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Impaired Backward Walking Linked to Motor Symptoms, Fear of Falling in Early Parkinson’s, Korean Study Suggests

backward walking

Backward walking is significantly impaired and associated with motor symptoms and fear of falling in newly diagnosed Parkinson’s patients, a small Korean study suggests.

These results point to backward walking parameters as potential biomarkers of Parkinson’s disease progression. The researchers called for future studies investigating the dynamics of backward walking in people with Parkinson’s, and its link to falls.

The study, “Backward Gait is Associated with Motor Symptoms and Fear of Falling in Patients with De Novo Parkinson’s Disease,” was published in the Journal of Clinical Neurology.

People with Parkinson’s are at a significant risk of falls due to gait (walking) and balance problems. Specifically, these patients show increased stride-to-stride variability and take shorter and slower steps.

While most gait studies in people with Parkinson’s have focused on walking forward, backward gait has been suggested to be even more impaired in these patients. It’s also been associated with freezing of gait, defined as not being able to start stepping forward, with no apparent cause.

Several studies have also shown that people with Parkinson’s have considerably more difficulties in walking while performing a secondary cognitive task, known as dual-task gait. Dual-tasking measures an individual’s ability to carry out a cognitive task — such as counting, or naming words that start with a particular letter — while engaging in a motor skill like walking.

However, since changes in walking parameters are closely associated with the progression of motor symptoms, most of what is known about walking difficulties in Parkinson’s patients comes from studies preformed in people at advanced stages of the disease.

Thus, understanding gait dynamics and difficulties in early-stage Parkinson’s disease remains largely unknown.

Now, a team of Korean researchers set out to determine which type of gait — forward, backward, or dual-task — was more strongly associated with motor symptoms or the risk of falling in people with de novo Parkinson’s disease, meaning they are newly diagnosed and still untreated.

The study involved 24 individuals with de novo Parkinson’s — 13 men and nine women, who had the disease for less than five years, were between 50 and 75 years old, and were able to perform various types of gaits. An additional 27 unaffected people, including 16 men and 11 women, were used as controls.

Clinical data for all participants was measured through several tests and scales, including the Korean version of the Montreal Cognitive Assessment, the Fear of Falling Measure (FFM) — a rating scale in which lower scores indicate greater fear of falling — and the Unified Parkinson’s Disease Rating Scale part II and III, which assesses motor symptoms.

The participants’ gait parameters were analyzed using the computerized GAITRite system with a 4.6-meters (16 foot) long, pressure-sensitive walkway mat. Each type of gait was tested 10 times while walking at a comfortable speed. Dual-task gait consisted of walking while subtracting serial sevens.

Results showed that de novo Parkinson’s patients had a slower walking speed and shorter stride in all three gaits, compared with unaffected people. However, backward gait showed the highest stride-to-stride variability in both stride time and length.

Dual-task gait also showed significant variability in stride length between the two groups of participants, while forward gait showed no significant differences.

When looking at the potential associations between gait speed, motor symptoms, and fear of falling in these patients, the team found that reduced backward gait speed was significantly associated with a wider range of motor symptoms. These included walking difficulties, bradykinesia (difficulty in body movement), postural instability, and total motor score. These individuals also had an increased fear of falling.

Reduced dual-task gait speed was specifically linked to worse bradykinesia and total motor score, while reduced forward gait speed was associated with reduced tremor score. That was consistent with previous studies suggesting that reduced gait speed is “more pronounced in non-tremor-dominant [Parkinson’s] patients,” the researchers said. None of these gaits’ speeds were associated with fear of falling.

“These results indicate that slow walking with a short stride is a clear feature of de novo PD regardless of the gait task being performed, and the earliest alterations of gait variability may first become apparent in [backward gait], followed by [dual-task gait] and then [forward gait],” the researchers said.

The team added that these findings suggest that backward walking speed is more strongly associated with the risk of falling and is “a potential surrogate marker for the progression of motor symptoms or gait impairment in PD.”

Future studies are required to confirm and better understand the association of backward gait and motor symptoms and to investigate the clinical relevance of stride-to-stride variability in the different types of gaits, the researchers said. They also called for additional studies into the link between backward walking and falls in people with Parkinson’s disease.

The post Impaired Backward Walking Linked to Motor Symptoms, Fear of Falling in Early Parkinson’s, Korean Study Suggests appeared first on Parkinson’s News Today.

New Method Developed to Identify Fear of Falling Among Parkinson’s Patients

A new tool to measure fear of falling may help improve patients’ personalized care, reduce the risk of falls, and enhance physical and social activity among patients with Parkinson’s disease, a study reports.
The study, “Differentiating cognitive or motor dimensions associated with the perception of fall-related self-efficacy in Parkinson’s disease,” was published in npj Parkinson’s Disease.
Fear of falling is a common concern among the elderly that can present a significant barrier to their physical and social activities, negatively affecting their quality of life and general health.
Parkinson’s disease carries one of the highest risks of falls among neurological illnesses. The decline of both cognitive and motor function, which characterize this disease, can significantly limit a person’s ability to perform daily tasks. It can also increase the fear of falling — a result of a person’s perceived risk of falling and cognitive functioning.
While it has been frequently proposed that the therapeutic management of fear of falling should focus on improving lower-level mobility problems, Parkinson’s patients can have cognitive dysfunction early in the course of the disease that may occur independently from motor system pathology.
As a result, a fear of falling may arise due to poor cognitive functioning rather than an underlying motor system impairment.
“It would therefore be highly desirable to develop precision medicine methods that would be able to differentiate domain-specific contributions of cognitive or motor impairments with respect to fear of falling,” the researchers wrote.
Researchers used analytical and machine-learning approaches to analyze data collected from 57 Parkinson’s patients who were registered in an ongoing trial (ISRCTN06023392) assessing a home-based music walking program called Ambulosono.
An integrated analysis revealed that data on Hoehn & Yahr (which measures Parkinson’s severity divided into five stages), UPDRS-III scores (a 50-question assessment of both motor and non-motor symptoms associated with Parkinson’s), and gait speed would all provide valuable information for the motor component domain. Visuospatial, attention, and memory retrieval test scores would make up the cognition domain.
Results showed that decreases in both motor and cognitive domain functioning were associated with an increased probability of fear of falling. In addition, the extracted cognitive components could significantly and independently predict fear of falling.
“The findings indicate the current standard treatment for fear of falling may not be effective for all patients. Many may benefit from treatments aimed at addressing their fear and improving their level of confidence to get up and be active,” study senior author Bin Hu, PhD, a professor at the University of Calgary and member of the Hotchkiss Brain Institute, said in a university news story.
Based on patients’ cognitive and motor characteristics, researchers built a predictive model that could separate patients with a fear of falling into different categories: those with mobility issues, those with cognitive dysfunction with relatively mild motor impairment, and those with a combination of the two. The model had an accuracy greater than 92%.
“Some patients have developed an excessive fear of falling that’s keeping them from participating in activities, but physically, they have no reason to be afraid,” Hu said. “On the opposite end of the spectrum, we discovered patients who are

Source: Parkinson's News Today

Beat It! Learning to Walk to Music Reduces Falls for Parkinson’s Patients

walking and music

A training program in which patients walk while listening to regular beats can improve the velocity and cadence of Parkinson’s disease patients, while reducing their risk of falling, a study shows.

The study, “Rhythmic auditory stimulation for reduction of falls in Parkinson’s disease: a randomized controlled study,” was published in the journal Clinical Rehabilitation.

Parkinson’s disease patients experience difficulties in movement that affect their ability to produce a steady gait, resulting in a high incidence of falls. More than half of all Parkinson’s patients fall recurrently.

While there are several training techniques to aid in maintaining a steady gait and avoiding falls, studies suggest that gait motor control is dependent on a patient’s internal timing and that rhythm-based training could reduce risk of falling.

The rhythmic auditory stimulation (RAS) technique is among the approaches used to synchronize gait movements with time cues. But there have been no studies assessing the benefits of RAS in Parkinson’s patients.

So, researchers in Canada set out to determine if a home-based RAS program could aid in decreasing falls in patients with that history.

The study was a randomized, controlled trial (NCT03316365) that involved 60 Parkinson’s patients, 47 of whom completed the study.

The RAS training protocol involved 30 minutes of daily walking using “click-embedded music,” which was designed to enhance rhythm perception. Essentially, patients listened to folk or classical music with embedded metronome beats while performing their walking exercises.

Participants were divided into two groups, experimental and control. Both groups received RAS training up to week 8, after which the control group stopped training and the experimental group continued. Then  training was resumed for the control group between weeks 16 and 24. Patients in the experimental group received RAS training for the entire 24 weeks.

Participants were assessed at the beginning of the study and at eight, 16, and 24 weeks following that. Assessment criteria included stride length, speed, balance, and falls.

As expected, no significant differences were seen between the two groups at week eight. However, at week 16, the experimental group showed significant improvement in velocity, cadence, stride length, decreased number of falls, and fear of falling compared to the control group.

At week 24 — after the control group had resumed RAS training — the signifiant differences in velocity, cadence, stride length, and fear of falling remained, but there were no longer significant differences in the number of falls.

Taken together, the findings indicate that “RAS gait training significantly reduced the number of falls and modified key [parameters] in gait control in patients with Parkinson’s disease,” researchers wrote.

“This clinical investigation demonstrates that RAS gait training is a potential intervention to reduce the risk of falling, since it directly addresses temporal instability, which is one of the most detrimental variables associated with falls,” they concluded.

The post Beat It! Learning to Walk to Music Reduces Falls for Parkinson’s Patients appeared first on Parkinson’s News Today.

Source: Parkinson's News Today