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Falls in Parkinson Disease: Causes, Prediction, and Prevention
Falls in Parkinson Disease: Causes, Prediction, and Prevention
• Knowing only fall history, FOG status and gait speed gives
little direction for intervention
• Nothing is perfect
• Ideal world:
• Twice yearly PT evaluation (Duncan et al. Parkinson’s Dis 2012)
• Patients would be tested on and off anti-PD medication
(Dibble LE Parkinsonism Relat Disord 2011)
• Implications for physical therapy for those with PD at risk for falling
• Control (n=27):
• Joint mobilization, motor coordination exercise, and muscle
stretching
• Stretching (n=65)
• Active control group - breathing, stretching, relaxation
• Incidence Rate
• Tai Chi significantly different from stretching (p=0.005)
• Tai Chi different from resistance (p=0.05)
• Control (n=66)
• Usual care at discretion of clinical team
• ParkFIT
• Activity coaching
• Education related to benefits of physical activity
• Identifying and overcoming barriers to engaging in physical
activity
• Systematic goal setting using health contract and logbook
• Stimulation to participate in group exercises
• Ambulatory monitor data with automated feedback
• ParkSAFE
• Traditional PT
• Education related to benefits of PT and safety of movements
• Active lifestyle not explicitly stimulated
van Nimwegen, BMJ, 2013
• ParkFit: 62%
• ParkSAFE: 67%
• Cueing
• Overground gait (Nieuwboer, 2007)
• Treadmill (Frazzitta, 2009)
• Gait speed
• Step length
• Freezing of Gait severity (5.5% reduction in freezers only)
• Twice weekly dance classes for one year (Argentine Tango) vs.
control group
• RESCUE trial
• Control
• Low intensity exercise of trunk, leg flexors and extensors, and hip
abductors at home
• 2 sets of each exercise twice weekly, started at 8 reps per set
• Increased reps by 2 every 4 weeks
• Orthostatic hypotension
• Hallucinations
• Impulsivity
• Falls are extremely complex and are not just a factor of physical
mobility and performance
• Funding sources