-
[show abstract]
[hide abstract]
ABSTRACT: Real-world environments comprise surfaces of different textures, densities and gradients, which can threaten postural stability and increase falls risk. However, there has been limited research that has examined how walking on compliant surfaces influences gait and postural stability in older people and PD patients.
PD patients (n = 49) and age-matched controls (n = 32) were assessed using three-dimensional motion analysis during self-paced walking on both firm and foam walkways. Falls were recorded prospectively over 12 months using daily falls calendars.
Walking on a foam surface influenced the temporospatial characteristics for all groups, but PD fallers adopted very different joint kinematics compared with controls. PD fallers also demonstrated reduced toe clearance and had increased mediolateral head motion (relative to walking velocity) compared with control participants.
Postural control deficits in PD fallers may impair their capacity to attenuate surface-related perturbations and control head motion. The risk of falling for PD patients may be increased on less stable surfaces.
Parkinsonism & Related Disorders 06/2011; 17(8):610-6. · 3.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment among older adults. This study explored the relationship between AMD, fall risk, and other injuries and identified visual risk factors for these adverse events.
Participants included 76 community-dwelling individuals with a range of severity of AMD (mean age, 77.0 ± 6.9 years). Baseline assessment included binocular visual acuity, contrast sensitivity, and merged visual fields. Participants completed monthly falls and injury diaries for 1 year after the baseline assessment.
Overall, 74% of participants reported having either a fall or a non-fall-related injury. Fifty-four percent of participants reported a fall and 30% reported more than one fall; of the 102 falls reported, 63% resulted in an injury. Most occurred outdoors (52%), between late morning and late afternoon (61%) and when navigating on level ground (62%). The most common non-fall-related injuries were lacerations (36%) and collisions with an object (35%). Reduced contrast sensitivity and visual acuity were associated with increased fall rate, after controlling for age, sex, cognitive function, cataract severity, and self-reported physical function. Reduced contrast sensitivity was the only significant predictor of non-fall-related injuries.
Among older adults with AMD, increased visual impairment was significantly associated with an increased incidence of falls and other injuries. Reduced contrast sensitivity was significantly associated with both increased rates of falls and other injuries, while reduced visual acuity was only associated with increased fall rate. These findings have important implications for the assessment of visually impaired older adults.
Investigative ophthalmology & visual science 04/2011; 52(8):5088-92. · 3.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Changes in stride characteristics and gait rhythmicity characterize gait in Parkinson's disease and are widely believed to contribute to falls in this population. However, few studies have examined gait in PD patients who fall. This study reports on the complexities of walking in PD patients who reported falling during a 12-month follow-up. Forty-nine patients clinically diagnosed with idiopathic PD and 34 controls had their gait assessed using three-dimensional motion analysis. Of the PD patients, 32 (65%) reported at least one fall during the follow-up compared with 17 (50%) controls. The results showed that PD patients had increased stride timing variability, reduced arm swing and walked with a more stooped posture than controls. Additionally, PD fallers took shorter strides, walked slower, spent more time in double-support, had poorer gait stability ratios and did not project their center of mass as far forward of their base of support when compared with controls. These stride changes were accompanied by a reduced range of angular motion for the hip and knee joints. Relative to walking velocity, PD fallers had increased mediolateral head motion compared with PD nonfallers and controls. Therefore, head motion could exceed "normal" limits, if patients increased their walking speed to match healthy individuals. This could be a limiting factor for improving gait in PD and emphasizes the importance of clinically assessing gait to facilitate the early identification of PD patients with a higher risk of falling.
Movement Disorders 10/2010; 25(14):2369-78. · 4.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Changes in stride characteristics and gait rhythmicity characterize gait in Parkinson's disease and are widely believed to contribute to falls in this population. However, few studies have examined gait in PD patients who fall. This study reports on the complexities of walking in PD patients who reported falling during a 12-month follow-up. Forty-nine patients clinically diagnosed with idiopathic PD and 34 controls had their gait assessed using three-dimensional motion analysis. Of the PD patients, 32 (65%) reported at least one fall during the follow-up compared with 17 (50%) controls. The results showed that PD patients had increased stride timing variability, reduced arm swing and walked with a more stooped posture than controls. Additionally, PD fallers took shorter strides, walked slower, spent more time in double-support, had poorer gait stability ratios and did not project their center of mass as far forward of their base of support when compared with controls. These stride changes were accompanied by a reduced range of angular motion for the hip and knee joints. Relative to walking velocity, PD fallers had increased mediolateral head motion compared with PD nonfallers and controls. Therefore, head motion could exceed “normal” limits, if patients increased their walking speed to match healthy individuals. This could be a limiting factor for improving gait in PD and emphasizes the importance of clinically assessing gait to facilitate the early identification of PD patients with a higher risk of falling. © 2010 Movement Disorder Society
Movement Disorders 10/2010; 25(14):2369 - 2378. · 4.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the efficacy of bilateral pedunculopontine nucleus (PPN) deep brain stimulation (DBS) as a treatment for primary progressive freezing of gait (PPFG).
A patient with PPFG underwent bilateral PPN-DBS and was followed clinically for over 14 months.
The PPFG patient exhibited a robust improvement in gait and posture following PPN-DBS. When PPN stimulation was deactivated, postural stability and gait skills declined to pre-DBS levels, and fluoro-2-deoxy-d-glucose positron emission tomography revealed hypoactive cerebellar and brainstem regions, which significantly normalised when PPN stimulation was reactivated.
This case demonstrates that the advantages of PPN-DBS may not be limited to addressing freezing of gait (FOG) in idiopathic Parkinson's disease. The PPN may also be an effective DBS target to address other forms of central gait failure.
Journal of neurology, neurosurgery, and psychiatry 10/2010; 82(11):1256-9. · 4.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the postural stability and gait characteristics of adults with age-related maculopathy (ARM) and to identify the visual factors associated with postural stability and gait in this clinical population.
Participants included 80 individuals with a range of severity of ARM (mean age, 77.2 years). Binocular visual function measures included visual acuity, contrast sensitivity, and merged binocular visual fields. Postural stability was assessed on both a firm and a foam surface using center-of-pressure measures derived from a force platform. Forty three of the participants underwent a three-dimensional motion analysis to quantify gait characteristics, including walking velocity, proportion of time spent with both feet in contact with the ground (double-support time), stride length, and step width.
After adjustment for age, sex, self-reported physical function, and cataract severity, all the vision measures were significantly associated with postural stability on the foam surface, with contrast sensitivity being the strongest correlate. In the analysis of the gait measures, only contrast sensitivity was significantly associated with walking velocity, step width, or stride length, whereas contrast sensitivity and visual field loss were both significantly associated with double-support time.
Impaired contrast sensitivity was associated with postural instability, slower walking velocity, increased step width, and reduced stride length. Impairments in either contrast sensitivity or visual fields were associated with increased double-support time. This result suggests that loss of contrast sensitivity and visual fields in patients with ARM can lead to balance and mobility problems.
Investigative ophthalmology & visual science 10/2008; 50(1):482-7. · 3.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: To assess the postural stability and gait characteristics of adults with age-related maculopathy (ARM) and to identify the visual factors associated with postural stability and gait in this clinical population.-----
METHODS: Participants included 80 individuals with a range of severity of ARM (mean age, 77.2 years). Binocular visual function measures included visual acuity, contrast sensitivity, and merged binocular visual fields. Postural stability was assessed on both a firm and a foam surface using center-of-pressure measures derived from a force platform. Forty three of the participants underwent a three-dimensional motion analysis to quantify gait characteristics, including walking velocity, proportion of time spent with both feet in contact with the ground (double-support time), stride length, and step width.-----
RESULTS: After adjustment for age, sex, self-reported physical function, and cataract severity, all the vision measures were significantly associated with postural stability on the foam surface, with contrast sensitivity being the strongest correlate. In the analysis of the gait measures, only contrast sensitivity was significantly associated with walking velocity, step width, or stride length, whereas contrast sensitivity and visual field loss were both significantly associated with double-support time.-----
CONCLUSIONS: Impaired contrast sensitivity was associated with postural instability, slower walking velocity, increased step width, and reduced stride length. Impairments in either contrast sensitivity or visual fields were associated with increased double-support time. This result suggests that loss of contrast sensitivity and visual fields in patients with ARM can lead to balance and mobility problems.
-
