Failing in Parkinson disease - Identifying and prioritizing risk factors in recurrent fallers

University of Houston, Houston, Texas, United States
American Journal of Physical Medicine & Rehabilitation (Impact Factor: 2.01). 09/2007; 86(8):621-32. DOI: 10.1097/PHM.0b013e311611583
Source: PubMed

ABSTRACT To identify falling risk factors in a study population of recurrent fallers compared with nonfallers who have Parkinson disease, and to prioritize falling risk factors in this patient population to target them for modification.
Twenty-three recurrent fallers and 25 nonfallers who have Parkinson disease were recruited, and they participated in a comprehensive assessment probing for the presence of falling risk factors. To identify falling risk factors, a group comparative design was used to compare recurrent fallers and nonfallers across an array of variables. To prioritize those risk factors, modeling using recursive partitioning was performed, entering into the model falling, risk factors identified in this and other studies that were considered potentially modifiable.
A specific profile of variables distinguished recurrent fallers who have Parkinson disease in our study population: higher disease severity, higher level of motor impairment, higher level of disability, impaired leg agility or lower-limb coordination, impaired ability to arise from a chair or compromised proximal lower-limb motor control, impaired ambulation, impaired motor planning of the hands and feet, impaired dynamic balance as measured by ability to walk in tandem, and fear of falling. Recursive partitioning prioritized three risk factors: impaired ambulation, impaired lower-limb motor planning, and orthostasis.
In this study, an idiosyncratic falling risk factor profile was demonstrated among our subjects who have Parkinson disease. Three variables were prioritized for potential modification: impaired ambulation, impaired lower-limb motor planning, and orthostasis.

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    ABSTRACT: People with Parkinson disease (PD) have twice the risk of falls as their age-matched peers. Medication and surgery have not ameliorated Parkinson-related falls (PRFs), which are characteristic of disease progression, leading to considerable morbidity and mortality. Exercise can improve postural stability and decrease risk of falls. Chinese and allopathic interventions for decreasing falls have been investigated. This research evaluated the effect of Qi Gong on postural stability and falls for individuals with PD. A pretest/posttest, repeated-measures design was used to demonstrate changes in balance scores and the number of falls after 3 months of therapeutic Qi Gong. Forty-one participants were recruited in New York City and surrounding counties. The sample included males and females with Hoehn and Yahr rating scale stage I-IV PD who were 55 years and older. Instruments included the Berg Balance Scale, the Parkinson Disease Fall Profile, and the Mini-Mental State Examination. The influence of Qi Gong on postural stability and PRFs was verified by statistically significant changes in improvement in balance scores and decreased number of falls. Qi Gong is mindful exercise, a healing component of Chinese medicine, which is congruent with neuroplasticity, brain reorganization, and repair. This original translational research implements enriched combined cognitive and physical exercise in a social environment that may contribute to the outcomes.
    Topics in Geriatric Rehabilitation 01/2014; 30(1):58-69. DOI:10.1097/TGR.0000000000000007 · 0.14 Impact Factor
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    ABSTRACT: Background: Postural balance and potentially fall risk increases among older adults living with neurological diseases, especially Parkinson's disease (PD). Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance, interest is growing in evaluating alternative PD therapies. Objective: The purpose of the current study was to assess improvement in postural balance in PD patients following electroacupuncture (EA) as an alternative therapy. Methods: 15 aging adults (71.2 ± 6.3 years) with idiopathic PD and 44 healthy age-matched participants (74.6 ± 6.5 years) were recruited. The PD participants were randomly assigned (at a ratio of 2:1) to an intervention (n = 10) or to a control group (n = 5). The intervention group received a 30-min EA treatment on a weekly basis for 3 weeks, while the control group received a sham treatment. Outcomes were assessed at baseline and after the final therapy. Measurements included balance assessment, specifically the ratio of medial-lateral (ML) center-of-gravity (COG) sway to anterior-posterior (AP) sway (COGML/AP) and ankle/hip sway during eyes-open, eyes-closed, and eyes-open dual-task trials, the Unified Parkinson's Disease Rating Scale (UPDRS), as well as quality of life, concerns for fall, and pain questionnaires. Results: No difference was observed for the assessed parameters between the intervention and the control group at baseline. After treatment, an improvement in balance performance was observed in the intervention group. Compared with the healthy population, PD patients prior to treatment had larger COGML/AP sway with more dependency on upper-body movements for maintaining balance. Following EA therapy, COGML/AP sway was reduced by 31% and ankle/hip sway increased by 46% in the different conditions (p = 0.02 for the dual-task condition). The clinical rating revealed an overall improvement (p < 0.01) in mentation, behavior, and mood (UPDRS part I, 49%), activities of daily living (UPDRS part II, 46%), and motor examination (UPDRS part III, 40%). There was a significant reduction (p < 0.02) in the specific items regarding UPDRS fall status (67%) and rigidity (48%). Changes were small and nonsignificant in the controls (p > 0.29). Conclusions: This pilot study demonstrates improvement in rigidity and balance following EA. These preliminary results suggest EA could be a promising alternative treatment for balance disturbance in PD. © 2014 S. Karger AG, Basel.
    Gerontology 10/2014; DOI:10.1159/000363442 · 2.68 Impact Factor


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