls ◽  
Risk Factors For Falls

Introduction. The aim of this study was to assess the risk factors for falls in patients with Parkinson’s disease. Materials and Methods. The study comprised 53 participants (52.8% women and 47.2% men). The Hoehn and Yahr 5-point disability scale was used to assess the severity of Parkinson’s disease. The Tinetti Balance and Gait Scale were used to evaluate the risk of falls. The Katz scale was used to test the independence of people with PD. The Falls Efficacy Scale-International Short Form (FES-I) was implemented to assess fear of falling. Results. The majority of participants was at a high risk of falls, being at the same level for women and men. A significant relationship was noted between the risk of falls and subjective assessment of mobility ( χ 2 = 31.86 , p < 0.001 ), number of falls ( χ 2 = 37.92 , p < 0.001 ), independence of the subjects ( χ 2 = 19.28 , p < 0.001 ), type of injury suffered during the fall ( χ 2 = 36.93 , p < 0.001 ), external factors ( χ 2 = 33.36 , p < 0.001 ), and the level of fear of falling ( χ 2 = 8.88 , p < 0.001 ). A significant relationship also occurred between the number of falls and the fear of falling ( χ 2 = 33.49 , p < 0.001 ) and between the number of falls and disease severity ( χ 2 = 45.34 , p < 0.001 ). The applied physiotherapy did not reduce the risk of falls ( χ 2 = 3.18 , p = 0.17 ). Conclusions. Individuals who rated their mobility as good or excellent were at a low risk of falls. People who fell more times were at a high risk of falling. People more independent were at a low risk of falls. Previous injuries were the most associated with being at risk of falling. Uneven surfaces and obstacles on one’s path are the external factors most associated with the risk of falling. People with low levels of fall anxiety were at a low risk of falls. Most people with low fall anxiety have never fallen. Additionally, the majority of patients with stage 1 of the disease have not fallen at all. The reason for the ineffectiveness of physiotherapy may be due to the exercise programs used and the lack of systematic implementation of them. PD is different for each patient; thus, it is important to select individually customized physiotherapy depending on motor and nonmotor symptoms, as well as general health of a patient.

scholarly journals The Effect of Pramipexole Therapy on Balance Disorder and Fall Risk in Parkinson’s Disease at Early Stage: Clinical and Posturographic Assessment

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sibel Güler ◽  
Levent Sinan Bir ◽  
Beyza Akdag ◽  
Fusun Ardıc
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Drug Therapy ◽  
Fall Risk ◽  
Early Stage ◽  
Postural Instability ◽  
Assessment Tools ◽  
Control Subjects ◽  
Significant Difference ◽  
And Control

The aim of this study was to determine balance problems and severity and ratio of postural instability of newly diagnosed, early stage Parkinson’s patients who did not receive any antiparkinson treatment before, to evaluate fall risk clinically and posturographically and to examine the effects of pramipexole on these signs and symptoms. Detailed posturographic assessments which involved central vestibular, visual, peripheric vestibular somatosensory field tests were applied to both patient and control subjects and fall risk was determined. There was not statistically significant difference between patients and control subjects before and after drug therapy in the assesment of fall risk in posturography and there was not any improvement with drug usage in the patient group. However, in the analysis of subsystems separately, only the involvement in central vestibular field was more severe and could appear at all positions in Parkinson’s patients comparing with the control group, and pramipexole was partially effective in improving this disorder. Central vestibular field is the subsystem that should be examined with first priority. Posturography is relatively reliable in defining fall risk and postural instability ratio in Parkinson’s disease. But it should be considered that clinical assessment tools can be more sensitive in the evaluation of balance and postural disorders and in the follow-up of the response to drug therapy.

Cervicothoracic Mechanical Impairment as Part of Complete Neurological Fall Risk Appraisal

2020 ◽  
pp. 1-9
Author(s):  
Janine L. Johnston ◽  
Graham Featherstone ◽  
Shane L. Harms ◽  
Glen T. D. Thomson
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Musculoskeletal Symptoms ◽  
Risk Of Falling ◽  
Risk Appraisal ◽  
Fall Risk Factors ◽  
Increased Risk ◽  
Restricted Mobility

ABSTRACT: Background: Assessment of individuals at risk for falling entails comprehensive neurological and vestibular examinations. Chronic limitation in cervical mobility reduces gaze accuracy, potentially impairing navigation through complex visual environments. Additionally, humans with scoliosis have altered otolithic vestibular responses, causing imbalance. We sought to determine whether dynamic cervical mobility restrictions or static cervicothoracic impairments are also fall risk factors. Methods: We examined 435 patients referred for soft-tissue musculoskeletal complaints; 376 met criteria for inclusion (mean age 52; 266 women). Patients were divided into nonfallers, single fallers, and multiple fallers, less or greater than 65 years old. Subject characteristics, dynamic cervical rotations, and static cervicothoracic axial measurements were compared between groups. Fear of falling was evaluated using the Falls Efficacy Scale-International questionnaire. Results: Long-standing cervicothoracic pain and stiffness conferred increased risk of falling. Neck rotation amplitudes decreased with longer duration musculoskeletal symptoms and were significantly more restricted in fallers, doubling the risk of falling and contributing to increased fear of falling. Mid-thoracic scoliosis amplitudes increased over time, but static axial abnormalities were not greater among fallers, although thoracic kyphoscoliosis heightened fear of falling. Conclusion: In patients at fall risk, thoracic kyphoscoliosis and dynamic neck movements should be assessed, in addition to standard vestibular and neurological evaluations. Additionally, patients with soft tissue cervicothoracic pain and restricted mobility have increased fall frequency and fear of falling, independent of other fall risk factors and should undergo complete fall risk appraisal.

scholarly journals Comparing Balance Performance on Force Platform Measures in Individuals with Parkinson’s Disease and Healthy Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Cathy C. Harro ◽  
Amanda Kelch ◽  
Cora Hargis ◽  
Abigail DeWitt
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postural Control ◽  
Fall Risk ◽  
Postural Instability ◽  
Healthy Adults ◽  
Force Platform ◽  
Disease Stage ◽  
Balance Performance ◽  
Platform System

Introduction. Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson’s disease (PD). Computerized posturography employing a force platform system provides objective, quantitative assessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population.Methods. Participants—42 individuals with PD (Hoehn and Yahr stage = 2.33 ± 0.77) and 55 age-matched healthy adults—were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independentt-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann–WhitneyUtest for PD subtypes.Results. The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P=0.013, CI-95% = 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P=0.001, CI-95% = 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1–3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with thePosture Gait Instabilitysubtype demonstrating poorer balance performance thanTremor Dominantsubtype.Conclusion. These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regarding intrinsic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD.

The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease

2007 ◽  
Vol 21 (8) ◽  
pp. 698-705 ◽  
Author(s):  
Burcu Duyur Cakit ◽  
Meryem Saracoglu ◽  
Hakan Genc ◽  
Hatice Rana Erdem ◽  
Levent Inan
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Fear Of Falling ◽  
Postural Instability ◽  
Treadmill Training

scholarly journals A-079 Hand Preference in Men and Women with Parkinson’s Disease: A Preliminary Investigation

2020 ◽  
Vol 35 (6) ◽  
pp. 871-871
Author(s):  
Ryan J ◽  
Kreiner D ◽  
Gontkovsky S ◽  
Paolo A
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neurological Disorders ◽  
Rating Scale ◽  
Preliminary Investigation ◽  
Hand Preference ◽  
Dominant Hand ◽  
Healthy Individuals ◽  
Left Handed ◽  
Increased Risk

Abstract Objective Research has identified common genetic influences on handedness and neurological/mental health phenotypes. It also has been shown there may be increased risk for development of neurological disorders/diseases among individuals naturally left-handed or demonstrating non-right-hand preference. This investigation examined prevalence of right-handed versus non-right-handed individuals with Parkinson’s disease (PD) compared to controls. Method Participants were 264 patients with PD (mean age = 69.83 years) and 256 control volunteers (mean age = 71.42 years). Mean Dementia Rating Scale composites for the groups were 123.68 and 136.00, respectively. Participants self-identified their dominant hand for writing and usage was confirmed during the session. Results Proportions of non-right- and right-handed controls (7.0% and 93.0%) versus individuals with PD (6.8% and 93.2%) did not differ. Changes in proportions of non-right- and right-handedness across age ranges were not significant for controls or patients. There was a trend for a larger proportion of women (55.9%) versus men among controls (44.1%), □ 2 (1) = 3.29, p &lt; .10; whereas, the proportion of men (64.4%) with PD was larger than that of women. (35.6%), □ 2 (1) = 21.31, p &lt; .001. For controls and patients, non-right and right handedness gender proportions were similar. Conclusions This study is the first to assess handedness prevalence rates in PD. Results suggest prevalence of non-right handedness is similar in PD and healthy individuals and does not appear to differ markedly by gender or with advancing age. The occurrence of a trend for a larger proportion of women than men among controls is consistent with census-based statistics.

Sign in / Sign up

Export Citation Format

Share Document