Parkinson's Disease - Falls & Considerations Flashcards
What is the prevalence of falls in PD?
- 45-68% fall annually
- 2/3 fall recurrently
- PD patients make up largest group of fallers in Aus
- Increased risk of fall related hip fractures (2.8x in women, 5.3x in men)
What did Stolze et al 2004 find regarding falls in neurological patients?
- Examined falls prevalence in neurological inpatients
- 62% of PD patients had fallen within last 12 months
- Compared to 33% of MND patients & 31% of MS patients
What did Bloem et al 2001 find regarding falls in PD?
- Recorded details of falls of control & PD patients over 6 months
- PD patients had 205 falls, control had 10
What activities did Bloom et al 2001 find falls were associated with in PD?
- Standing up
- Walking
- Turning around
- Squatting/bending down
- Completing dual tasks
- Negotiating obstacles
- Wearing inappropriate shoes
- Walking on slippery floors
- Walking in areas of poor lighting
What are the main factors that contribute to falls in PD?
- Freezing of gait
- Fall in previous year
- Cognitive impairment (<27/30 MMSE)
- Flexed posture
- Impaired coordinated postural stability (e.g. reactive postural control)
- Knee extensor weakness
- Patient-specific, complex & multifactorial
What are some of the other factors that may contribute to falls in PD?
- Increased age
- Visual impairment
- Slower cadence
- Reduced gait speed
- Reduced TUG
- Bradykinesia
- Multiple medications
- Increased disease severity & duration
What is included in the assessment of falls risk in PD?
- Freezing of gait (FOG)
- Previous falls
- Walking speed
What are the outcome measure cut-off scores for assessing falls risk in PD?
- TUG: >16s (compared to >13.5s in healthy older adults)
- Pastor’s test: > or equal to 2
- Berg balance: <45/56
- Dynamic gait index (>18/24 in health older adults)
What are the reliable and valid measurement tools for falls?
- Falls efficacy scale international
- Activity-specific balance confidence scale (ABC scale)
- Falls diary
What did Allen et al 2011 find regarding balance & exercise in PD?
- Systematic review & meta-analysis
- Exercise &/or motor training significantly improved balance-related activity performance
- No evidence of effect on falls reduction
What did Morris et al 2015 find when comparing movement strategies & progressive resistance training (PRT)?
- RCT comparing movement strategies + falls education, PRT + falls education & control
- 2 hours, 1 x week, 8 weeks
- Both reduced falls compared to control (PRT by 85%, MST by 61.5%)
- No difference in time to first fall, proportion of multiple falls or number of injurious falls
What did Canning et al 2015 find regarding exercise therapy for falls?
- RCT comparing home exercise program (balance, freezing, strength) + falls prevention advice with control (usual care, falls prevention advice)
- Falls rate decreased in people with lower disease severity
- Falls rates increased in people with higher disease severity
What did Li et al 2014 find regarding Tai chi in PD?
- Compared stretching vs resistance vs tai chi
- 60 mins, 2 x week, 24 weeks
- Tai chi group had reduced number of falls throughout intervention & at 3 month follow up
What are the general principles when choosing interventions for reducing falls in PD?
- Train balance
- Use external cueing (movement strategies)
- Apply PRT principles
- Environmental setup/lifestyle modification
- Tailor programs based on individual falls risk & present risk factors
What are the strategies that should be implemented for low risk of falls?
- Falls prevention addressed in early stage of disease
- Balance-challenging exercises
- Group balance class early
- Strength training & large trunk movements to prevent disuse weakness & flexed posture
- Falls education & prevention early
- Community-based options
