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Haertner L, Elshehabi M, Zaunbrecher L, Pham MH, Maetzler C, van Uem JMT, Hobert MA, Hucker S, Nussbaum S, Berg D, Liepelt-Scarfone I, Maetzler W. Effect of Fear of Falling on Turning Performance in Parkinson's Disease in the Lab and at Home. Front Aging Neurosci 2018; 10:78. [PMID: 29636676 PMCID: PMC5880950 DOI: 10.3389/fnagi.2018.00078] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/08/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Parkinson’s disease (PD) is a neurodegenerative movement disorder associated with gait and balance problems and a substantially increased risk of falling. Falls occur often during complex movements, such as turns. Both fear of falling (FOF) and previous falls are relevant risk factors for future falls. Based on recent studies indicating that lab-based and home assessment of similar movements show different results, we hypothesized that FOF and a positive fall history would influence the quantitative turning parameters differently in the laboratory and home. Methods: Fifty-five PD patients (43 underwent a standardized lab assessment; 40 were assessed over a mean of 12 days at home with approximately 10,000 turns per participant; and 28 contributed to both assessments) were classified regarding FOF and previous falls as “vigorous” (no FOF, negative fall history), “anxious” (FOF, negative fall history), “stoic” (no FOF, positive fall history) and “aware” (FOF, positive fall history). During the assessments, each participant wore a sensor on the lower back. Results: In the lab assessment, FOF was associated with a longer turning duration and lowered maximum and middle angular velocities of turns. In the home evaluations, a lack of FOF was associated with lowered maximum and average angular velocities of turns. Positive falls history was not significantly associated with turning parameters, neither in the lab nor in the home. Conclusion: FOF but not a positive fall history influences turning metrics in PD patients in both supervised and unsupervised environments, and this association is different between lab and home assessments. Our findings underline the relevance of comprehensive assessments including home-based data collection strategies for fall risk evaluation.
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Affiliation(s)
- Linda Haertner
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Morad Elshehabi
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Laura Zaunbrecher
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Minh H Pham
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Corina Maetzler
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Janet M T van Uem
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Markus A Hobert
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Svenja Hucker
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Susanne Nussbaum
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Daniela Berg
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Walter Maetzler
- Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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152
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Bryant MS, Hou JGG, Workman CD, Protas EJ. Predictive ability of functional tests for postural instability and gait difficulty in Parkinson's disease. Eur Geriatr Med 2018; 9:83-88. [PMID: 34654285 DOI: 10.1007/s41999-017-0021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/16/2017] [Indexed: 11/29/2022]
Abstract
The objective of this study is to identify clinical determinants for postural instability and gait difficulty in persons with Parkinson's disease (PD). Ninety-one persons (68 males; 74.7%) with PD were studied. Their mean age was 68.73 ± 8.74 years. The average time since diagnosis was 7.69 ± 5.23 years. The average Hoehn and Yahr stage was 2.43 ± 0.44. Age, gender, disease duration, disease severity and motor impairment were recorded. Participants were asked to perform timed clinical mobility tests that included a 5-step test, turns, forward walk, backward walk, and a sideways walk. The mobility tests were investigated for their contribution to predict the postural instability and gait difficulty (PIGD) score (falling, freezing, walking, gait and postural stability) of the Unified Parkinson Disease Rating Scale (UPDRS). PIGD score was significantly correlated with age, disease duration, Hoehn and Yahr score, comorbidity, UPDRS motor score, gait speed of forward, backward and sideways walks, and time to turn. PIGD score was marginally significantly correlated with timed 5-step test. After controlling for age, disease duration, disease severity, comorbidity, and motor impairment, sideway gait speed (β = - 0.335; p = 0.024), timed 5-step test (β = - 0.397; p = 0.003) and time to turn (β = 0.289; p = 0.028) significantly predicted postural instability and gait difficulty. Walking sideways, 5-step test, and turning are significant predictors of PIGD score. These simple mobility tests can be quickly applied in clinical practice to determine postural instability and gait problems in persons with PD.
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Affiliation(s)
- Mon S Bryant
- Research Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Mail Code 153, Houston, TX, 77030, USA. .,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA. .,School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA.
| | - Jyh-Gong Gabriel Hou
- Lehigh Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Craig D Workman
- Research Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Mail Code 153, Houston, TX, 77030, USA.,Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Elizabeth J Protas
- School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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153
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Greene BR, Caulfield B, Lamichhane D, Bond W, Svendsen J, Zurski C, Pratt D. Longitudinal assessment of falls in patients with Parkinson's disease using inertial sensors and the Timed Up and Go test. J Rehabil Assist Technol Eng 2018; 5:2055668317750811. [PMID: 31191922 PMCID: PMC6453040 DOI: 10.1177/2055668317750811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/03/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To examine the predictive validity of a TUG test for falls risk, quantified using body-worn sensors (QTUG) in people with Parkinson's Disease (PD). We also sought to examine the inter-session reliability of QTUG sensor measures and their association with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score. Approach A six-month longitudinal study of 15 patients with Parkinson's disease. Participants were asked to complete a weekly diary recording any falls activity for six months following baseline assessment. Participants were assessed monthly, using a Timed Up and Go test, quantified using body-worn sensors, placed on each leg below the knee. Main results The results suggest that the QTUG falls risk estimate recorded at baseline is 73.33% (44.90, 92.21) accurate in predicting falls within 90 days, while the Timed Up and Go time at baseline was 46.67% (21.27, 73.41) accurate. The Timed Up and Go time and QTUG falls risk estimate were strongly correlated with UPDRS motor score. Fifty-two of 59 inertial sensor parameters exhibited excellent inter-session reliability, five exhibited moderate reliability, while two parameters exhibited poor reliability. Significance The results suggest that QTUG is a reliable tool for the assessment of gait and mobility in Parkinson's disease and, furthermore, that it may have utility in predicting falls in patients with Parkinson's disease.
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Affiliation(s)
| | - Brian Caulfield
- 2Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Dronacharya Lamichhane
- OSF Health Care, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, IL, USA
| | - William Bond
- Jump Simulation, OSF HealthCare, Peoria, IL, USA.,Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | | | | | - Dyveke Pratt
- OSF Health Care, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, IL, USA.,Saint Thomas Rutherford Hospitalist Services, Murfreesboro, TN, USA
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154
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Franzoni LT, Monteiro EP, Oliveira HB, da Rosa RG, Costa RR, Rieder C, Martinez FG, Peyré-Tartaruga LA. A 9-Week Nordic and Free Walking Improve Postural Balance in Parkinson's Disease. Sports Med Int Open 2018; 2:E28-E34. [PMID: 30539114 PMCID: PMC6225959 DOI: 10.1055/s-0043-124757] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 11/01/2022] Open
Abstract
Aerobic training has a neuroprotective effect in people with Parkinson's disease. Recent evidence indicates that Nordic walking seems a promising alternative due to positive outcomes in functional mobility. However, the effects of Nordic walking compared to free walking on static and functional balance parameters are still unknown. The aim of this study was to evaluate the effects of nine weeks of Nordic and free walking training on static and functional balance. The sample size was 33 individuals with eight dropouts, leaving 25 individuals in the final sample (Nordic Walking, n=14, Free Walking, n=11). The participants underwent two evaluations in the present randomized clinical trial, pre- and post-training, to determine average velocity and root-mean-square values from center of pressure with eyes open and eyes closed. The functional balance showed approximately 5% improvement for the two groups ( p =0.04). The results indicate that nine weeks of Nordic and free walking training were enough to induce improvements in the proprioceptive system and functional balance.
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Affiliation(s)
- Leandro Tolfo Franzoni
- Federal University of Rio Grande do Sul, Exercise Research Laboratory, Porto Alegre, Brazil
| | - Elren Passos Monteiro
- Federal University of Rio Grande do Sul, Exercise Research Laboratory, Porto Alegre, Brazil
| | | | - Rodrigo Gomes da Rosa
- Federal University of Rio Grande do Sul, Exercise Research Laboratory, Porto Alegre, Brazil
| | - Rochelle Rocha Costa
- Federal University of Rio Grande do Sul, Exercise Research Laboratory, Porto Alegre, Brazil
| | - Carlos Rieder
- Hospital de Clinicas de Porto Alegre, Sleep and Movement Disorders Clinics, Division of Neurology, Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- Federal University of Rio Grande do Sul, Exercise Research Laboratory, Porto Alegre, Brazil
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155
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An Overview of the Physiology and Pathophysiology of Postural Control. BIOSYSTEMS & BIOROBOTICS 2018. [DOI: 10.1007/978-3-319-72736-3_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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156
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Abstract
Parkinson disease (PD) is a complex, multisystem disorder with both neurologic and systemic nonmotor manifestations. It is neurodegenerative in nature in which disordered balance, gait, and falls are universal problems that can be present at initial diagnosis, and which progress over time. Freezing of gait is a particularly debilitating feature of PD that becomes more prevalent over time with disease progression, being present in approximately 7% after 2 years of disease and 28% after 5 years. Approximately 60% of people with PD fall each year, with around 70% of fallers falling recurrently, and some recurrent fallers falling multiple times per week. Many risk factors for falls in people with PD have been identified; these include a history of falls, freezing of gait, and abnormalities in measures of balance, leg muscle strength, mobility, cognition, and fear of falling. Therapies for improving physical function and mobility include levodopa, cholinesterase inhibitors, methylphenidate, deep-brain stimulation, cuing for freezing of gait, and exercise. This chapter reviews the clinical, pathologic, and physiologic correlates of gait disturbance and falls in PD, as well as the evidence for medical and nonmedical interventions.
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Affiliation(s)
- Samuel D Kim
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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157
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Leavy B, Berntsson J, Franzén E, Skavberg Roaldsen K. Perceptions of balance and falls following a supervised training intervention - a qualitative study of people with Parkinson's disease. Disabil Rehabil 2017; 41:934-940. [PMID: 29265899 DOI: 10.1080/09638288.2017.1417498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore perceptions of balance and falls among people with mild to moderate Parkinson's disease 3 - 12 months following participation in supervised balance training. MATERIALS AND METHODS This qualitative study used in-depth individual interviews for data collection among 13 people with Parkinson's disease. Interviews were systematically analyzed using qualitative content analysis with an inductive approach. RESULTS Three main themes arose: Falls - avoided and intended highlights the wide spectrum of fall perceptions, ranging from worse-case scenario to undramatized events; Balance identity incorporates how gradual deterioration in balance served as a reminder of disease progression and how identifying themselves as "aware not afraid" helped certain participants to maintain balance confidence despite everyday activity restriction; Training as treatment recounts how participants used exercise as disease self-management with the aim to maintain independence in daily life. Interpretation of the underlying patterns of these main themes resulted in the overarching theme Training as treatment when battling problems with balance and falls. CONCLUSIONS Whereas certain participants expressed a fear of falling which they managed by activity restriction, others described being confident in their balance despite avoidance of balance-challenging activities. Training was used as treatment to self-manage disease-related balance impairments in order to maintain independence in daily life. Implication for Rehabilitation People with Parkinson's disease require early advice about the positive effects of physical activity as well as strategies for self-management in order to ease the psychological and physical burden of progressive balance impairment. Fear of falling should be investigated alongside activity avoidance in this group in order to provide a more accurate insight into the scope of psychological concerns regarding balance and falls in everyday life. Certain people with Parkinson's disease define their balance according to activities they continue to participate in, while others who express fear-related activity avoidance require help to adapt balance-challenging activities in order to maintain balance confidence and avoid physical inactivity.
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Affiliation(s)
- Breiffni Leavy
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Huddinge , Sweden.,b Stockholms Sjukhem Foundation , Stockholm , Sweden
| | - Johan Berntsson
- c Karolinska University Hospital, Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function , Stockholm , Sweden
| | - Erika Franzén
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Huddinge , Sweden.,b Stockholms Sjukhem Foundation , Stockholm , Sweden.,c Karolinska University Hospital, Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function , Stockholm , Sweden
| | - Kirsti Skavberg Roaldsen
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Huddinge , Sweden.,d Department of Research , Sunnaas Rehabilitation Hospital , Oslo , Norway.,e Faculty of Health Sciences, Department of Physiotherapy , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
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158
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Mollaei N, Bicho E, Sousa N, Gago MF. Different protocols for analyzing behavior and adaptability in obstacle crossing in Parkinson's disease. Clin Interv Aging 2017; 12:1843-1857. [PMID: 29158667 PMCID: PMC5683812 DOI: 10.2147/cia.s147428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Imbalance and tripping over obstacles as a result of altered gait in older adults, especially in patients with Parkinson’s disease (PD), are one of the most common causes of falls. During obstacle crossing, patients with PD modify their behavior in order to decrease the mechanical demands and enhance dynamic stability. Various descriptions of dynamic traits of gait that have been collected over longer periods, probably better synthesize the underlying structure and pattern of fluctuations in gait and can be more sensitive markers of aging or early neurological dysfunction and increased risk of falls. This confirmation challenges the clinimetric of different protocols and paradigms used for gait analysis up till now, in particular when analyzing obstacle crossing. The authors here present a critical review of current knowledge concerning the interplay between the cognition and gait in aging and PD, emphasizing the differences in gait behavior and adaptability while walking over different and challenging obstacle paradigms, and the implications of obstacle negotiation as a predictor of falls. Some evidence concerning the effectiveness of future rehabilitation protocols on reviving obstacle crossing behavior by trial and error relearning, taking advantage of dual-task paradigms, physical exercise, and virtual reality have been put forward in this article.
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Affiliation(s)
- Nafiseh Mollaei
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Estela Bicho
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga
| | - Miguel Fernandes Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga.,Neurology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
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159
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Fasano A, Canning CG, Hausdorff JM, Lord S, Rochester L. Falls in Parkinson's disease: A complex and evolving picture. Mov Disord 2017; 32:1524-1536. [PMID: 29067726 DOI: 10.1002/mds.27195] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/10/2017] [Accepted: 09/13/2017] [Indexed: 12/23/2022] Open
Abstract
Falls are a major determinant of poor quality of life, immobilization, and reduced life expectancy in people affected by Parkinson's disease (PD) and in older adults more generally. Although many questions remain, recent research has advanced the understanding of this complex problem. The goal of this review is to condense new knowledge of falls in PD from prodromal to advanced disease, taking into account risk factors, assessment, and classification as well as treatment. The fundamental steps of clinical and research-based approaches to falls are described, namely, the identification of fall risk factors, clinical and instrumental methods to evaluate and classify fall risk, and the latest evidence to reduce or delay falls in PD. We summarize recent developments, the direction in which the field should be heading, and what can be recommended at this stage. We also provide a practical algorithm for clinicians.© 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Jeffrey M Hausdorff
- Center for Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, US
| | - Sue Lord
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Auckland University of Technology, Auckland, New Zealand
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne, UK
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160
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Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol 2017; 13:689-703. [DOI: 10.1038/nrneurol.2017.128] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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161
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Identification of specific gait patterns in patients with cerebellar ataxia, spastic paraplegia, and Parkinson's disease: A non-hierarchical cluster analysis. Hum Mov Sci 2017; 57:267-279. [PMID: 28967438 DOI: 10.1016/j.humov.2017.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with degenerative neurological diseases such as cerebellar ataxia, spastic paraplegia, and Parkinson's disease often display progressive gait function decline that inexorably impacts their autonomy and quality of life. Therefore, considering the related social and economic costs, one of the most important areas of intervention in neurorehabilitation should be the treatment of gait abnormalities. This study aims to determine whether an entire dataset of gait parameters recorded in patients with degenerative neurological diseases can be clustered into homogeneous groups distinct from each other and from healthy subjects. Patients affected by three different types of primary degenerative neurological diseases were studied. These diseases were: i) cerebellar ataxia (28 patients), ii) hereditary spastic paraplegia (31 patients), and iii) Parkinson's disease (70 patients). Sixty-five gender-age-matched healthy subjects were enrolled as a control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls. When clustering single parameters, step width and ankle joint range of motion (RoM) in the sagittal plane differentiated cerebellar ataxia group from the other groups. When clustering sets of two, three, or four parameters, several pairs, triples, and quadruples of clusters differentiated the cerebellar ataxia group from the other groups. Interestingly, the ankle joint RoM parameter was present in 100% of the clusters and the step width in approximately 50% of clusters. In addition, in almost all clusters, patients with cerebellar ataxia showed the lowest ankle joint RoM and the largest step width values compared to healthy controls, patients with hereditary spastic paraplegia, and Parkinson's disease subjects. This study identified several clusters reflecting specific gait patterns in patients with degenerative neurological diseases. In particular, the specific gait pattern formed by the increased step width, reduced ankle joint RoM, and increased gait variability, can differentiate patients with cerebellar ataxia from healthy subjects and patients with spastic paraplegia or Parkinson's disease. These abnormal parameters may be adopted as sensitive tools for evaluating the effect of pharmacological and rehabilitative treatments.
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162
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Lord S, Galna B, Yarnall AJ, Morris R, Coleman S, Burn D, Rochester L. Natural history of falls in an incident cohort of Parkinson's disease: early evolution, risk and protective features. J Neurol 2017; 264:2268-2276. [PMID: 28948348 PMCID: PMC5656700 DOI: 10.1007/s00415-017-8620-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022]
Abstract
The natural history of falls in early Parkinson’s disease (PD) is poorly understood despite the profound effect of falls on outcome. The primary aim of this study was to describe the natural history of falls, and characterise fallers over 54 months in 99 newly diagnosed people with PD. Seventy-nine (79.7%) participants fell over 54 months and 20 (20.3%) remained falls-naïve. Twenty six (26.2%) reported retrospective falls at baseline. Gait outcomes, disease severity and self-efficacy significantly discriminated across groups. Subjective cognitive complaints emerged as the only significant cognitive predictor. Without exception, outcomes were better for non-fallers compared with fallers at any time point. Between group differences for 54 month fallers and non-fallers were influenced by the inclusion of retrospective fallers and showed a broader range of discriminant characteristics, notably stance time variability and balance self-efficacy. Single fallers (n = 7) were significantly younger than recurrent fallers (n = 58) by almost 15 years (P = 0.013). Baseline performance in early PD discriminates fallers over 54 months, thereby identifying those at risk of falls. Clinical profiles for established and emergent fallers are to some extent distinct. These results reiterate the need for timely interventions to improve postural control and gait.
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Affiliation(s)
- Sue Lord
- Human Movement Science, Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK.,School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Brook Galna
- Human Movement Science, Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alison J Yarnall
- Human Movement Science, Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rosie Morris
- Human Movement Science, Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Shirley Coleman
- UK and Industrial Statistics Research Unit, Newcastle University, Newcastle upon Tyne, UK
| | - David Burn
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Human Movement Science, Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. .,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK. .,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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163
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Just KS, Schneider KL, Schurig M, Stingl JC, Brockmöller J. Falls: the adverse drug reaction of the elderly and the impact of pharmacogenetics. Pharmacogenomics 2017; 18:1281-1297. [PMID: 28776468 DOI: 10.2217/pgs-2017-0018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Falls is a frequent type of adverse drug reactions causing significant morbidity and mortality in the elderly. We reviewed, with which drugs the risk of falls is relevant and might depend on genomic variation. Pharmacogenetic variability may contribute to drug-induced falls for instance mediated by impaired drug elimination due to inherited deficiency in enzymes like CYP2C9, CYP2C19 and CYP2D6. The relative role of specific genes and polymorphisms in old age may differ from younger people. Biomarkers for frailty, but also genomic biomarkers might help identifying patients at high risk for drug-induced falls. Many other factors including disease and drug-drug interactions also contribute to risk of falls. Further studies analyzing the impact of genomic variation on the medication-related fall risk in the older adult are urgently needed.
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Affiliation(s)
- Katja Susanne Just
- Research Division, Federal Institute for Drugs & Medical Devices, Bonn, Germany
| | | | - Marlen Schurig
- Research Division, Federal Institute for Drugs & Medical Devices, Bonn, Germany
| | - Julia Carolin Stingl
- Research Division, Federal Institute for Drugs & Medical Devices, Bonn, Germany.,Centre for Translational Medicine, MedicalFaculty, University of Bonn, Bonn, Germany
| | - Jürgen Brockmöller
- Institute of Clinical Pharmacology, University of Göttingen, Göttingen, Germany
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164
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Vinik AI, Camacho P, Reddy S, Valencia WM, Trence D, Matsumoto AM, Morley JE. AGING, DIABETES, AND FALLS. Endocr Pract 2017; 23:1117-1139. [PMID: 28704101 DOI: 10.4158/ep171794.ra] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
KEY POINTS Falls are a major health issue for older adults, leading to adverse events and even death. Older persons with type 2 diabetes are at increased risk of falling compared to healthy adults of a similar age. Over 400 factors are associated with falls risk, making identification and targeting of key factors to prevent falls problematic. However, the major risk factors include hypertension, diabetes, pain, and polypharmacy. In addition to age and polypharmacy, diabetes-related loss of strength, sensory perception, and balance secondary to peripheral neuropathy along with decline in cognitive function lead to increased risk of falling. Designing specific interventions to target strength and balance training, reducing polypharmacy to improve cognitive function, relaxation of diabetes management to avoid hypoglycemia and hypotension, and relief of pain will produce the greatest benefit for reducing falls in older persons with diabetes. Abbreviation: DPN = diabetic polyneuropathy.
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165
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A Cross-sectional Analysis of the Characteristics of Individuals With Parkinson Disease Who Avoid Activities and Participation Due to Fear of Falling. J Neurol Phys Ther 2017; 41:31-42. [PMID: 27977519 DOI: 10.1097/npt.0000000000000162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Avoidance behavior can have deleterious consequences on health and quality of life for persons with Parkinson disease (PD); for this reason, it is important to identify potentially mitigable characteristics. We compared the characteristics of individuals with PD who exhibit fear of falling (FOF) avoidance behavior with those who do not. METHODS Fifty-nine participants with PD were classified as avoiders (n = 27) or nonavoiders (n = 32) by using the Fear of Falling Avoidance Behavior Questionnaire and compared across 5 domains: demographic characteristics; PD-specific symptoms (subtype, Movement Disorder Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-39 [PDQ-39]); balance and falls (fall history, Berg Balance Scale [BBS], Activities-Specific Balance Confidence [ABC] Scale, Impact of Events Scale, Consequences of Falling Questionnaire [CoFQ]); physical performance (30 Second Sit-to-Stand Test, Timed Up and Go Test, physical activity monitoring); and psychological factors (Zung Anxiety Scale, Beck Depression Inventory [BDI]). RESULTS There were no differences between avoiders and nonavoiders for demographic characteristics and fall history (Ps > 0.272). Avoiders had worse MDS-UPDRS (Ps < 0.014) and PDQ-39 scores (Ps < 0.028). Avoiders had poorer balance performance (BBS, P = 0.003), lower balance confidence (ABC, P < 0.001), and more fall catastrophization (CoFQ, P < 0.001). Avoiders reported more depression (P = 0.015) and anxiety (P = 0.028). DISCUSSION AND CONCLUSIONS PD FOF avoiders had more involved symptoms and scored lower on balance and physical performance measures. In addition, they reported greater psychological stress. Several potentially mitigable characteristics of those with FOF avoidance behavior were identified.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A153).
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166
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Lamont RM, Morris ME, Menz HB, McGinley JL, Brauer SG. Falls in people with Parkinson's disease: A prospective comparison of community and home-based falls. Gait Posture 2017; 55:62-67. [PMID: 28419875 DOI: 10.1016/j.gaitpost.2017.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/27/2017] [Accepted: 04/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are common and debilitating in people with Parkinson's disease (PD) and restrict participation in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to target therapy more effectively. OBJECTIVE To compare the characteristics of community and home fallers and the circumstances that contribute to falls in people living with PD. METHODS People with mild-moderately severe PD (n=196) used a daily falls diary and telephone hotline to report prospectively the occurrence, location and circumstances of falls over 14 months. RESULTS 62% of people with PD fell, with most falling at least once in the community. Compared to people who fell at home, the community-only fallers had shorter durations of PD (p=0.012), less severe disease (p=0.008) and reported fewer falls in the year prior to the study (p=0.003). Most falls occurred while people were ambulant, during postural transitions and when medication was working well. Community-based falls were frequently attributed to environmental factors such as challenging terrains (p<0.001), high attention demands (p=0.029), busy or cluttered areas (p<0.001) and tasks requiring speed (p=0.020). Physical loads were more often present in home than community-based falls (p=0.027). CONCLUSION Falls that occur in the community typically affect people with earlier PD and less severe disease than home-based falls. Individuals experiencing community-based falls may benefit from physiotherapy to manage challenging environments and high attention demands.
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Affiliation(s)
- Robyn M Lamont
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, 4072, Australia.
| | - Meg E Morris
- School of Allied Health, La Trobe University, Melbourne, 3086, Australia; Northpark Private Hospital Healthscope, Melbourne, Australia.
| | - Hylton B Menz
- School of Allied Health, La Trobe University, Melbourne, 3086, Australia.
| | - Jennifer L McGinley
- Melbourne School of Health Sciences, The University of Melbourne, 3010, Melbourne, Australia.
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, 4072, Australia.
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167
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François C, Biaggioni I, Shibao C, Ogbonnaya A, Shih HC, Farrelly E, Ziemann A, Duhig A. Fall-related healthcare use and costs in neurogenic orthostatic hypotension with Parkinson's disease. J Med Econ 2017; 20:525-532. [PMID: 28125950 DOI: 10.1080/13696998.2017.1284668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To compare patient characteristics, rates, and costs of medically attended falls among patients with Parkinson's disease (PD) and probable PD plus neurogenic orthostatic hypotension (PD + nOH). MATERIALS AND METHODS MarketScan Commercial and Medicare Supplemental databases (January 1, 2009-December 31, 2013) were used to identify PD and probable PD + nOH patients. The first medical or prescription claim suggesting these diagnoses served as the index date. Baseline characteristics and post-index all-cause and fall-related healthcare utilization and costs were compared between patient groups. RESULTS A total of 17,421 PD and 281 PD + nOH patients were identified. Compared with PD patients, PD + nOH patients were older (77 vs 74 years; p < .0001) and had more comorbidities. Pre- and post-index date, more PD + nOH patients had a medically attended fall than PD patients (25% vs 20% [p = .0159] and 30% vs 21% [p = 0.0002], respectively). Fallers in both groups had similar numbers of medically attended falls 12-months pre-index (mean =1.9), but PD + nOH fallers had more falls post-index (2.5 vs 2.0; p = .0176). Compared with PD patients, more PD + nOH patients (all p < .01) had fall-related emergency department (ED) visits (18% vs 10%), hospitalizations (7% vs 3%), and non-office visit outpatient services (15% vs 10%). Adjusted total post-index medical costs for falls ($2,260 vs $1,049; p = .0002) and total all-cause costs ($31,260 vs $20,910; p < .0001) were higher for PD + nOH vs PD patients. LIMITATIONS This study had some limitations. There is no ICD-9-CM diagnosis code for nOH, so a combination of PD and OH diagnoses (with confounding conditions excluded) served as a proxy for an nOH diagnosis. Also, the rate of falls and associated costs in these cohorts might be under-reported because only medically attended falls were evaluated. CONCLUSIONS PD + nOH patients had a higher prevalence of pre-existing comorbidities and a higher rate of medically attended falls than those with PD alone, leading to increased costs of care.
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Affiliation(s)
| | - Italo Biaggioni
- b Division of Clinical Pharmacology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Cyndya Shibao
- b Division of Clinical Pharmacology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA
| | | | | | | | | | - Amy Duhig
- c Xcenda, LLC , Palm Harbor , FL , USA
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168
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Chou KL, Elm JJ, Wielinski CL, Simon DK, Aminoff MJ, Christine CW, Liang GS, Hauser RA, Sudarsky L, Umeh CC, Voss T, Juncos J, Fang JY, Boyd JT, Bodis-Wollner I, Mari Z, Morgan JC, Wills AM, Lee SL, Parashos SA. Factors associated with falling in early, treated Parkinson's disease: The NET-PD LS1 cohort. J Neurol Sci 2017; 377:137-143. [PMID: 28477684 DOI: 10.1016/j.jns.2017.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/08/2017] [Accepted: 04/10/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Recognizing the factors associated with falling in Parkinson's disease (PD) would improve identification of at-risk individuals. OBJECTIVE To examine frequency of falling and baseline characteristics associated with falling in PD using the National Institute of Neurological Disorders and Stroke (NINDS) Exploratory Trials in PD Long-term Study-1 (NET-PD LS-1) dataset. METHODS The LS-1 database included 1741 early treated PD subjects (median 4year follow-up). Baseline characteristics were tested for a univariate association with post-baseline falling during the trial. Significant variables were included in a multivariable logistic regression model. A separate analysis using a negative binomial model investigated baseline factors on fall rate. RESULTS 728 subjects (42%) fell during the trial, including at baseline. A baseline history of falls was the factor most associated with post-baseline falling. Men had lower odds of post-baseline falling compared to women, but for men, the probability of a post-baseline fall increased with age such that after age 70, men and women had similar odds of falling. Other baseline factors associated with a post-baseline fall and increased fall rate included the Unified PD Rating Scale (UPDRS) Activities of Daily Living (ADL) score, total functional capacity (TFC), baseline ambulatory capacity score and dopamine agonist monotherapy. CONCLUSION Falls are common in early treated PD. The biggest risk factor for falls in PD remains a history of falling. Measures of functional ability (UPDRS ADL, TFC) and ambulatory capacity are novel clinical risk factors needing further study. A significant age by sex interaction may help to explain why age has been an inconsistent risk factor for falls in PD.
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Affiliation(s)
- Kelvin L Chou
- Departments of Neurology and Neurosurgery, University of Michigan, Ann Arbor, MI, United States.
| | - Jordan J Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | | | - David K Simon
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michael J Aminoff
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Chadwick W Christine
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Grace S Liang
- Neurocrine Biosciences, Inc., San Diego, CA, United States
| | - Robert A Hauser
- University of South Florida, Parkinson's Disease and Movement Disorders Center, Tampa, FL, United States
| | - Lewis Sudarsky
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Chizoba C Umeh
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Jorge Juncos
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - John Y Fang
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
| | - James T Boyd
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, United States
| | - Ivan Bodis-Wollner
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John C Morgan
- Department of Neurology, Medical College of Georgia, Augusta, GA, United States
| | - Anne-Marie Wills
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Stephen L Lee
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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169
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Trigueiro LCDL, Gama GL, Ribeiro TS, Ferreira LGLDM, Galvão ÉRVP, Silva EMGDSE, Júnior CDOG, Lindquist ARR. Influence of treadmill gait training with additional load on motor function, postural instability and history of falls for individuals with Parkinson's disease: A randomized clinical trial. J Bodyw Mov Ther 2017; 21:93-100. [PMID: 28167197 DOI: 10.1016/j.jbmt.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evaluate the effects of additional load (5% and 10% of body weight) with treadmill gait training on the motor aspects in Parkinson's disease (PD). METHODS Randomized controlled single-blind trial with 30 individuals with PD. The volunteers were divided into three groups (treadmill with 0%, 5% or 10% load), where Unified Parkinson's Disease Rating Scale was applied. Treadmill gait training was conducted over 4 consecutive weeks, with three weekly sessions of 30 min each. RESULTS There was a significant reduction in all groups in the time factor for motor function (F = 12.92; P = 0.001) and postural instability (F = 11.23; P = 0.002). No significant difference was observed in group × time interaction (F < 1.76; P > 0.19). CONCLUSION The treadmill comprises an effective therapy for people with PD, for important motor aspects such as motor function and postural instability. Additional load had no influence on results.
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Affiliation(s)
| | - Gabriela Lopes Gama
- Institute of Physical Activity and Sports Science, Cruzeiro do Sul University, São Paulo, Brazil
| | - Tatiana Souza Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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170
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Leavy B, Kwak L, Hagströmer M, Franzén E. Evaluation and implementation of highly challenging balance training in clinical practice for people with Parkinson's disease: protocol for the HiBalance effectiveness-implementation trial. BMC Neurol 2017; 17:27. [PMID: 28173775 PMCID: PMC5297172 DOI: 10.1186/s12883-017-0809-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND If people with progressive neurological diseases are to avail of evidence-based rehabilitation, programs found effective in randomized controlled trials (RCT's) must firstly be adapted and tested in clinical effectiveness studies as a means of strengthening their evidence base. This paper describes the protocol for an effectiveness-implementation trial that will assess the clinical effectiveness of a highly challenging balance training program (the HiBalance program) for people with mild-moderate Parkinson's disease (PD) while simultaneously collecting data concerning the way in which the program is implemented. The HiBalance program is systemically designed to target balance impairments in PD and has been shown effective at improving balance control and gait in a previous RCT. Study aims are to i) determine the effectiveness of the adapted HiBalance program on performance and self-rated outcomes such as balance control, gait and physical activity level ii) conduct a process evaluation of program implementation at the various clinics iii) determine barriers and facilitators to program implementation in these settings. METHODS This effectiveness-implementation type 1 hybrid study will use a non-randomized controlled design with consecutive inclusion of people with PD at multiple clinical sites. A mixed method approach will be used to collect clinical effectiveness data and process evaluation data which is both quantitative and qualitative in nature. The consolidated framework for implementation research (CFIR) will be used to guide the planning and collection of data concerning implementation barriers and facilitators. The HiBalance program will be provided by physical therapists as a part of standard rehabilitation care at the clinical sites, while the evaluation of the implementation process will be performed by the research group and funded by research grants. DISCUSSION An effectiveness-implementation study design benefits patients by speeding up the process of translating findings from research settings to routine health care. Findings from this study will also be highly relevant for those working with neurological rehabilitation when faced with decisions concerning the translation of training programs from efficacy studies to everyday clinical practice. TRIAL REGISTRATION ClinicalTrials.gov march 2016, NCT02727478 .
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Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden. .,Stockholms Sjukhem Foundation, Stockholm, Sweden.
| | - Lydia Kwak
- Institute of Environmental Medicine, Intervention and implementation research, Karolinska Institute, Solna, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden.,Function Area Occupational therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden.,Stockholms Sjukhem Foundation, Stockholm, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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171
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De la Casa-Fages B, Alonso-Frech F, Grandas F. Effect of subthalamic nucleus deep brain stimulation on balance in Parkinson's disease: A static posturographic analysis. Gait Posture 2017; 52:374-380. [PMID: 28061431 DOI: 10.1016/j.gaitpost.2016.12.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/17/2016] [Accepted: 12/20/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effect of subthalamic deep brain stimulation on balance in Parkinson's disease remains unclear. OBJECTIVE To evaluate the effect of subthalamic nucleus stimulation on balance in Parkinson's disease using posturography. METHODS 16 patients (9 women) who underwent subthalamic deep brain stimulation [mean age 59.6 years (46-70); mean disease duration 15.6 years (7-25); mean duration of subthalamic stimulation 32.1 months (3.0-69.6)] and 13 healthy age-matched controls were evaluated using a static posturography analysis. Patients were assessed under four conditions: 1) off medication/off stimulation; 2) off medication/on stimulation; 3) on medication/off stimulation and 4) on medication/on stimulation in ten experimental paradigms, some reproducing common situations of daily living. The displacement of the centre of pressure was analyzed using 14 posturographic parameters. The Mann-Whitney test was used to compare patients with controls. The Wilcoxon signed rank test was used to compare patients under different clinical conditions. RESULTS Patients off medication/off stimulation showed larger and more rapid displacements of the centre of pressure than controls in most paradigms (p<0.05), particularly when performing a dual task. Subthalamic stimulation alone reduced the lateral excursion and anterior-posterior velocity of the centre of pressure in quite stance paradigms (p<0.05). Subthalamic stimulation combined with antiparkinsonian medication did not induce statistically significant changes in posturagraphic measures in any experimental paradigm. CONCLUSIONS Although subthalamic stimulation alone may induce some positive effect on balance, subthalamic stimulation in addition to antiparkinsonian medication, which is the usual treatment in clinical practice, did not modify balance as assessed by static posturography in patients with Parkinson's disease.
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Affiliation(s)
- Beatriz De la Casa-Fages
- Movement Disorders Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo n°46, 28007, Madrid, Spain.
| | - Fernando Alonso-Frech
- Movement Disorders Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Francisco Grandas
- Movement Disorders Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo n°46, 28007, Madrid, Spain.
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172
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Conradsson D, Nero H, Löfgren N, Hagströmer M, Franzén E. Monitoring training activity during gait-related balance exercise in individuals with Parkinson's disease: a proof-of-concept-study. BMC Neurol 2017; 17:19. [PMID: 28143463 PMCID: PMC5282864 DOI: 10.1186/s12883-017-0804-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/20/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the benefits of balance exercise in clinical populations, balance training programs tend to be poorly described, which in turn makes it difficult to evaluate important training components and compare between programs. However, the use of wearable sensors may have the potential to monitor certain elements of balance training. Therefore, this study aimed to investigate the feasibility of using wearable sensors to provide objective indicators of the levels and progression of training activity during gait-related balance exercise in individuals with Parkinson's disease. METHODS Ten individuals with Parkinson's disease participated in 10 weeks of group training (three sessions/week) addressing highly-challenging balance exercises. The training program was designed to be progressive by gradually increasing the amount of gait-related balance exercise exercises (e.g. walking) and time spent dual-tasking throughout the intervention period. Accelerometers (Actigraph GT3X+) were used to measure volume (number of steps/session) and intensity (time spent walking >1.0 m/s) of dynamic training activity. Training activity was also expressed in relation to the participants' total daily volume of physical activity prior to the training period (i.e. number of steps during training/the number of steps per day). Feasibility encompassed the adequacy of data sampling, the output of accelerometer data and the participants' perception of the level of difficulty of training. RESULTS Training activity data were successfully obtained in 98% of the training sessions (n = 256) and data sampling did not interfere with training. Reflecting the progressive features of this intervention, training activity increased throughout the program, and corresponded to a high level of the participants' daily activity (28-43%). In line with the accelerometer data, a majority of the participants (n = 8) perceived the training as challenging. CONCLUSIONS The findings of this proof-of-concept study support the feasibility of applying wearable sensors in clinical settings to gain objective informative measures of gait-related balance exercise in individuals with Parkinson's disease. Still, this activity monitoring approach needs to be further validated in other populations and programs including gait-related balance exercises. TRIAL REGISTRATION NCT01417598 , 15th August 2011.
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Affiliation(s)
- David Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden. .,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
| | - Håkan Nero
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Löfgren
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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173
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Paul SS, Harvey L, Canning CG, Boufous S, Lord SR, Close JCT, Sherrington C. Fall-related hospitalization in people with Parkinson's disease. Eur J Neurol 2017; 24:523-529. [PMID: 28117538 DOI: 10.1111/ene.13238] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Falls are common in people with Parkinson's disease (PD) but few data exist on fall-related hospitalizations in this group. This population-based study compared fall-related hospital admissions, injury rates and consequences in people with and without PD, and determined whether PD was an independent predictor of fall-related hospital length of stay. METHODS This was a retrospective study using probabilistic linkage of hospital data in people aged ≥65 years hospitalized for a fall between 1 July 2005 and 31 December 2013 in New South Wales, Australia. Rates of hospital admissions and injuries per person admitted over the study period were compared between people with and without PD using Poisson or negative binomial regression. Multilevel linear modelling was used to analyse length of stay by clustering individuals and adjusting for possible confounders. RESULTS There were 342 265 fall-related hospital admissions in people aged ≥65 years during the study period, of which 8487 (2.5%) were for people with PD. Sixty-seven per cent of fall-related PD admissions were associated with injury and 35% were associated with fracture. People with PD had higher rate ratios for fall admissions (1.63, 95% confidence interval 1.59-1.67) and injury (1.47, 95% confidence interval 1.43-1.51) and longer median length of stay [9 (interquartile range 1-27) vs. 6 (interquartile range 1-20) days in people without PD; P < 0.001]. PD remained associated with increased length of stay after controlling for comorbidity, age, sex and injury (P < 0.001). CONCLUSIONS This study provides important benchmark data for hospitalizations for falls and fall injuries for older people with PD, which may be used to monitor the effect of fall prevention programmes.
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Affiliation(s)
- S S Paul
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - L Harvey
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - C G Canning
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - S Boufous
- Transport and Road Safety, UNSW, Kensington, NSW, Australia
| | - S R Lord
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - J C T Close
- Neuroscience Research Australia, Randwick, NSW, Australia.,Prince of Wales Clinical School, UNSW, Kensington, NSW, Australia
| | - C Sherrington
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Droxidopa and Reduced Falls in a Trial of Parkinson Disease Patients With Neurogenic Orthostatic Hypotension. Clin Neuropharmacol 2017; 39:220-6. [PMID: 27332626 PMCID: PMC5028156 DOI: 10.1097/wnf.0000000000000168] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Droxidopa is a prodrug of norepinephrine indicated for the treatment of orthostatic dizziness, lightheadedness, or the "feeling that you are about to black out" in adult patients with symptomatic neurogenic orthostatic hypotension caused by primary autonomic failure including Parkinson disease (PD). The objective of this study was to compare fall rates in PD patients with symptomatic neurogenic orthostatic hypotension randomized to droxidopa or placebo. METHODS Study NOH306 was a 10-week, phase 3, randomized, placebo-controlled, double-blind trial of droxidopa in PD patients with symptomatic neurogenic orthostatic hypotension that included assessments of falls as a key secondary end point. In this report, the principal analysis consisted of a comparison of the rate of patient-reported falls from randomization to end of study in droxidopa versus placebo groups. RESULTS A total of 225 patients were randomized; 222 patients were included in the safety analyses, and 197 patients provided efficacy data and were included in the falls analyses. The 92 droxidopa patients reported 308 falls, and the 105 placebo patients reported 908 falls. In the droxidopa group, the fall rate was 0.4 falls per patient-week; in the placebo group, the rate was 1.05 falls per patient-week (prespecified Wilcoxon rank sum P = 0.704; post hoc Poisson-inverse Gaussian test P = 0.014), yielding a relative risk reduction of 77% using the Poisson-inverse Gaussian model. Fall-related injuries occurred in 16.7% of droxidopa-treated patients and 26.9% of placebo-treated patients. CONCLUSIONS Treatment with droxidopa appears to reduce falls in PD patients with symptomatic neurogenic orthostatic hypotension, but this finding must be confirmed.
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"Pushing the Limits": Rethinking Motor and Cognitive Resources After a Highly Challenging Balance Training Program for Parkinson Disease. Phys Ther 2017; 97:81-89. [PMID: 27515945 DOI: 10.2522/ptj.20160090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is growing evidence for the positive effects of exercise training programs on balance control in Parkinson disease (PD). To be effective, balance training needs to be specific, progressive, and highly challenging. Little evidence exists, however, for how people with PD-related balance impairments perceive highly challenging and progressive balance training programs with dual-task components. OBJECTIVE The purpose of this study was to explore and describe perceptions of a highly challenging balance training program among people with mild to moderate PD. DESIGN This study was qualitative in nature. In-depth interviews were conducted with 13 individuals with mild to moderate PD who had participated in a highly challenging balance training program. Interview transcripts were analyzed using qualitative content analysis, with an inductive approach. RESULTS The analysis revealed 3 subthemes concerning participants' perceptions of highly challenging and progressive balance training: (1) movement to counter the disease, (2) dual-task training in contrast to everyday strategies, and (3) the struggle to maintain positive effects. The first subtheme reflects how physical activity was used as a short-term and long-term strategy for counteracting PD symptoms and their progression. The second subtheme incorporates the described experiences of being maximally challenged in a secure and supportive group environment, circumstances that stood in contrast to participants' everyday lives. The third subtheme describes participants' long-term struggle to maintain program effects on cognitive and physical function in the face of disease progression. Interpretation of the underlying patterns of these subthemes resulted in one overarching theme: training at the limits of balance capacity causes a rethinking motor and cognitive resources. LIMITATIONS The findings of this study cannot be considered to reflect the beliefs of those with weaker or negative beliefs concerning physical activity or be transferred to those at more severe stages of the disease. CONCLUSIONS Findings from this study suggest that being pushed to the limits of balance capacity provoked people with mild to moderate PD to rethink their individual motor and cognitive resources, a process that was further enabled by the PD-specific group setting.
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Hiorth YH, Alves G, Larsen JP, Schulz J, Tysnes OB, Pedersen KF. Long-term risk of falls in an incident Parkinson's disease cohort: the Norwegian ParkWest study. J Neurol 2016; 264:364-372. [PMID: 28000003 DOI: 10.1007/s00415-016-8365-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study is to examine the frequency, development, concomitants, and risk factors of falls in a population-based incident Parkinson's disease (PD) cohort. One hundred eighty-one drug-naïve patients with incident PD and 173 normal controls recruited from the Norwegian ParkWest study were prospectively monitored over 7 years. Information on falls was obtained biannually from patients, and at baseline and after 1, 3, 5, and 7 years of follow-up in control subjects. Generalized estimating equation models for correlated data were applied to investigate concomitant features of falls and risk factors for incident falls during 7 years of follow-up in PD. Overall, 64.1% of patients reported falling during the study period. The 7-year cumulative incidence of falls in non-falling patients at baseline (n = 153) was 57.5%, with a relative risk to controls of at least 3.1 (95% confidence interval 1.5-6.3; p < 0.002). Significant concomitants of falls in patients during the study period were higher age, Unified PD Rating Scale motor score, postural instability and gait difficulties (PIGD) phenotype, dementia, and follow-up time. Higher age at baseline, PIGD phenotype at 1-year visit, and follow-up time were independent risk factors for incident falls during follow-up. Nearly two-thirds of patients in the general PD population experience falls within 7 years of diagnosis, representing a more than threefold increased risk compared to age- and gender-matched controls. Patients with higher age at baseline and early PIGD have the greatest risk of falling and may, therefore, be the prime target of specialized assessment and treatment interventions.
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Affiliation(s)
- Ylva Hivand Hiorth
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway. .,Department of Physical Medicine and Rehabilitation, Stavanger University Hospital, Stavanger, Norway.
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Jörn Schulz
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Ole-Bjørn Tysnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kenn Freddy Pedersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway
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The role of postural instability/gait difficulty and fear of falling in predicting falls in non-demented older adults. Arch Gerontol Geriatr 2016; 69:15-20. [PMID: 27866086 DOI: 10.1016/j.archger.2016.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/09/2016] [Accepted: 09/28/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Postural instability/gait difficulty (PIGD) and fear of falling (FoF) frequently co-exist, but their individual predictive values for falls have not been compared in aging. This study aims to determine both independent and combined effect of PIGD and FoF to falls in older adults without dementia. METHODS PIGD and other extrapyramidal signs were systematically assessed in 449 community-dwelling participants without Parkinson's disease (76.48±6.61 ys; 56.8% female) enrolled in this longitudinal cohort study. Presence of FoF was measured by a single-item question (Do you have a FoF?) and self-confidence by the Activities-specific Balance Confidence scale (ABC scale). RESULTS One hundred sixty-nine participants (38%) had an incident fall over a mean follow-up of 20.1±12.2months. PIGD was present in 32% and FoF in 23% of the participants. Both PIGD (adjusted hazard ratio (aHR): 2.28; p=0.016) and self-confidence (aHR: 0.99; p=0.040) predicted falls when entered simultaneously in the Cox model. However, presence of FoF (aHR: 1.99; p=0.021) and self-confidence (aHR: 0.98; p=0.006) predicted falls only in individuals with PIGD. CONCLUSIONS PIGD and FoF were associated with future falls in older adults without dementia but FoF was a fall's predictor only in individuals with PIGD.
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Custodio N, Lira D, Herrera-Perez E, Montesinos R, Castro-Suarez S, Cuenca-Alfaro J, Cortijo P. Predictive model for falling in Parkinson disease patients. eNeurologicalSci 2016; 5:20-24. [PMID: 29430553 PMCID: PMC5803085 DOI: 10.1016/j.ensci.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/05/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background/aims Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The aim of this study was to develop a multivariate model to predict falling in PD patients. Methods Prospective cohort with forty-nine PD patients. The area under the receiver-operating characteristic curve (AUC) was calculated to evaluate predictive performance of the purposed multivariate model. Results The median of PD duration and UPDRS-III score in the cohort was 6 years and 24 points, respectively. Falls occurred in 18 PD patients (30%). Predictive factors for falling identified by univariate analysis were age, PD duration, physical activity, and scores of UPDRS motor, FOG, ACE, IFS, PFAQ and GDS (p-value < 0.001), as well as fear of falling score (p-value = 0.04). The final multivariate model (PD duration, FOG, ACE, and physical activity) showed an AUC = 0.9282 (correctly classified = 89.83%; sensitivity = 92.68%; specificity = 83.33%). Conclusions This study showed that our multivariate model have a high performance to predict falling in a sample of PD patients. In PD patients the fall rates doubles the reported rates in community welling older people without neurological disease, ranging from 35% to 90%. Falls have a negative psychosocial impact creating a spiral of increased fear of falling and reduced physical activity, and increased likelihood of nursing home admission. A multivariate model (PD duration, freezing of gait, Addenbrook's Cognitive Examination, and physical activity) to predict falling in our sample of PD patients showed a high performance.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Corresponding author at: Instituto Peruano de Neurociencias, – Bartolomé Herrera 161, Lima, Peru.Instituto Peruano de NeurocienciasBartolomé Herrera 161LimaPeru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Desarrollo de Investigación, Tecnologías y Docencia, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
- Centro de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Lima, Peru
| | - Sheila Castro-Suarez
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Jose Cuenca-Alfaro
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Patricia Cortijo
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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Gazibara T, Kisic-Tepavcevic D, Svetel M, Tomic A, Stankovic I, Kostic VS, Pekmezovic T. Health-related quality of life as a predictor of recurrent falling in Parkinson's disease: 1-year follow-up study. Psychogeriatrics 2016; 16:362-367. [PMID: 26756787 DOI: 10.1111/psyg.12178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 10/09/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether various domains related to health-related quality of life could be predictive of recurrent falls among persons with Parkinson's disease (PD) during a 1-year follow-up study. METHODS A total of 120 consecutive persons with PD who had denied falling in past 6 months were recruited at regular check-ups at the Department of Movement Disorders, Neurology Clinic, Clinical Center of Serbia in Belgrade, from 15 August 2011 to 15 December 2012. At baseline, study participants were clinically assessed. Health-related quality of life was evaluated with the generic 36-item Short Form Health Survey. Participants were prospectively followed for 1 year, and occurrence of falls was registered. RESULTS The median age of subjects was 60.0 years, with a median disease duration of 4.0 years. Of 120 persons with PD, 42 (35%) experienced falls during the 12-month study period, including 23 (19.2%) who fell repeatedly. After adjustment for gender, age, PD duration, levodopa dosage, Hoehn and Yahr stage, Unified Parkinson's Disease Rating Scale I-IV, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scales, we identified the 36-item Short Form Health Survey domains of role physical (P = 0.033) and vitality (P = 0.019) as being associated with recurrent falls of persons with PD within the 1-year follow-up period. CONCLUSION Baseline 36-item Short Form Health Survey scores regarding both the physical and mental components of overall health may be related to recurrent falling among persons with PD. These HRQoL domains could be considered as potential markers for persons with PD who are prone to recurrent falls.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Marina Svetel
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Tomic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Iva Stankovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir S Kostic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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180
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Efficacy and Safety of Pedunculopontine Nuclei (PPN) Deep Brain Stimulation in the Treatment of Gait Disorders: A Meta-Analysis of Clinical Studies. Can J Neurol Sci 2016; 43:120-6. [PMID: 26786642 DOI: 10.1017/cjn.2015.318] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pedunculopontine nucleus (PPN) has complex reciprocal connections with basal ganglia, especially with internal globus pallidus and substantia nigra, and it has been postulated that PPN stimulation may improve gait instability and freezing of gait. In this meta-analysis, we will assess the evidence for PPN deep brain stimulation in treatment of gait and motor abnormalities especially focusing on Parkinson disease patients. METHODS PubMed and Scopus electronic databases were searched for related studies published before February 2014. Medline (1966-2014), Embase (1974-2010), CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases (1960-2014) were also searched for studies investigating effect of PPN deep brain stimulation in treatment of postural and postural instability and total of ten studies met the inclusion criteria for this analysis. RESULTS Our findings showed a significant improvement in postural instability (p<0.001) and motor symptoms of Parkinson disease on and off medications (p<0.05), but failed to show improvement in freezing of gait. CONCLUSIONS Despite significant improvement in postural instability observed in included studies, evidence from current literature is not sufficient to generalize these findings to the majority of patients.
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181
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Almeida LRS, Sherrington C, Allen NE, Paul SS, Valenca GT, Oliveira-Filho J, Canning CG. Disability is an Independent Predictor of Falls and Recurrent Falls in People with Parkinson's Disease Without a History of Falls: A One-Year Prospective Study. JOURNAL OF PARKINSONS DISEASE 2016; 5:855-64. [PMID: 26444093 DOI: 10.3233/jpd-150651] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Predictors of falls in people with Parkinson's disease (PD) who have not previously fallen are yet to be identified. OBJECTIVES We aimed to identify predictors of all falls and recurrent falls in people with PD who had not fallen in the previous year and to explore the timing of falls in a 12-month follow-up period. METHODS Participants with PD (n = 130) were assessed by disease-specific, self-report and balance measures. Falls were recorded prospectively for 12 months. Univariate and multivariate analyses were performed. Kaplan-Meier survival analysis was used to investigate time to falling. RESULTS Forty participants (31%) had ≥1 fall during follow-up and 21 (16%) had ≥2 falls. Disability, reduced balance confidence and greater concern about falling were associated with ≥1 fall in univariate analyses. Additionally, PD duration and severity, freezing of gait and impaired balance were associated with ≥2 falls (p < 0.05). Disability (Schwab and England scale, Odds Ratio [OR] = 0.56 per 10 points increase; 95% confidence interval [CI] 0.39-0.80; p = 0.002) was associated with ≥1 fall in the final multivariate model (area under the receiver operating characteristic curve [AUC] = 0.65; 95% CI 0.55-0.76; p = 0.005). Disability (Unified Parkinson's Disease Rating Scale activities of daily living, OR = 1.20; 95% CI 1.07-1.34; p = 0.001) and levodopa equivalent dose (OR = 1.11 per 100 mg increase; 95% CI 0.95-1.30; p = 0.19) were associated with ≥2 falls in the final multivariate model (AUC = 0.72; 95% CI 0.60-0.84; p = 0.001). Recurrent fallers experienced their first fall earlier than single fallers (p < 0.05). CONCLUSIONS Self-reported disability was the strongest single predictor of all falls and recurrent falls.
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Affiliation(s)
- Lorena R S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital, Salvador, BA, Brazil.,Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, BA, Brazil.,Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Natalie E Allen
- Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Serene S Paul
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Guilherme T Valenca
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital, Salvador, BA, Brazil
| | - Jamary Oliveira-Filho
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, BA, Brazil
| | - Colleen G Canning
- Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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182
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Bowen C, Ashburn A, Cole M, Donovan-Hall M, Burnett M, Robison J, Mamode L, Pickering R, Bader D, Kunkel D. A survey exploring self-reported indoor and outdoor footwear habits, foot problems and fall status in people with stroke and Parkinson's. J Foot Ankle Res 2016; 9:39. [PMID: 27688813 PMCID: PMC5034630 DOI: 10.1186/s13047-016-0170-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/10/2016] [Indexed: 01/19/2023] Open
Abstract
Background Ill-fitting shoes have been implicated as a risk factor for falls but research to date has focused on people with arthritis, diabetes and the general older population; little is known about people with neurological conditions. This survey for people with stroke and Parkinson’s explored people’s choice of indoor and outdoor footwear, foot problems and fall history. Methods Following ethical approval, 1000 anonymous postal questionnaires were distributed to health professionals, leads of Parkinson’s UK groups and stroke clubs in the wider Southampton area, UK. These collaborators handed out survey packs to people with a confirmed diagnosis of stroke or Parkinson’s. Results Three hundred and sixty three completed surveys were returned (218 from people with Parkinson’s and 145 from people with stroke). Most respondents wore slippers indoors and walking shoes outdoors and considered comfort and fit the most important factors when buying footwear. Foot problems were reported by 43 % (95 % confidence intervals 36 to 52 %; stroke) and 53 % (95 % confidence interval 46 to 59 %; Parkinson’s) of respondents; over 50 % had never accessed foot care support. Fifty percent of all respondents reported falls. In comparison to non-fallers, a greater proportion of fallers reported foot problems (57 %), with greater proportions reporting problems impacting on balance and influencing choice of footwear (p < 0.01) in comparison to non-fallers in each case. Forty-seven percent of fallers with foot problems had not accessed foot care support. Conclusions Many people with stroke and Parkinson’s wear slippers indoors. A high percentage of these individuals reported both foot problems and falls impacting on footwear habits and choice of footwear; however many did not receive foot care support. These findings highlight that further exploration of footwear and foot problems in these populations is warranted to provide evidence based advice on safe and appropriate footwear to support rehabilitation and fall prevention. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0170-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Bowen
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ann Ashburn
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mark Cole
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Malcolm Burnett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Judy Robison
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Louis Mamode
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ruth Pickering
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dan Bader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Dorit Kunkel
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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183
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Farombi TH, Owolabi MO, Ogunniyi A. Falls and Their Associated Risks in Parkinson's Disease Patients in Nigeria. J Mov Disord 2016; 9:160-5. [PMID: 27667188 PMCID: PMC5035939 DOI: 10.14802/jmd.16011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/08/2016] [Accepted: 05/16/2016] [Indexed: 11/24/2022] Open
Abstract
Objective Falls are a devastating consequence of Parkinson’s disease (PD) and are due to motor imbalance. However, the frequency of falls and their risk factors among Nigerians with PD is not known despite the significant increase in PD cases in the country. To assess fall risk factors and frequency in Nigerian PD patients. Methods Using an analytical design to compare falling versus non-falling patients, 81 PD patients were assessed for clinical factors, frequency of falls, and candidate risk factors for falls according to the Tinetti Balance and Gait, Unified Parkinson’s Disease Rating Scale subsection 1, and Timed Up and Go Tests. Descriptive, bivariate, and multivariate analyses were performed at the 95% confidence level. Results The mean age of participants was 65.6 ± 9.7 years. Falls were about three times (p < 0.001) more common in PD patients. Of the falling patients, 67.7% sustained injuries, 67.7% had recurrent falls and 44.9% admitted to having a fear of falling. The independent statistical predictors of fall were fear of falling [odds ratio (OR): 3.86], disease severity (OR: 1.09) and disease duration (OR: 1.01). Conclusion The frequency of falls in PD patients was significantly higher when compared with the healthy adult population, and the modifiable predictor was fear of falling with a potential to significantly reduce falls when strategically addressed.
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Affiliation(s)
- Temitope Hannah Farombi
- Deparment of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Mayowa O Owolabi
- Deparment of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Deparment of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
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184
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Lindholm B, Nilsson MH, Hansson O, Hagell P. External validation of a 3-step falls prediction model in mild Parkinson's disease. J Neurol 2016; 263:2462-2469. [PMID: 27646115 PMCID: PMC5110600 DOI: 10.1007/s00415-016-8287-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022]
Abstract
The 3-step falls prediction model (3-step model) that include history of falls, history of freezing of gait and comfortable gait speed <1.1 m/s was suggested as a clinical fall prediction tool in Parkinson’s disease (PD). We aimed to externally validate this model as well as to explore the value of additional predictors in 138 individuals with relatively mild PD. We found the discriminative ability of the 3-step model in identifying fallers to be comparable to previously studies [area under curve (AUC), 0.74; 95 % CI 0.65–0.84] and to be better than that of single predictors (AUC, 0.61–0.69). Extended analyses generated a new model for prediction of falls and near falls (AUC, 0.82; 95 % CI 0.75–0.89) including history of near falls, retropulsion according to the Nutt Retropulsion test (NRT) and tandem gait (TG). This study confirms the value of the 3-step model as a clinical falls prediction tool in relatively mild PD and illustrates that it outperforms the use of single predictors. However, to improve future outcomes, further studies are needed to firmly establish a scoring system and risk categories based on this model. The influence of methodological aspects of data collection also needs to be scrutinized. A new model for prediction of falls and near falls, including history of near falls, TG and retropulsion (NRT) may be considered as an alternative to the 3-step model, but needs to be tested in additional samples before being recommended. Taken together, our observations provide important additions to the evidence base for clinical fall prediction in PD.
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Affiliation(s)
- Beata Lindholm
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Malmö, Sweden. .,Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Peter Hagell
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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185
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Effects of Exercise Therapy on Postural Instability in Parkinson Disease: A Meta-analysis. J Neurol Phys Ther 2016; 40:3-14. [PMID: 26655098 DOI: 10.1097/npt.0000000000000117] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Exercise therapy is a common intervention for improving postural stability. The purpose of this meta-analysis was to assess the effect of exercise therapy on postural instability in persons with Parkinson disease (PD) based on the available literature, and to evaluate the efficacy across various types of exercise interventions. DATA SOURCES AND STUDY SELECTION In January 2015, electronic databases (PubMed, Scopus, PEDro) and study reference lists were searched for randomized controlled trials with moderate or high methodological quality (PEDro score ≥ 5), investigating the effect of exercise on postural instability in persons with PD. DATA EXTRACTION AND SYNTHESIS Three reviewers extracted data and assessed quality. MAIN OUTCOME AND MEASURE Postural stability as measured using the Berg Balance Scale, postural sway, Timed Up and Go, or Functional Reach test. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. RESULTS Twenty-two trials, with a total of 1072 participants, were eligible for inclusion. The pooled estimates of effects showed significantly improved postural instability (SMD, 0.23; 95% CI, 0.10-0.36; P < 0.001) after exercise therapy, in comparison with no exercise or sham treatment. Exercise interventions specifically addressing components of balance dysfunction demonstrated the largest efficacy, with moderate to high effect sizes (SMD, 0.43; 95% CI, 0.21-0.66; P < 0.001). Little or no beneficial effects were observed for interventions not specifically targeted at postural stability (SMD, 0.20; 95% CI -0.04 to 0.44; P = 0.11) or for home-based, multicomponent exercise programs (SMD, 0.02; 95% CI -0.20 to 0.25; P = 0.86). DISCUSSION AND CONCLUSIONS Exercise therapies specifically addressing balance dysfunction are an important treatment option for improving postural stability in persons with PD. Future studies should investigate sustainability of the short-term effects and establish the dose-response relationship of balance training in persons with PD.Video abstract available for additional insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A121).
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Lord S, Galna B, Yarnall AJ, Coleman S, Burn D, Rochester L. Predicting first fall in newly diagnosed Parkinson's disease: Insights from a fall-naïve cohort. Mov Disord 2016; 31:1829-1836. [PMID: 27621153 DOI: 10.1002/mds.26742] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls are common and associated with reduced independence and mortality in Parkinson's disease. Previous research has been conducted on falls-prevalent or advanced disease cohorts. OBJECTIVE This study identifies risk factors for first fall for 36 months in a newly diagnosed, falls-naïve cohort. METHODS A total of 121 consecutive Parkinson's disease patients were recruited. Falls data were collected prospectively during 36 months from diagnosis via monthly falls diaries and telephone follow-up for 117 participants. Assessment comprised a comprehensive battery of clinical, gait, and cognitive measures. Significant predictors were identified from decision-tree analysis and survival analysis with time to first fall during 36 months as the dependent variable. FINDINGS At baseline, 26 (22%) participants reported retrospective falls. At 36 months, the remaining cohort (n = 91) comprised 47 fallers (52%) and 30 (33%) nonfallers and 14 (15%) participants with incomplete diaries. Fallers presented with a significantly higher disease severity, poorer ability to stand on one leg, slower gait speed, increased stance time variability, and higher swing time asymmetry. Median time to first fall was 847 days. Gait speed, stance time, and Hoehn & Yahr III stage emerged as significant predictors of first fall, hazard ratio 3.44 (95% confidence interval [CI] 1.58 to 7.48), 3.31(95% CI 1.40 to 7.80), and 2.80 (95% CI 1.38 to 5.65), respectively. The hazard ratio for risk factors combined was 7.82 (CI 2.80 to 21.84). CONCLUSIONS Interventions that target gait deficit and postural control in early Parkinson's disease may limit the potential for first fall. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sue Lord
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Brook Galna
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Shirley Coleman
- UK and Industrial Statistics Research Unit, Newcastle University, Newcastle upon Tyne, UK
| | - David Burn
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
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Ross A, Yarnall AJ, Rochester L, Lord S. A novel approach to falls classification in Parkinson's disease: development of the Fall-Related Activity Classification (FRAC). Physiotherapy 2016; 103:459-464. [PMID: 27913063 DOI: 10.1016/j.physio.2016.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Falls are a major problem for people with Parkinson's disease (PD). Despite years of focused research knowledge of falls aetiology is poor. This may be partly due to classification approaches which conventionally report fall frequency. This nosology is blunt, and does not take into account causality or the circumstances in which the fall occurred. For example, it is likely that people who fall from a postural transition are phenotypically different to those who fall during high level activities. Recent evidence supports the use of a novel falls classification based on fall related activity, however its clinimetric properties have not yet been tested. OBJECTIVE This study describes further development of the Fall-Related Activity Classification (FRAC) and reports on its inter-rater reliability (IRR). METHOD Descriptors of the FRAC were refined through an iterative process with a multidisciplinary team. Three categories based on the activity preceding the fall were identified. PD fallers were categorised as: (1) advanced (2) combined or (3) transitional. Fifty-five fall scenarios were rated by 23 raters using a standardised process. Raters comprised 3 clinical subgroups: (1) physiotherapists, (2) physicians, (3) non-medical researchers. IRR analysis was performed using weighted kappa coefficients and included sub group analysis based on clinical speciality. RESULTS Excellent agreement was reached for all clinicians, κ=0.807 (95% CI 0.732 to 0.870). Clinical subgroups performed similarly well (range of κ=0.780 to 0.822). CONCLUSION The FRAC can be reliably used to classify falls. This may discriminate between phenotypically different fallers and subsequently strengthen falls predictors in future studies.
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Affiliation(s)
- Annie Ross
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK.
| | - Alison J Yarnall
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK.
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK.
| | - Sue Lord
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK.
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Changes in postural control in patients with Parkinson's disease: a posturographic study. Physiotherapy 2016; 102:272-9. [DOI: 10.1016/j.physio.2015.08.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 08/30/2015] [Indexed: 01/05/2023]
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Santos L, Fernandez-Rio J, Winge K, Barragán-Pérez B, Rodríguez-Pérez V, González-Díez V, Blanco-Traba M, Suman OE, Philip Gabel C, Rodríguez-Gómez J. Effects of supervised slackline training on postural instability, freezing of gait, and falls efficacy in people with Parkinson's disease. Disabil Rehabil 2016; 39:1573-1580. [PMID: 27416005 DOI: 10.1080/09638288.2016.1207104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to assess whether supervised slackline training reduces the risk of falls in people with Parkinson's disease (PD). METHODS Twenty-two patients with idiopathic PD were randomized into experimental (EG, N = 11) and control (CG, N = 11) groups. Center of Pressure (CoP), Freezing of Gait (FOG), and Falls Efficacy Scale (FES) were assessed at pre-test, post-test and re-test. Rate perceived exertion (RPE, Borg's 6-20 scale) and local muscle perceived exertion (LRPE) were also assessed at the end of the training sessions. RESULTS The EG group showed significant improvements in FOG and FES scores from pre-test to post-test. Both decreased at re-test, though they did not return to pre-test levels. No significant differences were detected in CoP parameters. Analysis of RPE and LRPE scores revealed that slackline was associated with minimal fatigue and involved the major lower limb and lumbar muscles. CONCLUSIONS These findings suggest that slacklining is a simple, safe, and challenging training and rehabilitation tool for PD patients. It could be introduced into their physical activity routine to reduce the risk of falls and improve confidence related to fear of falling. Implications for Rehabilitation Individuals with Parkinson's disease (PD) are twice as likely to have falls compared to patients with other neurological conditions. This study support slackline as a simple, safe, and challenging training and rehabilitation tool for people with PD, which reduce their risk of falls and improve confidence related to fear of falling. Slackline in people with PD yields a low tiredness or fatigue impact and involves the major lower limb and lumbar muscles.
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Affiliation(s)
- Luis Santos
- a University School of Sports Medicine, University of Oviedo , Oviedo , Spain.,b Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education , University of A Coruna , Spain
| | | | - Kristian Winge
- c Department of Neurology , Bispebjerg Movement Disorders Biobank, Bispebjerg University Hospital , Copenhagen , Denmark
| | | | | | | | | | - Oscar E Suman
- f Department of Surgery , University of Texas Medical Branch , Galveston , TX , USA.,g Shriners Hospitals for Children , Galveston , TX , USA
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Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study. Phys Ther 2016; 96:1074-84. [PMID: 26821572 DOI: 10.2522/ptj.20150168] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 01/17/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease (PD). However, the accuracy for predicting falls on the basis of self-report measures has not been widely investigated. OBJECTIVE The study objectives were: (1) to compare the accuracy of the Activities-specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I) with that of the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), and Timed "Up & Go" Test (TUG) for predicting recurrent falls in people with PD and (2) to explore the ability of combinations of up to 3 tests to predict recurrent falls. DESIGN This was a prospective cohort study involving 225 people with PD. METHODS Participants were assessed with the ABC, FES-I, BBS, FRT, TUG, and DGI. Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers. Areas under the receiver operating characteristic curves were determined, and the Akaike information criterion was used to select the best predictive model. RESULTS Eighty-four participants (37.3%) were classified as recurrent fallers. Areas under the receiver operating characteristic curves for the ABC, FES-I, TUG, FRT, DGI, and BBS were 0.73, 0.74, 0.72, 0.74, 0.76, and 0.79, respectively. Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models, particularly the combination of the BBS with the FES-I. LIMITATIONS The lack of an external validation sample was a limitation of this study. CONCLUSIONS The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures, especially the FRT and the TUG. Two-test models showed performance similar to that of 3-test models, suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD. Specifically, the combination of the BBS with the FES-I may be considered.
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Foongsathaporn C, Panyakaew P, Jitkritsadakul O, Bhidayasiri R. What daily activities increase the risk of falling in Parkinson patients? An analysis of the utility of the ABC-16 scale. J Neurol Sci 2016; 364:183-7. [DOI: 10.1016/j.jns.2016.03.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
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Cattaneo D, Carpinella I, Aprile I, Prosperini L, Montesano A, Jonsdottir J. Comparison of upright balance in stroke, Parkinson and multiple sclerosis. Acta Neurol Scand 2016; 133:346-54. [PMID: 26234280 DOI: 10.1111/ane.12466] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS), Parkinson's disease (PD) and stroke (ST) subjects show balance impairments due to damage of the balance control system. The objective of the study was to assess the impact of MS, PD and ST on upright posture in eyes open condition and when visual and/or proprioceptive inputs are altered. MATERIALS AND METHODS A total of 188 subjects with MS (n = 80), PD (n = 58) and ST (n = 50), mean age (SD), 57.9 (14.6) years, and 32 healthy subjects (HS) aged 53.7 (15.7) years were assessed by a stabilometric platform in a cross-sectional study. RESULTS Compared to HS, MS showed large deviations from normal performances with respect to magnitude (P < 0.001) and regularity (P < 0.05) of body sway irrespective of the altered sensory information. Similarly to MS, PD showed large and abnormal levels of body sway (P < 0.001) and postural tremor (P < 0.05), while ST was the least impaired except for an asymmetrical distribution of body weight between legs (P < 0.001). Finally, the MS group compared to PD and ST showed the largest body instability after eye closure (P < 0.05) and when visual and proprioceptive inputs were removed (P < 0.05). PD showed instability mainly after the alteration of proprioceptive inputs (P < 0.05), while ST showed the smallest increase of body instability when sensory inputs were reduced. DISCUSSION Objective assessment revealed pathology-specific balance disorders and showed the differential impact of MS, PD and ST on the ability to use sensory information for balance control.
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Affiliation(s)
- D. Cattaneo
- Don Gnocchi Foundation I.R.C.C.S.; Rome Italy
| | | | - I. Aprile
- Don Gnocchi Foundation I.R.C.C.S.; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; La Sapienza University; Rome Italy
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Vinik AI, Casellini C, Névoret ML. Alternative Quantitative Tools in the Assessment of Diabetic Peripheral and Autonomic Neuropathy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2016; 127:235-85. [PMID: 27133153 DOI: 10.1016/bs.irn.2016.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Here we review some seldom-discussed presentations of diabetic neuropathy, including large fiber dysfunction and peripheral autonomic dysfunction, emphasizing the impact of sympathetic/parasympathetic imbalance. Diabetic neuropathy is the most common complication of diabetes and contributes additional risks in the aging adult. Loss of sensory perception, loss of muscle strength, and ataxia or incoordination lead to a risk of falling that is 17-fold greater in the older diabetic compared to their young nondiabetic counterparts. A fall is accompanied by lacerations, tears, fractures, and worst of all, traumatic brain injury, from which more than 60% do not recover. Autonomic neuropathy has been hailed as the "Prophet of Doom" for good reason. It is conducive to increased risk of myocardial infarction and sudden death. An imbalance in the autonomic nervous system occurs early in the evolution of diabetes, at a stage when active intervention can abrogate the otherwise relentless progression. In addition to hypotension, many newly recognized syndromes can be attributed to cardiac autonomic neuropathy such as orthostatic tachycardia and bradycardia. Ultimately, this constellation of features of neuropathy conspire to impede activities of daily living, especially in the patient with pain, anxiety, depression, and sleep disorders. The resulting reduction in quality of life may worsen prognosis and should be routinely evaluated and addressed. Early neuropathy detection can only be achieved by assessment of both large and small- nerve fibers. New noninvasive sudomotor function technologies may play an increasing role in identifying early peripheral and autonomic neuropathy, allowing rapid intervention and potentially reversal of small-fiber loss.
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Affiliation(s)
- A I Vinik
- Eastern Virginia Medical School, Strelitz Diabetes and Neuroendocrine Center, Norfolk, VA, United States.
| | - C Casellini
- Eastern Virginia Medical School, Strelitz Diabetes and Neuroendocrine Center, Norfolk, VA, United States
| | - M-L Névoret
- Impeto Medical Inc., San Diego, CA, United States
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Hiorth YH, Larsen JP, Lode K, Tysnes OB, Godfrey A, Lord S, Rochester L, Pedersen KF. Impact of Falls on Physical Activity in People with Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2016; 6:175-82. [DOI: 10.3233/jpd-150640] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ylva Hivand Hiorth
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Physical Medicine and Rehabilitation, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Kirsten Lode
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Ole-Bjørn Tysnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Alan Godfrey
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Sue Lord
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Kenn Freddy Pedersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
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Heinzel S, Maechtel M, Hasmann SE, Hobert MA, Heger T, Berg D, Maetzler W. Motor dual-tasking deficits predict falls in Parkinson's disease: A prospective study. Parkinsonism Relat Disord 2016; 26:73-7. [PMID: 26997654 DOI: 10.1016/j.parkreldis.2016.03.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/16/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Falls severely affect lives of Parkinson's disease (PD) patients. Cognitive impairment including dual-tasking deficits contribute to fall risk in PD. However, types of dual-tasking deficits preceding falls in PD are still unclear. METHODS Walking velocities during box-checking and subtracting serial 7s were assessed twice a year in 40 PD patients over 2.8 ± 1.0 years. Fourteen patients reported a fall within this period (4 excluded fallers already reported falls at baseline). Their dual-task costs (DTC; mean ± standard deviation) 4.2 ± 2.2 months before the first fall were compared with 22 patients never reporting falls. ROC analyses and logistic regressions accounting for DTC, UPDRS-III and disease duration were used for faller classification and prediction. RESULTS Only walking/box-checking predicted fallers. Fallers showed higher DTC for walking while box-checking, p = 0.029, but not for box-checking while walking, p = 0.178 (combined motor DTC, p = 0.022), than non-fallers. Combined motor DTC classified fallers and non-fallers (area under curve: 0.75; 95% confidence interval, CI: 0.60-0.91) with 71.4% sensitivity (95%CI: 41.9%-91.6%) and 77.3% specificity (54.6%-92.2%), and significantly predicted future fallers (p = 0.023). Here, 20.4%-points higher combined motor DTC (i.e. the mean difference between fallers and non-fallers) was associated with a 2.6 (1.1-6.0) times higher odds to be a future faller. CONCLUSION Motor dual-tasking is a potentially valuable predictor of falls in PD, suggesting that avoiding dual task situations as well as specific motor dual-task training might help to prevent falls in PD. These findings and their therapeutic relevance need to be further validated in PD patients without fall history, in early PD stages, and with various motor-motor dual-task challenges.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Mirjam Maechtel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sandra E Hasmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Markus A Hobert
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Tanja Heger
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
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Paul SS, Thackeray A, Duncan RP, Cavanaugh JT, Ellis TD, Earhart GM, Ford MP, Foreman KB, Dibble LE. Two-Year Trajectory of Fall Risk in People With Parkinson Disease: A Latent Class Analysis. Arch Phys Med Rehabil 2016; 97:372-379.e1. [PMID: 26606871 PMCID: PMC4769916 DOI: 10.1016/j.apmr.2015.10.105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/26/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine fall risk trajectories occurring naturally in a sample of individuals with early to middle stage Parkinson disease (PD). DESIGN Latent class analysis, specifically growth mixture modeling (GMM), of longitudinal fall risk trajectories. SETTING Assessments were conducted at 1 of 4 universities. PARTICIPANTS Community-dwelling participants with PD of a longitudinal cohort study who attended at least 2 of 5 assessments over a 2-year follow-up period (N=230). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fall risk trajectory (low, medium, or high risk) and stability of fall risk trajectory (stable or fluctuating). Fall risk was determined at 6 monthly intervals using a simple clinical tool based on fall history, freezing of gait, and gait speed. RESULTS The GMM optimally grouped participants into 3 fall risk trajectories that closely mirrored baseline fall risk status (P=.001). The high fall risk trajectory was most common (42.6%) and included participants with longer and more severe disease and with higher postural instability and gait disability (PIGD) scores than the low and medium fall risk trajectories (P<.001). Fluctuating fall risk (posterior probability <0.8 of belonging to any trajectory) was found in only 22.6% of the sample, most commonly among individuals who were transitioning to PIGD predominance. CONCLUSIONS Regardless of their baseline characteristics, most participants had clear and stable fall risk trajectories over 2 years. Further investigation is required to determine whether interventions to improve gait and balance may improve fall risk trajectories in people with PD.
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Affiliation(s)
- Serene S Paul
- Department of Physical Therapy, University of Utah, Salt Lake City, UT; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Anne Thackeray
- Department of Physical Therapy, University of Utah, Salt Lake City, UT
| | - Ryan P Duncan
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, MO; Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME
| | - Theresa D Ellis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, MO; Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO; Department of Anatomy and Neurobiology, Washington University School of Medicine in St Louis, St Louis, MO
| | - Matthew P Ford
- Department of Physical Therapy, University of Alabama at Birmingham School of Health Professions, Birmingham, AL
| | - K Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT
| | - Leland E Dibble
- Department of Physical Therapy, University of Utah, Salt Lake City, UT.
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Henderson EJ, Lord SR, Brodie MA, Gaunt DM, Lawrence AD, Close JCT, Whone AL, Ben-Shlomo Y. Rivastigmine for gait stability in patients with Parkinson's disease (ReSPonD): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol 2016; 15:249-58. [PMID: 26795874 DOI: 10.1016/s1474-4422(15)00389-0] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Falls are a frequent and serious complication of Parkinson's disease and are related partly to an underlying cholinergic deficit that contributes to gait and cognitive dysfunction in these patients. Gait dysfunction can lead to an increased variability of gait from one step to another, raising the likelihood of falls. In the ReSPonD trial we aimed to assess whether ameliorating this cholinergic deficit with the acetylcholinesterase inhibitor rivastigmine would reduce gait variability. METHODS We did this randomised, double-blind, placebo-controlled, phase 2 trial at the North Bristol NHS Trust Hospital, Bristol, UK, in patients with Parkinson's disease recruited from community and hospital settings in the UK. We included patients who had fallen at least once in the year before enrolment, were able to walk 18 m without an aid, had no previous exposure to an acetylcholinesterase inhibitor, and did not have dementia. Our clinical trials unit randomly assigned (1:1) patients to oral rivastigmine or placebo capsules (both taken twice a day) using a computer-generated randomisation sequence and web-based allocation. Rivastigmine was uptitrated from 3 mg per day to the target dose of 12 mg per day over 12 weeks. Both the trial team and patients were masked to treatment allocation. Masking was achieved with matched placebo capsules and a dummy uptitration schedule. The primary endpoint was difference in step time variability between the two groups at 32 weeks, adjusted for baseline age, cognition, step time variability, and number of falls in the previous year. We measured step time variability with a triaxial accelerometer during an 18 m walking task in three conditions: normal walking, simple dual task with phonemic verbal fluency (walking while naming words beginning with a single letter), and complex dual task switching with phonemic verbal fluency (walking while naming words, alternating between two letters of the alphabet). Analysis was by modified intention to treat; we excluded from the primary analysis patients who withdrew, died, or did not attend the 32 week assessment. This trial is registered with ISRCTN, number 19880883. FINDINGS Between Oct 4, 2012 and March 28, 2013, we enrolled 130 patients and randomly assigned 65 to the rivastigmine group and 65 to the placebo group. At week 32, compared with patients assigned to placebo (59 assessed), those assigned to rivastigmine (55 assessed) had improved step time variability for normal walking (ratio of geometric means 0.72, 95% CI 0.58-0.88; p=0.002) and the simple dual task (0.79; 0.62-0.99; p=0.045). Improvements in step time variability for the complex dual task did not differ between groups (0.81, 0.60-1.09; p=0.17). Gastrointestinal side-effects were more common in the rivastigmine group than in the placebo group (p<0.0001); 20 (31%) patients in the rivastigmine group versus three (5%) in the placebo group had nausea and 15 (17%) versus three (5%) had vomiting. INTERPRETATION Rivastigmine can improve gait stability and might reduce the frequency of falls. A phase 3 study is needed to confirm these findings and show cost-effectiveness of rivastigmine treatment. FUNDING Parkinson's UK.
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Affiliation(s)
- Emily J Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - Daisy M Gaunt
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Andrew D Lawrence
- School of Psychology and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, UK
| | - Jacqueline C T Close
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - A L Whone
- Bristol Institute of Clinical Neurosciences, University of Bristol, UK; Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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198
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Gazibara T, Tepavcevic DK, Svetel M, Tomic A, Stankovic I, Kostic VS, Pekmezovic T. Recurrent falls in Parkinson's disease after one year of follow-up: A nested case-control study. Arch Gerontol Geriatr 2016; 65:17-24. [PMID: 26921677 DOI: 10.1016/j.archger.2016.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/30/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
The aims of this study were to compare clinical and fall characteristics of single and recurrent falls among persons with PD and to evaluate factors associated with recurrent falls. A total of 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited. Occurrence of falling was registered during one year. Each person was given a "fall diary" with the aim at writing characteristics of the fall and contacted by telephone each month. Over one year of follow-up 42 persons with PD (35.0%) reported falling. Of 42 persons, 19 (45.2%) went on to become single and 23 (54.8%) went on to become recurrent fallers. Indoor falls were more common among single fallers, whilst outdoor falls were more common among recurrent fallers (p=0.017). Slipping and freezing of gait was more common among single fallers (p=0.035 and p=0.024, respectively). Lower extremity weakness was more frequent among recurrent fallers (p=0.023). The most common injury both among single and recurrent fallers was the soft-tissue contusion. The only factor associated with recurrent falling among persons with PD, who did not fall in past 6 months before the start of follow-up, was worse motor performance as measured by the UPDRS III score (odds ratio [OR]=1.06, 95% confidence interval [CI] 1.01-1.11, p=0.022). These results could be used in selection of persons with PD to enroll in fall prevention programs.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
| | | | - Marina Svetel
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Tomic
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Iva Stankovic
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Vladimir S Kostic
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia.
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199
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Sedaghati P, Daneshmandi H, Karimi N, Barati AH. A Selective Corrective Exercise to Decrease Falling and Improve Functional Balance in Idiopathic Parkinson's Disease. Trauma Mon 2016; 21:e23573. [PMID: 27218051 PMCID: PMC4869417 DOI: 10.5812/traumamon.23573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Posture instability and unsteady gait disorders in Parkinson's Disease (PD) usually contribute to fall-related fractures. Fall-related trauma in PD is the most common reason for injury. Despite providing modern care for PD patients (PP) in the recent years, anti-PD drugs have no effect on falling. There is an urgent need to administer exercise interventions to reduce falls and related injuries in the rehabilitation program of PP. OBJECTIVES To explore the effect of a selective 10-week corrective exercise with an emphasis on gait training activities (GTA) on the number of falls (NOFs), fear of falling, functional balance, timed up and go (TUG) test among PD patients. PATIENTS AND METHODS A purposeful sampling was performed on PP who had fallen or were at risk of falling in 2014. The study intervention consisted of a 10-week (3 sessions each week, each lasting 60 min) corrective exercise program. Participants were randomly allocated to control and two exercise groups; the exercise group with balance pad (EGBP) or exercise group with no balance pad (EGNBP). The analysis of variance (ANOVA) and paired t-test were used for comparison between the groups (P ≤ 0.05). RESULTS Administrating a selective corrective exercise in exercise group with balance pad (EGBP) showed a significant difference in number of falls (NOF), Fall Efficacy Scale-international (FES-I), Berg balance scale (BBS) (and timed up and go) TUG (P = 0.001); while administrating the same exercise in exercise group with no balance pad (EGNBP) showed no significant difference in NOF (P = 0.225) and a significant difference in FES-I (P = 0.031), BBS (P = 0.047) and TUG (P = 0.012). The control group showed no significant difference in each of the dependent variables. CONCLUSIONS Performing a selective corrective exercise on balance pad improves falling and functional balance in idiopathic PD.
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Affiliation(s)
- Parisa Sedaghati
- Department of Sport Injuries and Corrective Exercise , University of Guilan, Rasht, IR Iran
| | - Hassan Daneshmandi
- Department of Sport Injuries and Corrective Exercise , University of Guilan, Rasht, IR Iran
- Corresponding author: Hassan Daneshmandi, Department of Sport Injuries and Corrective Exercise, University of Guilan, Rasht, IR Iran. Tel: +98-7644433661, Fax: +98-7644433661, E-mail:
| | - Noureddin Karimi
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Amir-Hossein Barati
- Department of Exercise Physiologies, Shahid Rajaee Teacher Training University, Tehran, IR Iran
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200
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Nyström H, Nordström A, Nordström P. Risk of Injurious Fall and Hip Fracture up to 26 y before the Diagnosis of Parkinson Disease: Nested Case-Control Studies in a Nationwide Cohort. PLoS Med 2016; 13:e1001954. [PMID: 26836965 PMCID: PMC4737490 DOI: 10.1371/journal.pmed.1001954] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 12/24/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Low muscle strength has been found in late adolescence in individuals diagnosed with Parkinson disease (PD) 30 y later. This study investigated whether this lower muscle strength also may translate into increased risks of falling and fracture before the diagnosis of PD. METHODS AND FINDINGS Among all Swedish citizens aged ≥50 y in 2005, two nested case-control cohorts were compiled. In cohort I, individuals diagnosed with PD during 1988-2012 (n = 24,412) were matched with up to ten controls (n = 243,363), and the risk of fall-related injuries before diagnosis of PD was evaluated. In cohort II, individuals with an injurious fall in need of emergency care during 1988-2012 (n = 622,333) were matched with one control (n = 622,333), and the risk of PD after the injurious fall was evaluated. In cohort I, 18.0% of cases and 11.5% of controls had at least one injurious fall (p < 0.001) prior to PD diagnosis in the case. Assessed by conditional logistic regression analysis adjusted for comorbid diagnoses and education level, PD was associated with increased risks of injurious fall up to 10 y before diagnosis (odds ratio [OR] 1.19, 95% CI 1.08-1.31; 7 to <10 y before diagnosis) and hip fracture ≥15 y before diagnosis (OR 1.36, 95% CI 1.10-1.69; 15-26 y before diagnosis). In cohort II, 0.7% of individuals with an injurious fall and 0.5% of controls were diagnosed with PD during follow-up (p < 0.001). The risk of PD was increased for up to 10 y after an injurious fall (OR 1.18, 95% CI 1.02-1.37; 7 to <10 y after diagnosis). An important limitation is that the diagnoses were obtained from registers and could not be clinically confirmed for the study. CONCLUSIONS The increased risks of falling and hip fracture prior to the diagnosis of PD may suggest the presence of clinically relevant neurodegenerative impairment many years before the diagnosis of this disease.
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Affiliation(s)
- Helena Nyström
- Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna Nordström
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- * E-mail:
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