1,721,078 research outputs found
Dysfunctional turning in Parkinson’s disease
No full textPurpose. People with Parkinson's disease (PD) frequently freeze or fall turning: They turn slowly taking numerous steps. We aimed to describe more fully the differences observed on turning between people with and without PD, in particular the extent of left-right asymmetry and the correlations between turning and age, balance and PD severity, using a simple clinical test.Method. Twenty-eight people with PD (median age 71; median years since diagnosis eight) and 12 controls (median age 70) performed the video-based Standing Start 180° Turn Test. We counted turning steps (n), evaluated turn time (sec), type and quality (0 – 5, based on independence, ground clearance, stability, continuity and posture) and calculated the 95% limits of left-right agreement.Results. The groups differed (p < 0.004) on step count (medians 4.5 vs. 3), time (2.3 sec vs. 1.7 sec) and quality (4 vs. 5). In the PD group, 75% turned ‘on-the-spot’ and differences turning left and right were marked (e.g., 95% upper limit for step count 6.6). Among controls, 42% turned ‘on-the-spot’ and turning was symmetrical (e.g., 95% upper limit for step count 1.7). Step count was most closely correlated with self-assessed disability in PD (r = 0.67; p = 0.001) and with age among controls (r = 0.87; p = 0.001).Conclusions. People having difficulty turning are likely to have trouble with many everyday activities and thus may benefit from rehabilitation. Directional asymmetry in turning is easily identifiable and future studies should explore its diagnostic value<br/
Fallers and non-fallers with Parkinson's disease (PD): the influence of a dual task on standing balance
No full textHow people with Parkinson's disease describe their difficulties in turning
No full textBackground: People with Parkinson’s disease (PD) fall more frequently than healthy elderly people (Nevitt et al,1989). Turning has been identified as an activity frequently associated with falls among people with PD (Stack and Ashburn, 1999). As part of a larger study comparing turning strategies used by repeat fallers and non-repeat fallers, participants were asked a series of questions about falling and turning. The aim of the study was to increase the understanding of the difficulties people with PD experience while turning and how they have attempted to overcome these difficulties.Method: Cross-sectional study of a community sample of 75 people with consultant-diagnosed PD. All subjects were independently mobile and were screened for cognitive impairment using the Middlesex Elderly Assessment of Mental State. Interviews took place in the participants’ own homes. Participants were asked how many times they had fallen in the previous 12 months and on the basis of this answer were categorised as repeat fallers or non-repeat fallers. They were asked to describe their location, activity at the time and suspected cause of each reported fall. In addition, participants were asked whether they experienced difficulty in turning, if they had consciously modified the way they turned and if they believed any modification made was successful. Contents of the interviews were categorised by two researchers.Results: Of the 75 participants, 32 were non-repeat fallers and 43 repeat fallers. Turning was identified as the second most common activity during which a reported fall had occurred (17%) after walking (41%). After loss of balance (21%), turning was identified as the second most common cause of the fall (14%). Difficulty in turning was reported by 45% of non-repeat fallers and 82% of repeat fallers. The most common difficulties experienced while turning were freezing (27%), falling (27%) and loss of balance (25%).32% of non-repeat fallers and 61% of repeat fallers said they had attempted to modify the way they turned. Over 80% of all participants considered their modifications successful. Modifications included slowing down (22%), concentrating (20%) and holding on (17%).Conclusion: As previously shown, people with PD who have fallen frequently report turning as a causative factor. We have highlighted some of the reasons why turning can be difficult for people with PD and the modifications they have made to their movement strategies in an attempt to overcome these difficulties. What remains to be understood is which movement strategies used by people with PD when turning are beneficial stabilising adaptations and which are associated with an increased risk of falling
Movement strategies used during fall-related activities by repeat fallers and nonrepeat fallers with Parkinson's Disease (PD) (abstract of paper presented at Society for Research in Rehabilitation, Manchester 2001)
No full textMovement strategies used during fall related activities by repeat fallers and nonrepeat fallers with Parkinson's disease (PD) E Stack, A Ashburn and K JuppBackground: Information about the movement strategies deployed by repeat fallers (RFs) during fall-related activities is limited. The aims of this study were to describe how people with PD naturally turn and reach and compare the movement strategies of RFs with those of nonrepeat fallers (NRFs).Method: Independently mobile people with PD living in the community were recruited through GPs. Their disease severity, self-assessed disability and fall history was assessed at home. How subjects turned, reached high and reached low whilst making a cup of tea was video-recorded and rated blind using a validated, reliable checklist. Results: Seventy-five subjects (48 men), median age 73 years and median Hoehn and Yahr grade III were recruited. Forty-three subjects were RFs: they had greater disease severity and self-assessed disability than NRFs. Falls reported had occurred most frequently when walking (41%) or turning (17%). When turning, forwards stepping (33%) or sideways stepping (32%) movements were common, a median of six steps was taken, 88% demonstrated reduced heel strike and 25% used support. When reaching, 75% of subjects used support, 82% aligned forwards and 69% stood with their feet parallel. RFs and NRFs moved in similar ways, but RFs had a significantly smaller base width between their feet prior to moving (p < 0.001). Increased disease severity was linked with a high number of turning steps and observed instability.Conclusion: Surprisingly, the RFs were not distinguishable from NRFs by the way they moved during common fall-related activities. Rather, the small base area and apparent instability during functional activity should be targeted for intervention
People with stroke living in the community: a study of falling (abstract of paper presented at Society for Research in Rehabilitation, Liverpool, July 2000)
No full textA pilot study of attention deficits, balance control and falls in the subacute stage following stroke
No full textObjectives: To (1) identify and monitor changes in deficits of attention and balance in the subacute stage following stroke, (2) investigate fall events, (3) explore relationships between deficits of attention, balance and falling post stroke.Design: A prospective observational study.Setting: Hospitalized patients with stroke were recruited from a rehabilitation ward.Subjects: Fourteen subjects were recruited, 13 subjects (age 21–80 years) completed all assessments. Ten had right and three had left hemispheric lesions. Eight subjects were male.Main outcome measures: Subjects were assessed on two occasions during a six-week period. Standardized tests were used to measure unilateral visual neglect, sustained and selective attention and balance. Fall histories were collected by chart review and semi-structured interview.Results: At the initial assessment six subjects had sustained auditory attention deficit, eight had deficits of auditory selective attention, 12 had visual selective attention deficits and seven subjects presented with visual inattention. Scores for visual inattention and visual selective attention improved over time (p = 0.006, p = 0.026 respectively) as did scores for balance control (p = 0.001). Auditory selective attention scores at the first assessment were found to correlate with measures of balance (p < 0.01), subjects with normal attention scores achieved better balance scores. Four subjects fell at least once during the six weeks. Scores for attention and balance of fallers were not found to be significantly different from the scores of nonfallers.Conclusions: The sample size was small but high levels of attention deficit were identified. Findings suggest a weak or no relationship between attention deficits and falls. Further studies are required to explore the extent of attention deficits post stroke and its impact on balance control and falling
Development of a checklist for describing the performance of fall related activities by people with Parkinson's Disease
No full textIntroduction: Falls are a major problem for elderly people in general but those with Parkinson’s Disease (PD) are at greater risk of instability. Knowledge is limited about the ways in which repeat fallers move about their environment. The aims of this study were to develop a tool for describing the movement strategies used when turning and reaching and to test for inter-observer reliability.Method: People with PD (independently mobile and screened for cognitive dysfunction) were recruited through GPs. Video recordings of individuals turning and reaching high and low while making a cup of tea were made in participants’ homes. First, five skilled therapists independently identified movement strategies from the videos of seven people. Key strategies, agreed through consensus, formed the rating scale and comprised six items for turning (eg number of steps, turn type), five items for high reach (eg body alignment and support) and four items for low reach (eg instability and support). Inter-rater reliability was examined using two observers who independently rated the video recordings of performances.Results: The video recordings of 66 subjects with PD were analysed. Their median age was 73 years (range 36 to 88) and they had moderate disease severity (median grade III,Hoehn and Yahr). Eleven out of the 14 items reached acceptable agreement, using Kappa coefficients (0.6 to 1.00), but turn type (0.56) and observed instability when turning were not shown to be reliable (0.48). The difference in the number of steps counted by observers was analysed using a Bland Altman approach and showed high agreement (mean difference –0.06, 95% range of difference –1.4 to1.2).Conclusion: A checklist for analysing the components used when individuals turn and reach high and low when making a cup of tea was developed. Procedures for ensuring content validity and reliability were followed. The rating scale was designed for use in the home environment for assessment and evaluation of intervention
Developing methods to evaluate how people with Parkinson's Disease turn 180°; an activity frequently associated with falls
No full textPURPOSE: To develop a test that identified fallers from their turning strategies, as people with Parkinson's Disease (PD) commonly fall turning. METHOD: We compared (1) Turn Types demonstrated when turning 180 degrees during the Timed Up and Go Test (TUG Test) by 19 non-fallers and 29 fallers (median age 71) and (2) Turn Types, Turning Steps, Heelstrike, Stability and the Use of Space and Support demonstrated when turning 180 degrees during an everyday activity by 15 non-fallers and 26 fallers (median age 75). Turns were rated from video by observers blinded to group. Inter-observer agreement was tested. RESULTS: Similar proportions of fallers and non-fallers demonstrated multiple-step Turn Types during the TUG Test (69% v 58% p=0.433) and the everyday activity (66% vs. 46%; p=0.241). When turning, similar proportions of each group lacked Heelstrike, lost Stability and used the available Space and Support (p>0.7); Turning Step counts were also similar (p=0.891). Inter-observer agreement proved acceptable except for Turn Type during everyday activity (Kappa=0.46). CONCLUSIONS: The anticipated differences between fallers and non-fallers were not identified, perhaps obscured by insufficiently or overly challenging protocols and/or the compensations deployed by fallers. Further methodological development is needed in the analysis of fall-related activities with high-risk group
What constitutes a ´near-miss´ among frequent fallers with Parkinson´s: can sensors detect the indications of instability that clinicians note?
No full textRelevance: Sensors in the home afford the opportunity to monitor a patient's risk of falling, allowing timely intervention. Sensors can detect falls (and raise the alarm). The challenge is to develop technology capable of measuring the frequency of near-misses, so that help may be provided before a significant fall.Purpose:(1)To identify the features of ‘near-misses’ that observers note in people at high risk of falling moving freely around their homes.(2)To design a protocol for establishing whether sensor can identify the same features and thus determine whether an individual is at imminent risk of falling.Methods/analysis: Via support groups, with Ethics Approval (from the University of Southampton), we recruited five people with Parkinson's who could (a) describe frequent falls or near-misses and (b) mobilise independently indoors. We observed and video-recorded each participant at home (a maximum four times) performing their usual activities. An independent reviewer noted and counted instances when participants appeared to ‘lose their balance’ and nearly fall. We then designed a protocol for testing the ability of depth cameras and wearable amonitors to detect indications of instability during frequently challenging activities.Results: Participants had been diagnosed between 5 and 11 years; they all had moderate or severe Parkinson's and were largely sedentary. Reviewing 246 minutes of video, participants appeared at imminent risk of falling 227 times, most frequently when turning, on steps, if they walked immediately on rising or if they did not use support when transferring. Balance was often lost backwards unless walking (when participants tended to stumble forwards or sideways if their feet did not clear the floor or crossed, or they tripped or froze). Unsteady transfers were characterised by swaying backwards on rising (toes lifting off floor) or by falling into the chair, either on rising or during sitting (feet lifting off floor). We designed a protocol to capture these features plus ‘pausing and repositioning’, ‘aborted attempts’, ‘increased sway’ and ‘loss of control’ during the following activities: chair transfers, walking, turning and standing.Discussion and conclusions: ‘Teaching’ machines to recognise changing postural instability is a multistage process. By observing individuals who nearly fell almost every minute they were active we have identified the features that ‘flag’ a near-miss to clinicians. Unlike the simulated falls (by healthy volunteers) on which others have based their machine learning, we are progressing towards sensor-based detection of fall risk using real events demonstrated by people with marked postural instability.Impact and implications: Clinicians cannot observe their patients all day every day, certainly not at home. As we move through a planned series of studies, we move closer to addressing one of the most significant questions in falls research: can you identify someone at risk of falling before they have their first fall? If sensors can detect worsening postural stability (i.e. increasingly frequent near-misses), physiotherapists will be better informed and have the chance to intervene early when a patient is optimally placed to benefit.Funding acknowledgement: This work is funded by the Engineering and Physical Sciences Research Council and is part of the SPHERE Interdisciplinary Research Collaboration.<br/
Strategies used by people with Parkinson's Disease when turning over in bed: associations with disease severity, fatigue, function and mood
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