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Almeida LRS, Vasconcelos L, Valenca GT, Carvalho K, Pinto EB, Oliveira-Filho J, Canning CG. Psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral Scale in people with Parkinson's disease. Disabil Rehabil 2024; 46:2684-2690. [PMID: 37403370 DOI: 10.1080/09638288.2023.2230132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To verify the psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale in Parkinson's disease (PD). MATERIAL AND METHODS Participants (n = 96) were assessed by disease-specific, self-report and functional mobility measures. Internal consistency of the FaB-Brazil scale was evaluated using Cronbach's alpha and inter-rater and test-retest reliability using intraclass correlation coefficients (ICC). The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, and convergent and discriminative validity were evaluated. RESULTS Internal consistency was moderate (α = 0.77). Excellent inter-rater (ICC = 0.90; p < 0.001) and test-retest (ICC = 0.91; p < 0.001) reliability were found. The SEM was 0.20 and MDC was 0.38. Ceiling and floor effects were not found. Convergent validity was established by the positive correlations between the FaB-Brazil scale and age, modified Hoehn and Yahr, PD duration, Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Motor Aspects of Experiences of Daily Living, Timed Up & Go and 8-item Parkinson's Disease Questionnaire, and negative correlations between the FaB-Brazil scale and community mobility, Schwab & England, and Activities-specific Balance Confidence scale. Females showed greater protective behaviors than males; recurrent fallers showed greater protective behaviors than non-recurrent fallers (p < 0.05). CONCLUSIONS The FaB-Brazil scale is reliable and valid for assessing people with PD.
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Affiliation(s)
- Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
| | - Lara Vasconcelos
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Guilherme T Valenca
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Kárin Carvalho
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Elen Beatriz Pinto
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Department of Life Sciences (DCV), Bahia State University, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Wales J, Moore J, Naisby J, Ratcliffe N, Barry G, Amjad A, Godfrey A, Standerline G, Webster E, Morris R. Coproduction and Usability of a Smartphone App for Falls Reporting in Parkinson Disease. Phys Ther 2024; 104:pzad076. [PMID: 37369034 PMCID: PMC10851851 DOI: 10.1093/ptj/pzad076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/10/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The purpose of this study was to coproduce a smart-phone application for digital falls reporting in people with Parkinson disease (PD) and to determine usability using an explanatory mixed-methods approach. METHODS This study was undertaken in 3 phases. Phase 1 was the development phase, in which people with PD were recruited as co-researchers to the project. The researchers, alongside a project advisory group, coproduced the app over 6 months. Phase 2 was the implementation phase, in which 15 people with PD were invited to test the usability of the app. Phase 3 was the evaluation phase, in which usability was assessed using the systems usability scale by 2 focus groups with 10 people with PD from phase 2. RESULTS A prototype was successfully developed by researchers and the project advisory group. The usability of the app was determined as good (75.8%) by people with PD when rating using the systems usability scale. Two focus groups (n = 5 per group) identified themes of 1) usability, 2) enhancing and understanding management of falls, and 3) recommendations and future developments. CONCLUSIONS A successful prototype of the iFall app was developed and deemed easy to use by people with PD. The iFall app has potential use as a self-management tool for people with PD alongside integration into clinical care and research studies. IMPACT This is the first digital outcome tool to offer reporting of falls and near-miss fall events. The app may benefit people with PD by supporting self-management, aiding clinical decisions in practice, and providing an accurate and reliable outcome measure for future research. LAY SUMMARY A smartphone application designed in collaboration with people who have PD to record their falls was acceptable and easy to use by people with PD.
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Affiliation(s)
- Jill Wales
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Jason Moore
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | | | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | | | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | | | | | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
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Wang Y, Zhang C, Hikichi H, Kawachi I, Li X. Longitudinal Associations Between Disaster Damage and Falls/Fear of Falling in Older Adults: 9-Year Follow-Up of Survivors of the 2011 Great East Japan Earthquake and Tsunami. Innov Aging 2023; 7:igad020. [PMID: 37056712 PMCID: PMC10089294 DOI: 10.1093/geroni/igad020] [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: 10/29/2022] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives Fear of falling and falls are common in older adults. However, their associations with natural disaster exposures remain poorly understood. This study aims to examine longitudinal associations between disaster damage with fear of falling/falls among older disaster survivors. Research Design and Methods In this natural experiment study, the baseline survey (4,957 valid responses) took place 7 months before the 2011 Great East Japan Earthquake and Tsunami, and 3 follow-ups were conducted in 2013, 2016, and 2020. Exposures were different types of disaster damage and community social capital. Outcomes were fear of falling and falls (including incident and recurrent falls). We used lagged outcomes in logistic models adjusting for covariates and further examined instrumental activities of daily living (IADLs) as a mediator. Results The baseline sample had a mean (standard deviation) age of 74.8 (7.1) years; 56.4% were female. Financial hardship was associated with fear of falling (odds ratio (OR), 1.75; 95% confidence interval (CI) [1.33, 2.28]) and falls (OR, 1.29; 95% CI [1.05, 1.58]), especially recurrent falls (OR, 3.53; 95% CI [1.90, 6.57]). Relocation was inversely linked with fear of falling (OR, 0.57; 95% CI [0.34, 0.94]). Social cohesion was protectively associated with fear of falling (OR, 0.82; 95% CI [0.71, 0.95]) and falls (OR, 0.88; 95% CI [0.78, 0.98]) whereas social participation increased the risk of these issues. IADL partially mediated observed associations between disaster damage and fear of falling/falls. Discussion and Implications Experiences of material damage rather than psychological trauma were associated with falls and fear of falling, and the increased risk of recurrent falls revealed a process of cumulative disadvantage. Findings could inform targeted strategies for protecting older disaster survivors.
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Affiliation(s)
- Yuhang Wang
- Department of Sociology, Tsinghua University, Beijing, China
| | - Chenggang Zhang
- Department of Sociology, Tsinghua University, Beijing, China
| | - Hiroyuki Hikichi
- School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Ichiro Kawachi
- Department of Sociology, Tsinghua University, Beijing, China
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Xiaoyu Li
- Department of Sociology, Tsinghua University, Beijing, China
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Castro IP, Valença GT, Pinto EB, Cavalcanti HM, Oliveira‐Filho J, Almeida LRS. Predictors of Falls with Injuries in People with Parkinson's Disease. Mov Disord Clin Pract 2022; 10:258-268. [PMID: 36825046 PMCID: PMC9941941 DOI: 10.1002/mdc3.13636] [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: 12/06/2021] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Falls are frequent in Parkinson's disease (PD), but there is lack of information about predictors of injurious falls. Objectives To determine predictors of falls with injuries in people with PD; to compare circumstances and consequences of falls in single and recurrent fallers. Methods Participants (n = 225) were assessed by disease-specific, self-report, and balance measures, and followed-up for 12 months with a diary to record falls, their circumstances, and injuries. Univariate and multivariate analyses were performed. Circumstances and consequences of falls presented by single and recurrent fallers were compared. Results A total of 805 falls were analyzed, 107 (13%) were falls with injuries. Multivariate logistic regression model revealed that greater PD duration and higher balance confidence were protective factors; better balance during gait, outdoor falls, and falls related to extrinsic factors were risk factors for falls with injuries, when compared to falls with no injuries. Multivariate multinomial regression model revealed that, when compared to zero fall, past falls and daily levodopa equivalent dose were predictors of falls with injuries; these predictors together with disability were predictors of falls with no injuries. Single falls (n = 27; 3%) were more common outdoors because of extrinsic factors, whereas recurrent falls (n = 778; 97%) were more common indoors because of intrinsic factors. Single falls led to more injuries than recurrent falls (P < 0.05). Conclusions Different predictors of falls with injuries were obtained when different outcomes were compared. It should be noted that falls with injuries might be influenced by fall-related activities and environmental factors. Single and recurrent falls differed on circumstances and consequences.
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Affiliation(s)
- Isabella P.R. Castro
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil,Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil
| | - Guilherme T. Valença
- Movement Disorders and Parkinson's Disease ClinicRoberto Santos General HospitalSalvadorBahiaBrazil
| | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil,Department of Life Sciences (DCV)Bahia State UniversitySalvadorBahiaBrazil
| | - Helen M. Cavalcanti
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil,Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil
| | - Jamary Oliveira‐Filho
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil
| | - Lorena Rosa S. Almeida
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil,Movement Disorders and Parkinson's Disease ClinicRoberto Santos General HospitalSalvadorBahiaBrazil
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Liu WY, Tung TH, Zhang C, Shi L. Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease. Brain Behav 2022; 12:e2690. [PMID: 35837986 PMCID: PMC9392538 DOI: 10.1002/brb3.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 04/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To synthesize recent empirical evidence for the prevention and management of falls and fear of falling in patients with Parkinson's disease (PD). DATA SOURCE Database from PubMed, Cochrane Library, and EMBASE. STUDY DESIGN Systematic review. DATA COLLECTION We searched the PubMed, Cochrane Library, and EMBASE databases for studies published from inception to February 27, 2021. Inclusion criteria were nonreview articles on prevention and management measures related to falls and fall prevention in Parkinson's disease patients. PRINCIPAL FINDINGS We selected 45 articles and conducted in-depth research and discussion. According to the causes of falls in PD patients, they were divided into five directions, namely physical status, pre-existing conditions, environment, medical care, and cognition. In the cognitive domain, we focused on the fear of falling. On the above basis, we constructed a fall prevention model, which is a tertiary prevention health care network, based on The Johns Hopkins Fall Risk Assessment Tool to provide ideas for the prevention and management of falling and fear of falling in PD patients in clinical practice CONCLUSIONS: Falls and fear of falls in patients with Parkinson's disease can be reduced by effective clinical prevention and management. Future studies are needed to explore the efficacy of treatment and prevention of falls and fear of falls.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Shanghai Bluecross Medical Science Institute, Shanghai, China.,Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Kinematic Relations during Double Support Phase in Parkinsonian Gait. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12030949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The gait of Parkinson’s disease (PD) patients is shuffling, slow, and hesitant. We investigated peculiar gait relations during the double support phase (DSP) in PD patients and healthy controls. We used 3D motion capture (SIMI) to collect kinematic parameters of the natural gait of 11 PD patients (Hoehn and Yahr 2–3, 5 females, 6 males) tested on medication and the same-sized control sample (5 females, 6 males). The difference between groups was evaluated by the Mann-Whitney U test; for target parameters, the Spearman correlation was computed. Compared to the controls, the Parkinsonian step length index was significantly smaller (0.27 vs. 0.35, p < 0.05), step width index higher (0.12 vs. 0.09, p < 0.05), and the DSP duration was extended (0.165 s vs. 0.13 s, p < 0.05), whereas the single support phase was shortened (0.38 s vs. 0.4 s, p < 0.05). The Parkinsonians were faster during DSP initiation and slower during DSP termination (0.908 m·s−1 vs. 0.785 m·s−1, p < 0.05); the Parkinsonian speed was more constant. The patients showed significantly decreased range of motion (ROM) in the hip, ankle, and shoulder and adopted straighter posture during the gait. Understanding gait concatenations can update physiotherapy approaches to target the roots of movement problems instead of the consequences.
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Chang CM, Tsai CH, Lu MK, Tseng HC, Lu G, Liu BL, Lin HC. The neuromuscular responses in patients with Parkinson's disease under different conditions during whole-body vibration training. BMC Complement Med Ther 2022; 22:2. [PMID: 34980075 PMCID: PMC8722001 DOI: 10.1186/s12906-021-03481-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Whole-body vibration (WBV) training can provoke reactive muscle response and thus exert beneficial effects in various neurological patients. This study aimed to investigate the muscles activation and acceleration transmissibility of the lower extremity to try to understand the neuromuscular control in the Parkinson's disease (PD) patients under different conditions of the WBV training, including position and frequency. METHODS Sixteen PD patients and sixteen controls were enrolled. Each of them would receive two WBV training sessions with 3 and 20 Hz mechanical vibration in separated days. In each session, they were asked to stand on the WBV machine with straight and then bended knee joint positions, while the vibration stimulation was delivered or not. The electromyographic (EMG) signals and the segmental acceleration from the lower extremity were recorded and processed. The amplitude, co-contraction indexes (CCI), and normalized median frequency slope (NMFS) from the EMG signals, and the acceleration transmissibility were calculated. RESULTS The results showed larger rectus femoris (RF) amplitudes under 3 Hz vibration than those in 20 Hz and no vibration conditions; larger tibialis anterior (TA) in 20 Hz than in no vibration; larger gastrocnemius (GAS) in 20 Hz than in 3 Hz and no vibration. These results indicated that different vibration frequencies mainly induced reactive responses in different muscles, by showing higher activation of the knee extensors in 3 Hz and of the lower leg muscles in 20 Hz condition, respectively. Comparing between groups, the PD patients reacted to the WBV stimulation by showing larger muscle activations in hamstring (HAM), TA and GAS, and smaller CCI in thigh than those in the controls. In bended knee, it demonstrated a higher RF amplitude and a steeper NMFS but smaller HAM activations than in straight knee position. The higher acceleration transmissibility was found in the control group, in the straight knee position and in the 3 Hz vibration conditions. CONCLUSION The PD patients demonstrated altered neuromuscular control compared with the controls in responding to the WBV stimulations, with generally higher EMG amplitude of lower extremity muscles. For designing WBV strengthening protocol in the PD population, the 3 Hz with straight or flexed knee protocol was recommended to recruit more thigh muscles; the bended knee position with 20 Hz vibration was for the shank muscles.
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Affiliation(s)
- Chia-Ming Chang
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Hsin-Chun Tseng
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C
| | - Grace Lu
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C
| | - Bey-Ling Liu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C.
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Longhurst JK, Rider JV, Eckard K, Hammar R, Vukojevic F, Campbell PJ, Landers MR. Factors predicting fear of falling avoidance behavior in parkinsonisms. NeuroRehabilitation 2021; 50:65-73. [PMID: 34957961 DOI: 10.3233/nre-210267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fear of falling avoidance behavior (FFAB) is common in parkinsonisms and results in potentially mitigable downstream consequences. OBJECTIVE Determine the characteristics of individuals with parkinsonisms most associated with FFAB. METHODS A retrospective, cross-sectional study was conducted from medical records data of 142 patients with parkinsonisms. These data included: demographics (age, sex), disease severity (Movement Disorders Society -Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), years since diagnosis), fall history (number of fall injuries in previous year), and gait and balance function (five times sit to stand, MiniBESTest, Timed Up and Go (TUG), dual-task TUG, ten-meter walk test (10MWT), observed freezing of gait (FOG) (MDS-UPDRS III item 11)). RESULTS 10MWT (p < .001) and MDS-UPDRS III item 11 (p < .014) were significantly associated with FFAB above and beyond disease severity, which also contributed significantly to the overall model (ps < .046). Fall history was not associated with FFAB. CONCLUSION Our findings suggest that the largest portion of variability in FFAB is explained by gait velocity and FOG; however, disease severity also explains a significant portion of the variability of FFAB. Further investigation into factors predictive of FFAB and mitigation of downstream consequences, using more robust designs, is warranted.
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Affiliation(s)
- Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO, USA.,Department of Neurorehabilitation, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.,Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | - John V Rider
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA.,School of Occupational Therapy, Touro University Nevada, Henderson, NV, USA
| | - Kameron Eckard
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | - Ryan Hammar
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | - Franjo Vukojevic
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
| | | | - Merrill R Landers
- Department of Physical Therapy, University of Nevada - Las Vegas, Las Vegas, NV, USA
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Siragy T, Hill A, Nantel J. Recovery of dynamic stability during slips unaffected by arm swing in people with Parkinson's Disease. PLoS One 2021; 16:e0249303. [PMID: 33822806 PMCID: PMC8023478 DOI: 10.1371/journal.pone.0249303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
The arm elevation strategy assists in recovering stability during slips in healthy young and elderly individuals. However, in people with Parkinson's Disease, one of the main motor symptoms affecting the upper limbs is reduced arm swing which intensifies throughout the course of the disease before becoming absent. This holds direct implications for these individuals when encountering slips as the arm elevation strategy is an integral component in the interlimb slip response to restore stability. Arm swing's effect in recovering from slips in people with Parkinson's Disease though remains unexamined. Twenty people with Parkinson's Disease (63.78 ± 8.97 years) walked with restricted and unrestricted arm swing conditions on a dual-belt treadmill where slips were induced on the least and most affected sides. Data were collected on the CAREN Extended System (Motek Medical, Amsterdam, NL). The Margin of Stability, linear and angular trunk velocities, as well as step length, time, and width were calculated. Data were examined during the slipped step and recovery step. The restricted arm swing condition, compared to unrestricted, caused a faster step time during the slipped step. Compared to the most affected leg, the least affected had a wider step width during the slipped step. During the recovery step, the least affected leg had a larger anteroposterior Margin of Stability and longer step time than the most affected. No differences between our arm swing conditions suggests that the normal arm swing in our participants was not more effective at restoring stability after an induced slip compared to when their arm motion was restricted. This may be due to the arm elevation strategy being ineffective in counteracting the slip's backward destabilization in these individuals. Differences between the legs revealed that our participants were asymmetrically impaired in their slip recovery response.
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Affiliation(s)
- Tarique Siragy
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Allen Hill
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- * E-mail:
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10
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Khalil H, Alissa N, Al-Sharman A, E'leimat I, Majdi Al Qawasmeh, El-Salem K. Understanding the influence of pain and fatigue on physical performance, fear of falling and falls in people with Parkinson's disease: a pilot study. Neurodegener Dis Manag 2021; 11:113-124. [PMID: 33730860 DOI: 10.2217/nmt-2020-0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: Pain and fatigue are highly prevalent debilitating symptoms in Parkinson's disease (PD), however, their relationship with physical performance, fear of falling (FOF) and falls is not clear. We aim in this pilot study to investigate the relationship of pain and fatigue with physical performance, FOF and falls in people with Parkinson's disease (PwPD). Materials & methods: 53 PD patients were assessed for fall history, physical performance, FOF, pain and fatigue. Results: Pain and fatigue are significantly associated with physical performance and FOF (p ≤ 0.002). Pain and fatigue were different between fallers and non-fallers (p < 0.5), but only fatigue could distinguish fallers from non-fallers (area under the receiver operating characteristics curve = 0.81; p < 0.0001). Conclusion: This pilot study indicated that FOF in PwPD is significantly associated with pain and fatigue. Furthermore, fatigue level is related to fall history. By addressing pain and fatigue, we may ameliorate the deterioration of FOF and falls in PwPD.
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Affiliation(s)
- Hanan Khalil
- Department of Rehabilitation Sciences, Jordan University of Science & Technology, Faculty of Applied Medical Sciences, Irbid, Jordan
| | - Nesreen Alissa
- School of Medicine, Department of Physical Therapy & Rehabilitation Science, University of Maryland, Baltimore, Baltimore, Maryland
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Jordan University of Science & Technology, Faculty of Applied Medical Sciences, Irbid, Jordan
| | - Islam E'leimat
- Faculty of Medicine, Department of Neurosciences, Jordan University of Science & Technology, Irbid, Jordan
| | - Majdi Al Qawasmeh
- Faculty of Medicine, Department of Neurosciences, Jordan University of Science & Technology, Irbid, Jordan
| | - Khalid El-Salem
- Faculty of Medicine, Department of Neurosciences, Jordan University of Science & Technology, Irbid, Jordan
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11
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Cohen JN, Seng E, Foley FW. Cognitive and motor slowing mediate the relationship between depression and falls in multiple sclerosis patients. Mult Scler Relat Disord 2021; 50:102808. [PMID: 33596493 DOI: 10.1016/j.msard.2021.102808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Given the limited research concerning the relationship between depression and falls in multiple sclerosis (MS), this study aimed to examine the direct and indirect association between fall history and depressive symptoms. METHODS One hundred and forty seven MS patients had completed at least one neuropsychological assessment that included detailed information regarding fall history, as well as measures of depression, motor function, and cognitive processing speed. RESULTS Fall history was associated with higher depressive symptoms and poorer overall motor function. Higher self-reported depressive symptoms were associated with higher odds of falls in the last year (OR = 1.64, 95% CI 1.16, 2.31) in an age adjusted model. Cognitive and motor slowing serially mediated the relationship between depressive symptoms and fall history (estimate = 0.060, 95% CI = 0.01, 0.15). CONCLUSIONS With the extensive research on the cognitive and motor correlates of falls in MS, our findings suggest that depressive symptoms are also associated with falls in people with MS. Moreover, this study provides preliminary support for a pathway by which depressive symptoms are related to falls in part through their relationships with cognitive and motor slowing.
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Affiliation(s)
- Jenna N Cohen
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, United States
| | - Elizabeth Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, United States; The Saul R Korey Department of Neurology, Albert Einstein College of Medicine, 1225 Morris Park Avenue, Van Etten Building, Bronx, NY 10461, United States
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, United States; Holy Name Medical Center Multiple Sclerosis Center, 718 Teaneck Road, Teaneck, NJ 07666, United States.
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Extrinsic and Behavioral Fall Risk Factors in People With Parkinson's Disease: An Integrative Review. Rehabil Nurs 2021; 46:3-10. [PMID: 33395012 DOI: 10.1097/rnj.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of the study was to explore extrinsic and behavioral risks for falls in older adults with Parkinson's disease (PD). BACKGROUND Falls that cause injury and disability in people with PD are common. Understanding the role of extrinsic and behavioral factors is important for fall prevention. DESIGN Integrative literature review with search of CINAHL, MEDLINE, and SCOPUS and ancestry searching was performed. METHODS The methodology of Whittemore and Knafl guided the review; ten studies were included. FINDINGS Falls occur indoors and outdoors, commonly during daily activities in familiar home environments, but also when out in the community. Common challenges include uneven and unfamiliar environments and risky behavior like hurrying. CONCLUSION Extrinsic risk factors combined with behavioral and intrinsic factors contribute to falls in people with PD both at home and in the community. CLINICAL RELEVANCE Rehabilitation of people with PD should include assessment of falls, function, extrinsic risk factors, and fit with their environment to develop fall prevention plans.
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13
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Using machine learning-based analytics of daily activities to identify modifiable risk factors for falling in Parkinson's disease. Parkinsonism Relat Disord 2020; 82:77-83. [PMID: 33249293 DOI: 10.1016/j.parkreldis.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although risk factors that lead to falling in Parkinson's disease (PD) have been previously studied, the established predictors are mostly non-modifiable. A novel method for fall risk assessment may provide more insight into preventable high-risk activities to reduce future falls. OBJECTIVES To explore the prediction of falling in PD patients using a machine learning-based approach. METHOD 305 PD patients, with or without a history of falls within the past month, were recruited. Data including clinical demographics, medications, and balance confidence, scaled by the 16-item Activities-Specific Balance Confidence Scale (ABC-16), were entered into the supervised machine learning models using XGBoost to explore the prediction of fallers/recurrent fallers in two separate models. RESULTS 99 (32%) patients were fallers and 58 (19%) were recurrent fallers. The accuracy of the model to predict falls was 72% (p = 0.001). The most important factors were item 7 (sweeping the floor), item 5 (reaching on tiptoes), and item 12 (walking in a crowded mall) in the ABC-16 scale, followed by disease stage and duration. When recurrent falls were analysed, the models had higher accuracy (81%, p = 0.02). The strongest predictors of recurrent falls were item 12, 5, and 10 (walking across parking lot), followed by disease stage and current age. CONCLUSION Our machine learning-based study demonstrated that predictors of falling combined demographics of PD with environmental factors, including high-risk activities that require cognitive attention and changes in vertical and lateral orientations. This enables physicians to focus on modifiable factors and appropriately implement fall prevention strategies for individual patients.
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Kiesmann M, Sauleau E, Perisse J, Jehl C, Konrad S, Karcher P, Fleury MC, Rohmer D, Sauer A, Ehret M, Vogel T, Kaltenbach G, Schmitt E. Parkinsonian gait in elderly people: Significance of the threshold value of two and more falls per year. Rev Neurol (Paris) 2020; 177:385-393. [PMID: 33032799 DOI: 10.1016/j.neurol.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/11/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Parkinsonism in the elderly presents a major risk factor for recurrent falls (2 and more falls per year), which is associated with increased morbidity. The main objective was to investigate explanatory variables relating to the risk of being recurrent fallers (RF) in persons with parkinsonian gait. METHODS Seventy-nine among 172 eligible persons were enrolled in this prospective study, the findings of which were analyzed at 12 months. Motor and non-motor features, as well as follow-up interviews to identify falls, loss of ability to walk, fluctuating cognition, traumatic falls, all-cause hospitalizations and deaths were collated and results compared between non RF (zero and one fall per year) and RF. Bayesian model averaging was used to predict the probability of patients being RF from their medical history as well as from cognitive assessment, gait velocity, vision and posture. RESULTS N=79, 0.58 men, 50% had Parkinson's disease, 14% other neurodegenerative parkinsonian syndrome, 23% vascular parkinsonism and 13% Lewy body disease, 58% were RF. Median age 81.2 years and median MMSE 25/30. A history of falls and of hallucinations, median odds ratio respectively 9.06 (CI 2.34-38.22), 4.21 (CI 1.04-18.67) were associated with the highest odds ratios along with fluctuating cognition and abnormal posture. Two or more falls a year was a relevant threshold to distinguish a population with a high risk of comorbidity. CONCLUSION The whole history of falls, hallucinations and fluctuating cognition can be considered predictive of recurrent falls in elderly people with parkinsonian gait and provide a tracking tool for patient management.
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Affiliation(s)
- M Kiesmann
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - E Sauleau
- Biostatistical Laboratory, iCube - CNRS UMR 7357, Department of Public Health, methods in clinical research, University of Strasbourg, Strasbourg, France
| | - J Perisse
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - C Jehl
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - S Konrad
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - P Karcher
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - M C Fleury
- Neurology Department, University Hospitals of Strasbourg, Strasbourg, France
| | - D Rohmer
- Otorhinolaryngology Department, University Hospitals of Strasbourg, Strasbourg, France
| | - A Sauer
- Ophthalmology Department, University Hospitals of Strasbourg and University of Strasbourg, Strasbourg, France
| | - M Ehret
- Otorhinolaryngology Department, University Hospitals of Strasbourg, Strasbourg, France
| | - T Vogel
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France; EA-3072, University of Strasbourg, Strasbourg, France
| | - G Kaltenbach
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - E Schmitt
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France; EA-3072, University of Strasbourg, Strasbourg, France.
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15
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Lopes LKR, Scianni AA, Lima LO, de Carvalho Lana R, Rodrigues-De-Paula F. The Mini-BESTest is an independent predictor of falls in Parkinson Disease. Braz J Phys Ther 2020; 24:433-440. [PMID: 31377123 PMCID: PMC7564029 DOI: 10.1016/j.bjpt.2019.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/18/2019] [Accepted: 07/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Falls in Parkinson Disease (PD) are a complex health problem, with multidimensional causes and consequences. OBJECTIVES To identify the fall predictors in individuals with PD and compare fallers and non-fallers considering their socio-demographic, anthropometric, clinical and functional status. METHODS A multicenter cross-sectional design was employed. Variables included: age, sex, body mass index, PD progression, levodopa dosage, activities limitation and motor impairments (UPDRS ADL/Motor), level of physical activity (human activity profile - HAP), fear of falls (Falls Efficacy Scale-International-FES-I), freezing of gait (Freezing of Gait Questionnaire - FOG-Q), gait speed (10 meters walk test - 10-MWT), lower limb functional strength (Five Times Sit-to-Stand Test - FTSST), balance (Mini-BESTest), mobility (Timed "Up & Go" - TUG) and dual-task dynamic (TUG-DT). Seventeen potential predictors were identified. Logistic regression and ROC curve were applied. RESULTS Three-hundred and seventy individuals (44.87% fallers and 55.13% non-fallers) completed the study. Fallers presented worse performance in UPDRS motor/ADL/Total, FES-I, FOG-Q, Mini-BESTest, HAP, TUG and TUG-DT and the majority were inactive. The Mini-BESTest Total was the main independent predictor of falls (OR=0.92; p<0.001; 95% CI=0.89, 0.95). For each one-unit increase in the Mini-BESTest, there was an average reduction of 8% in the probability of being a faller. A cut-off point of 21.5/28 (AUC=0.669, sensitivity 70.7% and specificity 55.1%) was determined. CONCLUSION Besides characterizing and comparing fallers and non-fallers, this study showed that the Mini-BESTest was the strongest individual predictor of falls in individuals with PD, highlighting the importance of evaluating dynamic balance ability during fall risk assessment.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Raquel de Carvalho Lana
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, Petricone-Westwood D, Rutkowski N, Ta V, Trudel G, Laflamme SZ, Lavigne AA, Dinkel A. Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PLoS One 2020; 15:e0234124. [PMID: 32716932 PMCID: PMC7384626 DOI: 10.1371/journal.pone.0234124] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses. METHODS We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained. RESULTS There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features. CONCLUSIONS The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christina Tomei
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Georden Jones
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Rutkowski
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Ta
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Trudel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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17
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Gong G, Wan W, Zhang X, Liu Y, Liu X, Yin J. Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia. BMC Geriatr 2019; 19:367. [PMID: 31870318 PMCID: PMC6929451 DOI: 10.1186/s12877-019-1395-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022] Open
Abstract
Background Sarcopenia is a decrease in skeletal muscle mass, physical performance, and muscle strength in older people. In this study, we aimed to explore the correlation between comorbidity and skeletal muscle mass and physical performance in older people. Methods This retrospective study included 168 subjects. Their medical history, physical function, computed tomography (CT) chest scans, and blood tests for nutrition were evaluated. The patients were divided into two groups: (1) a low muscle mass group and (2) a normal muscle mass group. Multivariate analysis of variance was used to compare multiple sets of mean vectors. Results Overall, 72.02% of the subjects had a low skeletal muscle index (SMI) and low gait speed. The patients with low skeletal muscle mass and physical performance were older, had more serious comorbidities, and had longer average hospitalization periods and lower albumin and hemoglobin levels. Subjects with a high Charlson comorbidity index (CCI) were more likely to be in the sarcopenic group than in the non-sarcopenic group. In addition, there was a linear correlation between the CCI and SMI (r = − 0.549, P < 0.05), and between the CCI and gait speed (r = − 0.614, P < 0.05). The area under the curve (AUC) value for low skeletal muscle mass with the CCI was 0.879. Conclusions We identified an independent association between comorbidity and skeletal muscle mass/physical performance by researching the correlation between the CCI and SMI/gait speed. Our results suggested that the CCI score may have important clinical diagnostic value for sarcopenia.
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Affiliation(s)
- Ge Gong
- Department of Geriatrics, Jinling Hospital, Medical School of Nanjing University, No.305, Zhongshan east road, Nanjing, 210002, China
| | - Wenhui Wan
- Department of Geriatrics, Jinling Hospital, Medical School of Nanjing University, No.305, Zhongshan east road, Nanjing, 210002, China
| | - Xinghu Zhang
- Department of Geriatrics, Jinling Hospital, Medical School of Nanjing University, No.305, Zhongshan east road, Nanjing, 210002, China
| | - Yu Liu
- Department of Geriatrics, Jinling Hospital, Medical School of Nanjing University, No.305, Zhongshan east road, Nanjing, 210002, China
| | - Xinhui Liu
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, China.
| | - Jian Yin
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, China.
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18
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Abstract
Parkinson's disease (PD) and other synucleinopathies, namely dementia with Lewy bodies (DLB) and multiple system atrophy (MSA), are common degenerative neurological disorders that share synuclein pathology. Although certain cardinal features of parkinsonism, including bradykinesia and rigidity, respond well to levodopa, axial features, such as gait and balance impairment, are less reliably responsive to dopaminergic therapy and surgical interventions. Consequently, falls are common in PD and other synucleinopathies and are a major contributor toward injury and loss of independence. This underscores the need for appropriate fall risk assessment and implementation of preventative measures in all patients with parkinsonism. The aim of this review is therefore to explore modifiable and non-modifiable risk factors for falls in synucleinopathies. We next review and evaluate the evidence for pharmacological, nonpharmacological, and surgical approaches for fall prevention, and emphasize individualized and multifaceted approaches.
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19
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Silva de Lima AL, Smits T, Darweesh SKL, Valenti G, Milosevic M, Pijl M, Baldus H, de Vries NM, Meinders MJ, Bloem BR. Home-based monitoring of falls using wearable sensors in Parkinson's disease. Mov Disord 2019; 35:109-115. [PMID: 31449705 PMCID: PMC7003816 DOI: 10.1002/mds.27830] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Falling is among the most serious clinical problems in Parkinson's disease (PD). We used body-worn sensors (falls detector worn as a necklace) to quantify the hazard ratio of falls in PD patients in real life. METHODS We matched all 2063 elderly individuals with self-reported PD to 2063 elderly individuals without PD based on age, gender, comorbidity, and living conditions. We analyzed fall events collected at home via a wearable sensor. Fall events were collected either automatically using the wearable falls detector or were registered by a button push on the same device. We extracted fall events from a 2.5-year window, with an average follow-up of 1.1 years. All falls included were confirmed immediately by a subsequent telephone call. The outcomes evaluated were (1) incidence rate of any fall, (2) incidence rate of a new fall after enrollment (ie, hazard ratio), and (3) 1-year cumulative incidence of falling. RESULTS The incidence rate of any fall was higher among self-reported PD patients than controls (2.1 vs. 0.7 falls/person, respectively; P < .0001). The incidence rate of a new fall after enrollment (ie, hazard ratio) was 1.8 times higher for self-reported PD patients than controls (95% confidence interval, 1.6-2.0). CONCLUSION Having PD nearly doubles the incidence of falling in real life. These findings highlight PD as a prime "falling disease." The results also point to the feasibility of using body-worn sensors to monitor falls in daily life. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ana Lígia Silva de Lima
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Tine Smits
- Philips Research, Department Personal Health, Eindhoven, the Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Giulio Valenti
- Philips Research, Department Personal Health, Eindhoven, the Netherlands
| | - Mladen Milosevic
- Philips Research North America, Acute Care Solutions Department, Cambridge, Massachusetts, USA
| | - Marten Pijl
- Philips Research, Department Personal Health, Eindhoven, the Netherlands
| | - Heribert Baldus
- Philips Research, Department Personal Health, Eindhoven, the Netherlands
| | - Nienke M de Vries
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
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20
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Terroba-Chambi C, Bruno V, Millar-Vernetti P, Bruce D, Brockman S, Merello M, Starkstein S. Design and validation of a new instrument to assess fear of falling in Parkinson's disease. Mov Disord 2019; 34:1496-1504. [PMID: 31442364 DOI: 10.1002/mds.27820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Fear of falling may be significantly associated with falls in Parkinson's disease (PD) and may have a negative impact on quality of life. Nevertheless, there are no valid and reliable tools to examine this condition in PD. The objective of this study was to design and determine the psychometric attributes of an instrument to assess fear of falling in PD. METHODS A prospective 1-year, 2-phase study was conducted to validate the Fear of Falling Scale, a self-assessed instrument for assessing fear of falling in PD. During phase 1, we designed a scale to measure the severity of fear of falling and determine its baseline psychometric characteristics, whereas phase 2 was a 1-year follow-up study to assess the frequency of falls and other clinical factors linked to fear of falling. Convergent and discriminant validity were assessed against the Fear of Falling Measure and the Starkstein Apathy Scale, respectively. RESULTS The Fear of Falling Scale showed high internal consistency, test-retest reliability, and strong convergent and discriminant validity. There was a significant association between fear of falling score and the presence of both generalized anxiety disorder and major depression, poor balance-related motor ability, increased nonmotor symptoms of PD, more severe impairments in activities of daily living, and increased motor fluctuations. Finally, generalized anxiety disorder was a significant predictor of number of falls during a 12-month follow-up period. CONCLUSIONS The Fear of Falling Scale is a valid and reliable instrument to assess fear of falling in PD. Fear of falling in PD is associated with specific psychiatric and motor disorders and is significantly related to the performance of balance-related motor functions. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cinthia Terroba-Chambi
- Raul Carrea Institute of Neurological Research, Movement Disorders Unit, FLENI, Buenos Aires, Argentina
| | - Veronica Bruno
- Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Patricio Millar-Vernetti
- Raul Carrea Institute of Neurological Research, Movement Disorders Unit, FLENI, Buenos Aires, Argentina
| | - David Bruce
- School of Psychiatry and Clinical Neurosciences, Fremantle, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Fremantle, Western Australia, Australia
| | - Simone Brockman
- School of Psychiatry and Clinical Neurosciences, Fremantle, Western Australia, Australia
| | - Marcelo Merello
- Raul Carrea Institute of Neurological Research, Movement Disorders Unit, FLENI, Buenos Aires, Argentina.,National Scientific and Technological Research Council (CONICET), Buenos Aires, Argentina
| | - Sergio Starkstein
- School of Psychiatry and Clinical Neurosciences, Fremantle, Western Australia, Australia
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21
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Lieberman A, Deep A, Olson MC, Smith Hussain V, Frames CW, McCauley M, Lockhart TE. Falls When Standing, Falls When Walking: Different Mechanisms, Different Outcomes in Parkinson Disease. Cureus 2019; 11:e5329. [PMID: 31598436 PMCID: PMC6777936 DOI: 10.7759/cureus.5329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
Our retrospective study of falls and resultant trauma in consecutive Parkinson disease (PD) patients seen in one year at the Muhammad Ali Parkinson Clinic found that multiple-fallers could be divided into patients who fell mainly when walking or those who fell mainly when standing. Patients who fell when walking were more likely to visit an emergency room or be admitted to a hospital. Of 455 consecutive patients who were evaluated over a one-year period, 51 were excluded because they had atypical Parkinson disorders, had multiple risk factors for falling, or were demented. Unified Parkinson Disease Rating Scales and Zeno Walkway results were compared among non-fallers, single-fallers, and multiple-fallers. Among multiple-fallers, comparisons were made between patients who fell mainly when standing and those who fell mainly when walking. Most patients (197, 49%) did not fall, 142 (35%) fell once, and 65 (16%) fell more than once. Multiple-fallers differed significantly from single-fallers and non-fallers: they had PD significantly longer (p<0.001), were more severely affected (p<0.001), and took shorter steps (p<0.001). Of 65 multiple-fallers, 26 (40%) fell mainly when standing, 28 (43%) fell mainly when walking, and 11 (17%) fell equally often when standing or walking. Falls when walking resulted in more severe injuries. Patients who fell mainly when standing did not realize they could fall when standing; engaged in inappropriate weight shifting, bending, reaching, and multitasking; and failed to use their assistive devices. Such patients would benefit from being counseled about falling when standing. Patients who fell mainly when walking were aware they could fall, despite using an assisted device, and were more likely to have freezing of gait (FOG). They were more likely to sustain a severe injury, and were more likely to be admitted to an emergency room or hospital. Such patients would benefit from reducing, if possible, FOG.
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Affiliation(s)
- Abraham Lieberman
- Neurology, Muhammad Ali Parkinson Center, Barrow Neurological Institute, Phoenix, USA
| | - Aman Deep
- Neurology, University of Tennessee Health Science Center, Memphis, USA
| | - Markey C Olson
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Victoria Smith Hussain
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Christopher W Frames
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Margaret McCauley
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Thurmon E Lockhart
- Biomedical Engineering, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, USA
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22
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Caetano MJD, Lord SR, Allen NE, Song J, Paul SS, Canning CG, Menant JCC. Executive Functioning, Muscle Power and Reactive Balance Are Major Contributors to Gait Adaptability in People With Parkinson's Disease. Front Aging Neurosci 2019; 11:154. [PMID: 31316371 PMCID: PMC6609859 DOI: 10.3389/fnagi.2019.00154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/11/2019] [Indexed: 01/17/2023] Open
Abstract
Background and Aim: The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This study investigated cognitive, physical and psychological factors associated with gait adaptability required for obstacle and stepping target negotiation in people with Parkinson’s disease (PD). Methods: Fifty-four people with PD were instructed to either: (a) avoid an obstacle at usual step distance; or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. Participants also completed clinical [Hoehn & Yahr rating scale; Movement Disorders Society version of the Unified Parkinson’s Disease Rating Scale motor section (MDS-UPDRS-III)], cognitive [simple reaction time, Trail Making and Stroop stepping (difference between incongruent and standard Choice Stepping Reaction Time, CSRT) tests], physical [hip abductor muscle power and reactive balance (pull test from the MDS-UPDRS-III)] and psychological (Fall Efficacy Scale–International) assessments. Results: Discriminant function analysis revealed Stroop stepping test (inhibitory control) performance was the best predictor of stepping errors across the Gait Adaptability Test (GAT) conditions. Poorer executive function [Trail Making Test (TMT)] and reactive balance predicted poorer stepping accuracy in the short target condition; poorer reactive balance predicted increased number of steps taken to approach the obstacle and the long target; and poorer executive function predicted obstacle avoidance. Weaker hip abductor muscle power, poorer reactive balance, slower reaction time, poorer executive function and higher concern about falling were significant predictors of shorter step length while negotiating the obstacle/targets. Conclusion: Superior executive function, effective reactive balance and good muscle power were associated with successful gait adaptability. Executive function and reactive balance appear particularly important for precise foot placements; and cognitive capacity for step length adjustments for avoiding obstacles. These findings suggest that impaired inhibitory control contributes to stepping errors and may increase fall risk in people with PD. These findings help elucidate mechanisms for why people with PD fall and may facilitate fall risk assessments and fall prevention strategies for this group.
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Affiliation(s)
- Maria Joana D Caetano
- Independent Researcher, São Carlos City Hall, São Carlos, Brazil.,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Stephen R Lord
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Natalie E Allen
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jooeun Song
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Serene S Paul
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Colleen G Canning
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jasmine C C Menant
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
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23
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Abstract
Parkinson's disease is the second most common neurodegenerative disease with a prevalence rate of 1-2 per 1000 of the population worldwide. Pharmacological management is the mainstay of treatment. Despite optimal medication, motor impairment particularly balance and gait impairment persist leading to various degree of disability and reduced quality-of-life. The present review describes motor impairment including postural impairment, gait dysfunction, reduced muscle strength and aerobic capacity and falls. Physical therapy and complementary exercises have been proven to improve motor performance and functional mobility. Evidence on the efficacy of physical therapy and complementary exercises is presented in this review. These exercises include gait training with cues, gait training with treadmill, Nordic walking, brisk walking, balance training, virtual reality interventions, Tai Chi and dance. All these treatment interventions produce short-term beneficial effects and some interventions demonstrate long-term benefit. Gait training with treadmill enhance walking performance and the effects sustain for 3-6 months. Balance training improves balance, function and reduces fall rate, and these effects carry over to at least 12 months after training ended. Sustained Tai Chi for 6 months, dance therapy for 12 months, progressive resistive training for 24 months alleviates the PD motor symptoms, suggesting that they could slow down PD progression. Based on this evidence, individuals with PD are encouraged to sustain their training in order to improve/maintain their physical ability and to combat the progression of PD.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Irene S K Wong-Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Borm CDJM, Werkmann M, Visser F, Peball M, Putz D, Seppi K, Poewe W, Notting IC, Vlaar A, Theelen T, Hoyng C, Bloem BR, de Vries NM. Towards seeing the visual impairments in Parkinson's disease: protocol for a multicentre observational, cross-sectional study. BMC Neurol 2019; 19:141. [PMID: 31238904 PMCID: PMC6591947 DOI: 10.1186/s12883-019-1365-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/13/2019] [Indexed: 01/21/2023] Open
Abstract
Background Visual disorders are common in Parkinson’s disease (PD) but their exact frequency and severity are unknown. Good visual functioning is crucial for patients with PD, because of their need to compensate for loss of automated motor control and their postural instability, forcing patients to guide their movements visually. Here, we describe the study design of a cross-sectional, multi-centre study aiming to: (1) validate the Visual Impairment screening questionnaire (VIPD-Q, which aims to identify PD patients who should be referred to an ophthalmologist for further assessment); (2) study the prevalence of visual disorders in PD; (3) study the severity and clinical impact of different types of visual disorders in PD; and (4) explore treatment options for ophthalmologic disorders in PD, as a basis for future guideline development. Methods This study consists of two phases. In phase one, 750 PD patients and 250 healthy controls will be recruited to complete the VIPD-Q. In phase two, a subgroup of responders (n = 100) (with the highest and lowest scores on the VIPD-Q) will be invited for an extensive neurological and ophthalmological assessment. The in-depth ophthalmologic examination will serve as the “gold standard” for validating the VIPD-Q. Moreover, these assessments will be used to study associations between visual disorders and clinical presentation, in order to gain more insight in their clinical impact. Discussion Our study will heighten the awareness of visual problems in PD and offers a robust starting point to systematically approach this subject. In current daily practice, the association between visual problems and PD is far from obvious to both patients and clinicians. Consequently, patients may not adequately report visual problems themselves, while clinicians miss potentially treatable visual disorders. Routinely asking patients to complete a simple screening questionnaire could be an easy solution leading to timely identification of visual problems, tailored treatment, restored mobility, greater independence and improved quality of life. Trial registration Dutch Trial Registration, NL7421, Registered on 4 December 2018 – Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12883-019-1365-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlijn D J M Borm
- Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, Donders institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Mario Werkmann
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Femke Visser
- Department of Neurology, Onze Lieve Vrouw Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Marina Peball
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Diana Putz
- Department of ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Irene C Notting
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Annemarie Vlaar
- Department of Neurology, Onze Lieve Vrouw Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Thomas Theelen
- Radboud University Medical Centre, Department of Ophthalmology, Nijmegen, The Netherlands
| | - Carel Hoyng
- Radboud University Medical Centre, Department of Ophthalmology, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, Donders institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, Donders institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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Major MJ. Fall Prevalence and Contributors to the Likelihood of Falling in Persons With Upper Limb Loss. Phys Ther 2019; 99:377-387. [PMID: 30561742 PMCID: PMC6684228 DOI: 10.1093/ptj/pzy156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Arms are important for locomotor stability and preventing falls by controlling whole-body angular momentum, redirecting the body's center of mass, and providing support to arrest descent. Hence, upper limb loss (ULL) can increase fall risk. However, the prevalence of falls and factors that influence fall risk have not previously been reported for people with ULL. OBJECTIVE This study quantified fall prevalence in persons with ULL at or proximal to the wrist and identified clinical factors that contributed to the likelihood of falling. DESIGN This was a cross-sectional study. METHODS Factors including body and health characteristics, activity level, fall history, prosthesis use, and balance confidence were determined for persons with ULL proximal to the wrist using an online survey. Logistic regression analyses assessed the contribution of these factors to the classification of fallers (≥2 falls in previous year) and nonfallers. RESULTS A percentage (28.6%) of participants (n = 105) reported experiencing 2 or more falls in the past year. The regression model (R2 = 0.473) correctly classified 84.5% of cases and indicated that increased likelihood of falling was significantly influenced by reduced balance confidence, use of upper limb prostheses, and reduced physical capabilities. LIMITATIONS Data were collected online from a convenience sample, and fall classification was based on retrospective data. CONCLUSIONS Falls in persons with ULL are prevalent, suggesting that clinicians should use screening methods to identify at-risk individuals. Balance confidence, use of upper limb prostheses, and perceived physical capabilities could be useful screening metrics. Research is warranted to better understand the factors that underlie fall risk in persons with ULL and the efficacy of therapeutic interventions capable of mitigating fall risk.
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Affiliation(s)
- Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611 (USA); and Jesse Brown VA Medical Center, Chicago, Illinois
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Multisystem Balance Training Reduces Injurious Fall Risk in Parkinson Disease. Am J Phys Med Rehabil 2019; 98:239-244. [DOI: 10.1097/phm.0000000000001035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Palmisano C, Brandt G, Pozzi NG, Leporini A, Maltese V, Canessa A, Volkmann J, Pezzoli G, Frigo CA, Isaias IU. Sit-to-walk performance in Parkinson's disease: A comparison between faller and non-faller patients. Clin Biomech (Bristol, Avon) 2019; 63:140-146. [PMID: 30889433 DOI: 10.1016/j.clinbiomech.2019.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Falls are one of the main concerns in people with Parkinson's disease, leading to poor quality of life and increased mortality. The sit-to-walk movement is the most frequent postural transition task during daily life and is highly demanding in terms of balance maintenance and muscular strength. METHODS With the aim of identifying biomechanical variables of high risk of falling, we investigated the sit-to-walk task performed by 9 Parkinson's disease patients with at least one fall episode in the six months preceding this study, 15 Parkinson's disease patients without previous falls, and 20 healthy controls. Motor performance was evaluated with an optoelectronic system and two dynamometric force plates after overnight suspension of all dopaminergic drugs and one hour after consumption of a standard dose of levodopa/benserazide. FINDINGS Poor trunk movements critically influenced the execution of the sit-to-walk movement in patients with a history of falling. The peak velocity of the trunk in the anterior-posterior direction discriminated faller from non-faller patients, with high specificity and sensitivity in both the medication-off and -on state. INTERPRETATION Our results confirm the difficulties in merging consecutive motor tasks in patients with Parkinson's disease. Trunk movements during the sit-to-walk can provide valuable measurements to monitor and possibly predict the risk of falling.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; Department of Electronic, Information and Bioengineering, MBMC Lab, Politecnico di Milano, via Colombo 40, 20133 Milan, Italy
| | - Gregor Brandt
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Nicoló Gabriele Pozzi
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Alice Leporini
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Virginia Maltese
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Andrea Canessa
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, via all'Opera Pia 13a, 16145 Genoa, Italy; Fondazione Europea di Ricerca Biomedica (FERB Onlus), Via Uboldo 18, 20063 Cernusco s/N, Milan, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Gianni Pezzoli
- Centro Parkinson ASST G. Pini-CTO, via Bignami 1, 20126 Milan, Italy
| | - Carlo Albino Frigo
- Department of Electronic, Information and Bioengineering, MBMC Lab, Politecnico di Milano, via Colombo 40, 20133 Milan, Italy
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; Centro Parkinson ASST G. Pini-CTO, via Bignami 1, 20126 Milan, Italy.
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Abstract
UNLABELLED ABSTRACTBackground:Fear of falling in Parkinson's disease (PD) has been suggested as predictor of future falling. The purpose of this study was to compare fear of falling score after two years of follow-up with those observed at baseline and to assess factors associated with change in fear of falling over time. METHODS A total of 120 consecutive persons with PD were recruited and followed for two years. Fear of falling was assessed by using the 10-item Falls Efficacy Scale (FES). Occurrence of falling was registered during the first year of follow-up. RESULTS After two years, the average FES score statistically significantly changed (p = 0.003) from 30.5 to 37.5 out of 100 (increase of 22.9%). We observed that median scores of all FES items, except for "Preparing a meal, not requiring carrying of heavy or hot objects" and "Personal grooming," significantly increased after two-year follow-up. After accounting for age, gender, PD duration, levodopa dosage, Hoehn and Yayhr stage, Unified Parkinson's Disease Rating Scale score three, depression, anxiety, and falling, we observed that sustaining greater number of falls in the first year of follow-up was associated with higher increase in FES score after two years (odds ratio 3.08, 95% confidence interval 1.30-4.87). CONCLUSION After two years of follow-up, we observed a decrease in confidence at performing nearly all basic daily activities. Fall prevention programs should be prioritized in management of PD.
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Creaby MW, Cole MH. Gait characteristics and falls in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2018; 57:1-8. [DOI: 10.1016/j.parkreldis.2018.07.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/28/2018] [Accepted: 07/16/2018] [Indexed: 12/26/2022]
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Borm CD, Krismer F, Wenning GK, Seppi K, Poewe W, Pellecchia MT, Barone P, Johnsen EL, Østergaard K, Gurevich T, Djaldetti R, Sambati L, Cortelli P, Petrović I, Kostić VS, Brožová H, Růžička E, Marti MJ, Tolosa E, Canesi M, Post B, Nonnekes J, Bloem BR, Østergaard K, Stamelou M, Tolosa E, Kostic VS, Cortelli P, Klockgether T, Dodel R, Abele M, Meissner W, Reichmann H, Lynch T, Slawek J, Poewe W, Wenning GK, Klaus Seppi M, Krismer F, Berg D, Ferreira J, Houlden H, Quinn NP, Widner H, Gerhard A, Eggert KM, Albanese A, Sorbo FD, Barone P, Pellecchia MT, Bloem B, Borm C, Djaldetti R, Berardelli A, Colosimo C, Berciano J, Traykov L, Giladi N, Gurevich T, Rascol O, Galitzky M, Gasser T. Axial motor clues to identify atypical parkinsonism: A multicentre European cohort study. Parkinsonism Relat Disord 2018; 56:33-40. [DOI: 10.1016/j.parkreldis.2018.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/04/2018] [Accepted: 06/07/2018] [Indexed: 11/17/2022]
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Jonasson SB, Nilsson MH, Lexell J, Carlsson G. Experiences of fear of falling in persons with Parkinson's disease - a qualitative study. BMC Geriatr 2018; 18:44. [PMID: 29409443 PMCID: PMC5801775 DOI: 10.1186/s12877-018-0735-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/28/2018] [Indexed: 12/02/2022] Open
Abstract
Background Fear of falling is common among persons with Parkinson’s disease and is negatively associated with quality of life. However a lack of in-depth understanding of fear of falling as a phenomenon persists. This qualitative study aimed to explore the experiences of fear of falling in persons with Parkinson’s disease. Methods Individual interviews were performed with twelve persons with Parkinson’s disease (median age 70 years, median Parkinson duration 9 years, 50% women). The interviews were semi-structured and followed a study-specific interview guide. The transcribed interviews were analyzed using qualitative content analysis. Results Fear of falling was experienced as a disturbing factor in everyday life. It generated a feeling of vulnerability and made daily activities and everyday environments seem potentially hazardous. Persons also missed performing previous activities. The fear of falling was a varying experience, fueled by an awareness of falls and near falls, Parkinson-related symptoms and disabilities, and by others in their environment. The persons adopted different strategies to handle their fear of falling. Activities were adapted, avoided, performed with help, or carried out despite their fear of falling. Conclusions The experiences of fear of falling were complex, multifaceted and varied over time and in relation to different activities and environments. This indicates that interventions targeting fear of falling need to be individually tailored for persons with Parkinson’s disease and should focus on several aspects, such as Parkinson-related symptoms and disabilities, activities and environmental factors. This study provides new information that increases the understanding of fear of falling, which has implications for researchers as well as clinicians working with persons with Parkinson’s disease and fear of falling. Electronic supplementary material The online version of this article (10.1186/s12877-018-0735-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stina B Jonasson
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden. .,Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden.
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden.,Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Gunilla Carlsson
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke. Arch Phys Med Rehabil 2018; 99:641-651. [PMID: 29102438 DOI: 10.1016/j.apmr.2017.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design. DESIGN Multicenter prospective cohort study. SETTING Institutions for physical therapy and rehabilitation. PARTICIPANTS Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used. RESULTS Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD). CONCLUSIONS PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level.
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Klanbut S, Phattanarudee S, Wongwiwatthananukit S, Suthisisang C, Bhidayasiri R. Symptomatic orthostatic hypotension in Parkinson's disease patients: Prevalence, associated factors and its impact on balance confidence. J Neurol Sci 2017; 385:168-174. [PMID: 29406900 DOI: 10.1016/j.jns.2017.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 12/26/2017] [Accepted: 12/28/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH) is a commonly reported sign of the cardiovascular autonomic dysfunctions associated with Parkinson's disease (PD). Patients might suffer from a variety of the clinical symptoms of OH, including dizziness, lightheadedness, or problems with vision and fatigue. OBJECTIVES To determine the prevalence of, and factors associated with, symptomatic orthostatic hypotension (OH) in Parkinson's disease (PD) and to identify any relationships between the clinical symptoms of OH and balance confidence in this patient population. METHODS Symptomatic OH was defined as a systolic or diastolic BP fall of ≥20 or ≥10mmHg respectively, within 3min of standing and an Orthostatic Hypotension Questionnaire (OHQ) score of more than zero. Factors related to symptomatic OH were identified from a multivariate logistic regression analysis. Pearson's correlation test was used to reveal any relationships between the clinical symptoms of OH and a patient's confidence in their ability to balance, assessed using the Activities-specific Balance Confidence (ABC) scale. RESULTS 100 Thai PD patients were consecutively recruited into this study. The prevalence of symptomatic OH was 18%, asymptomatic OH was 4%, while 78% were patients without OH. Factors associated with symptomatic OH were age (OR, 95%CI: 1.06, 1.003-1.115, p=0.038) and hypertension (OR, 95%CI: 6.16, 1.171-32.440, p=0.032). A significant and negative correlation (r=-0.229, p=0.022) between OHQ composite scores and item 3 of the ABC scale (picking up slippers from floor), one of the movements in a vertical orientation, was found. CONCLUSION Elderly PD patients and with a co-morbidity of essential hypertension should be closely evaluated for the presence of symptomatic OH. In addition, they should be advised to change positions slowly, especially those in a vertical orientation.
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Affiliation(s)
- Siranan Klanbut
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Siripan Phattanarudee
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
| | | | | | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Slaug B, Iwarsson S, Ayala JA, Nilsson MH. Housing accessibility problems for people with Parkinson's disease. Acta Neurol Scand 2017; 136:501-510. [PMID: 28393348 DOI: 10.1111/ane.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems. MATERIALS AND METHODS The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied. RESULTS HE-scores differed significantly (P<.001) in relation to HY stages. Overall balance problems explained 22% and walking devices 17% of the HE-scores, whereas environmental barriers contributed to a lesser extent. The environmental barriers generating the most HE-scores were "no grab bar at shower/bath/toilet" and "wall-mounted cupboards and shelves placed high". A simulation of improved balance significantly (P<.001) lowered the HE-scores in all HY stages. CONCLUSIONS The results suggest that actions targeting balance problems and dependence on walking devices have the greatest potential for reducing housing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services.
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Affiliation(s)
- B. Slaug
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - S. Iwarsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - J. A. Ayala
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine; Faculty of Health Sciences; Universidad Rey Juan Carlos; Alcorcón, Madrid Spain
| | - M. H. Nilsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
- Memory Clinic; Skåne University Hospital; Malmö Sweden
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Gazibara T, Kisic Tepavcevic D, Svetel M, Tomic A, Stankovic I, Kostic VS, Pekmezovic T. Near-falls in people with Parkinson's disease: Circumstances, contributing factors and association with falling. Clin Neurol Neurosurg 2017; 161:51-55. [PMID: 28858631 DOI: 10.1016/j.clineuro.2017.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 07/03/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe circumstances of near-falls among persons with Parkinson's disease (PD), assess factors associated with near-falling and assess whether near-falls in the first 6 months are associated with falling in the latter 6 months over one year of follow-up. MATERIALS AND METHODS In the period August 2011-December 2012, 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited at Clinical center of Serbia in Belgrade. Occurrence of falling and near-falls was followed for one year. RESULTS A total of 31 persons with PD (25.8%) experienced near-falls, but did not fall. Of 42 fallers, 32 (76.2%) experienced near-falls. Tripping was the most common cause of near-falls among fallers, whereas postural instability was the most common in non-fallers. Regardless of falling experience, the most common manner to avoid fall was holding onto furniture or wall. After adjustment for multiple motor and non-motor PD features, more severe freezing of gait was associated with occurrence of near-falls over one year of follow-up (odds ratio [OR]=1.08, 95% confidence interval [CI] 1.01-1.16; p=0.043). Adjusted regression analysis did not show associations between near-falling in the first 6 months and falling in the latter 6 months of follow-up. CONCLUSION Near-falls commonly occur in persons with PD. More severe freezing of gait appears to predispose near-falling. Fall prevention programs focusing on balance maintenance when experiencing freezing of gait could potentially be useful in reduction of near-falls.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Visegradska 26a, Faculty of Medicine, University of Belgrade, Serbia
| | - Darija Kisic Tepavcevic
- Institute of Epidemiology, Visegradska 26a, Faculty of Medicine, University of Belgrade, Serbia
| | - Marina Svetel
- Clinic of Neurology, Dr. Subotica 6, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Tomic
- Clinic of Neurology, Dr. Subotica 6, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Iva Stankovic
- Clinic of Neurology, Dr. Subotica 6, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Vladimir S Kostic
- Clinic of Neurology, Dr. Subotica 6, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Visegradska 26a, Faculty of Medicine, University of Belgrade, Serbia.
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Youn J, Okuma Y, Hwang M, Kim D, Cho JW. Falling Direction can Predict the Mechanism of Recurrent Falls in Advanced Parkinson's Disease. Sci Rep 2017. [PMID: 28634343 PMCID: PMC5478627 DOI: 10.1038/s41598-017-04302-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Falls are a common and disabling symptom in patients with Parkinson’s disease (PD). For prevention, it is important to understand the pathophysiology of falls in PD patients, but the predictors for the possible mechanisms underlying such falls have not been clearly elucidated. In this prospective observational study, we investigated the implications of falling direction to predict the mechanisms of recurrent falls in PD patients. We enrolled 62 recurrent fallers with PD and divided them into two groups according to the main falling directions: 45 PD fallers who fell forward (forward fallers), and 17 PD fallers who fell in the other directions (non-forward fallers). Although there was no difference in demographic data, parkinsonism, or frontal lobe function, forward fallers showed more severe falls and tended to fall during walking or turning, while non-forward fallers usually fell during sitting/standing or turning. Additionally, forward fallers revealed higher score on a freezing of gait (FOG) questionnaire. Logistic regression analysis demonstrated that FOG was associated with falling forward, while balance impairment, akinetic-rigid subtype, and neuropsychiatric symptoms were associated with falling into the other directions. Our results indicate that FOG and balance impairment are two major mechanisms for recurrent falling in PD patients, and falling direction is an important predictor for these mechanisms.
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Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Yasuyuki Okuma
- Department of Neurology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Minho Hwang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Dongyeop Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, Korea.
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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: 3.7] [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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Barr C, Barnard R, Edwards L, Lennon S, Bradnam L. Impairments of balance, stepping reactions and gait in people with cervical dystonia. Gait Posture 2017; 55:55-61. [PMID: 28412603 DOI: 10.1016/j.gaitpost.2017.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/23/2017] [Accepted: 04/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impaired balance is common in neurological disorders. Cervical dystonia is a neurological movement disorder affecting the neck. The effect of this aberrant head posture on physical function is unknown. OBJECTIVES To compare balance, mobility, gait and stepping reactions between ten people with cervical dystonia and ten control adults. METHODS Spatiotemporal gait parameters and walking speed were assessed using a computerised walkway. Step length and time, time in double support and gait variability were calculated, then normalised to gait speed. Centre of pressure path length was assessed with eyes open and eyes closed to calculate a Romberg Quotient. Simple and choice reaction times were measured using customised apparatus while mobility was assessed by the timed up and go. Cervical spine range of motion was measured using a head mounted goniometer. Self-reported scales included Falls Self Efficacy Scale and Dystonia Discomfort Scale. RESULTS There was a difference between groups for most outcome measures. The timed up-and-go and walking speed was slower (both P<0.005) and the Romberg Quotient lower (P=0.046) in cervical dystonia. People with cervical dystonia had lower falls self-efficacy (P=0.0002). Reduced cervical range of motion was correlated with balance, stepping reaction time and mobility (all P<0.05). Timed up and go was positively associated with stepping reaction time (P<0.01). Dystonia discomfort did not impact function. CONCLUSIONS People with cervical dystonia displayed deficits in balance, gait and stepping reactions, and expressed higher fear of falling. Studies to further elucidate functional limitations and their impact on activity and participation in daily life are required.
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Affiliation(s)
- Christopher Barr
- Clinical Rehabilitation, School of Health Sciences, Flinders University, Australia
| | - Rhiannon Barnard
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia
| | - Lauren Edwards
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia
| | - Lynley Bradnam
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Australia.
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Almeida LR, Valenca GT, Negreiros NN, Pinto EB, Oliveira-Filho J. Predictors of Recurrent Falls in People with Parkinson’s Disease and Proposal for a Predictive Tool. JOURNAL OF PARKINSONS DISEASE 2017; 7:313-324. [DOI: 10.3233/jpd-160934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Lorena R.S. Almeida
- Movement Disorders and Parkinson’s Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Guilherme T. Valenca
- Movement Disorders and Parkinson’s Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Health Sciences Center, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Nádja N. Negreiros
- Movement Disorders Clinic, State of Bahia Health Attention Center for the Elderly/SESAB, Salvador, Bahia, Brazil
| | - Elen B. Pinto
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
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Lindholm B, Beckman A, Duzynski W, Ekvall Hansson E. Outcome on Balance and Gait Following Botulinum Toxin Treatment for Striatal Foot in Parkinson's Disease. Mov Disord Clin Pract 2017; 4:309-315. [PMID: 30363465 PMCID: PMC6174462 DOI: 10.1002/mdc3.12411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/27/2016] [Accepted: 06/09/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Striatal foot deformity can shorten the stance phase of gait and impair the ability to stand and walk. Botulinum neurotoxin type A (BoNT A) is a treatment option. However, no previous study has included clinical balance testing in the evaluation of treatment effects. The aim of this study was to evaluate gait and balance in patients with striatal foot deformities and Parkinson's disease (PD) before and after treatment with BoNT A injections. METHOD The study included 10 patients with PD and striatal foot deformity who visited a neurological clinic. The mean ± standard deviation age and PD-duration was 62.8 ± 8.8 years and 4.9 ± 3.6 years, respectively. Clinical assessment was made before and 4 and 16 weeks after injection and included 5 clinical gait and balance tests. The intensity of distress due to deformities was investigated with a visual analogue scale. Parkinsonian motor status was assessed with the Unified Parkinson's Disease Rating Scale part III (motor part). Based on ordinary clinical examination, electromyography-guided BoNT A injection was given in affected muscles. Clinically effective doses of BoNT A were used. RESULTS Improvements were observed regarding functional, dynamic, and standing balance as well as intensity of distress at 4 weeks but not at 16 weeks compared with baseline. CONCLUSIONS BoNT A injection treatment improved gait and balance in patients with PD and striatal foot deformities. Multicenter trials are needed; and, to achieve increased power, a randomized, double-blind controlled design is needed and should focus on the ability of tests to capture subtle changes in gait and balance.
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Affiliation(s)
- Beata Lindholm
- Department of Clinical Sciences, Malmö Lund University Malmö Sweden
- Department of Neurology and Rehabilitation Medicine Skåne University Hospital Malmö Sweden
| | - Anders Beckman
- Department of Clinical Sciences, Malmö Lund University Malmö Sweden
| | - Wojciech Duzynski
- Department of Neurology and Rehabilitation Medicine Skåne University Hospital Malmö Sweden
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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: 1.3] [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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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: 3.1] [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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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: 1.9] [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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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: 0.9] [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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Shih MC, Wang RY, Cheng SJ, Yang YR. Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson's disease: a single-blinded randomized controlled trial. J Neuroeng Rehabil 2016; 13:78. [PMID: 27568011 PMCID: PMC5002324 DOI: 10.1186/s12984-016-0185-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background The present study examined the effects of a balance-based exergaming intervention using the Kinect sensor on postural stability and balance in people with Parkinson’s disease (PD). Methods We conducted a subject-blinded, randomized controlled study. Twenty people with PD (Hoehn and Yahr stages I through III) were recruited and randomly assigned to either a balance-based exergaming group (N = 10) or a balance training group (N = 10) for an 8-week balance training period. Postural stability was assessed using the limits of stability (LOS) and one-leg stance (OLS) tests. Balance was assessed using the Berg Balance Scale (BBS) and the timed up and go (TUG) test. Participants were assessed pre- and post-training. Results After training, participants in the balance-based exergaming group showed significant improvements in LOS performance, and in the eyes-closed condition of the OLS test. Both training programs led to improvements in BBS and TUG performance. Furthermore, balance-based exergaming training resulted in significantly better performance in directional control in the LOS test (78.9 ± 7.65 %) compared with conventional balance training (70.6 ± 9.37 %). Conclusions Balance-based exergaming training resulted in a greater improvement in postural stability compared with conventional balance training. Our results support the therapeutic use of exergaming aided by the Kinect sensor in people with PD. Trial registration ClinicalTrials.gov.NCT02671396 Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0185-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meng-Che Shih
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan.
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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: 3.5] [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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O’Connell E, Guidon M. Fear of falling and dual-task performance in people with Parkinson’s disease. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.3109/21679169.2016.1156156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eimear O’Connell
- Physiotherapy Department, Mercy University Hospital, Cork, Ireland
| | - Marie Guidon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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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: 2.3] [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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Task- and Context-Specific Balance Training Program Enhances Dynamic Balance and Functional Performance in Parkinsonian Nonfallers: A Randomized Controlled Trial With Six-Month Follow-Up. Arch Phys Med Rehabil 2015; 96:2103-11. [DOI: 10.1016/j.apmr.2015.08.409] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/03/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022]
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Predicting Falls in Parkinson Disease: What Is the Value of Instrumented Testing in OFF Medication State? PLoS One 2015; 10:e0139849. [PMID: 26443998 PMCID: PMC4596567 DOI: 10.1371/journal.pone.0139849] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
Background 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 objective of this prospective study was to investigate clinical and instrumented tests of balance and gait in both OFF and ON medication states and to verify their utility in the prediction of future falls in PD patients. Methods Forty-five patients with idiopathic PD were examined in defined OFF and ON medication states within one examination day including PD-specific clinical tests, instrumented Timed Up and Go test (iTUG) and computerized dynamic posturography. The same gait and balance tests were performed in 22 control subjects of comparable age and sex. Participants were then followed-up for 6 months using monthly fall diaries and phone calls. Results During the follow-up period, 27/45 PD patients and 4/22 control subjects fell one or more times. Previous falls, fear of falling, more severe motor impairment in the OFF state, higher PD stage, more pronounced depressive symptoms, higher daily levodopa dose and stride time variability in the OFF state were significant risk factors for future falls in PD patients. Increased stride time variability in the OFF state in combination with faster walking cadence appears to be the most significant predictor of future falls, superior to clinical predictors. Conclusion Incorporating instrumented gait measures into the baseline assessment battery as well as accounting for both OFF and ON medication states might improve future fall prediction in PD patients. However, instrumented testing in the OFF state is not routinely performed in clinical practice and has not been used in the development of fall prevention programs in PD. New assessment methods for daylong monitoring of gait, balance and falls are thus required to more effectively address the risk of falling in PD patients.
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