Falls in Parkinson's disease: Kinematic evidence for impaired head and trunk control

Authors

  • Michael H. Cole PhD,

    1. Movement Neuroscience Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
    2. School of Human Movement Studies, Queensland University of Technology, Australia
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  • Peter A. Silburn PhD, FRACP,

    1. Movement Neuroscience Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
    2. University of Queensland Centre for Clinical Research, Royal Brisbane and Womens Hospitals, Australia
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  • Joanne M. Wood PhD,

    1. School of Optometry, Queensland University of Technology, Australia
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  • Charles J. Worringham PhD,

    1. School of Human Movement Studies, Queensland University of Technology, Australia
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  • Graham K. Kerr PhD

    Corresponding author
    1. Movement Neuroscience Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
    2. School of Human Movement Studies, Queensland University of Technology, Australia
    • Movement Neuroscience Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
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  • Potential conflict of interest: Nothing to report.

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

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