Abstract
<strong>Background:</strong> An understanding of the functional aspects of gait and balance has wide ramifications. Individuals with balance disorders often restrict physical activity, travel, and social commitments to avoid falling, and loss of balance confidence, itself, is a source of disability. We studied the functional aspects of gait in patients with essential tremor (ET), placing their findings within the context of two other neurological disorders (Parkinson’s disease [PD] and dystonia) and comparing them with age-matched controls. <strong>Methods:</strong> We administered the six-item Activities of Balance Confidence (ABC-6) Scale and collected data on number of falls and near-falls, and use of walking aids in 422 participants (126 ET, 77 PD, 46 dystonia, 173 controls). <strong>Results:</strong> Balance confidence was lowest in PD, intermediate in ET, and relatively preserved in dystonia compared with controls. This ordering reoccurred for each of the six ABC-6 items. The number of near-falls and falls followed a similar ordering. Use of canes, walkers, and wheelchairs was elevated in ET and even greater in PD. Several measures of balance confidence (ABC-6 items 1, 4, 5, and 6) were lower in torticollis cases than in those with blepharospasm, although the two groups did not differ with respect to falls or use of walking aids. <strong>Discussion:</strong> Lower balance confidence, increased falls, and greater need for walking aids are variably features of a range of movement disorder patients compared to age-matched controls. While most marked among PD patients, these issues affected ET patients as well and, to a small degree, some patients with dystonia.
Highlights
There is a growing appreciation of the presence of gait and balance problems in patients with essential tremor (ET), who demonstrate a mild degree of ataxia.[1,2,3,4,5] these problems are often mild, in some patients, they are marked.[6]
While the objective metrics of this gait and balance disorder have been the focus of considerable study, less attention has been devoted to the functional aspects of this gait difficulty in ET
Balance confidence was lowest in Parkinson’s disease (PD) cases, intermediate in ET cases, and relatively preserved in dystonia cases compared with controls (Table 1)
Summary
There is a growing appreciation of the presence of gait and balance problems in patients with essential tremor (ET), who demonstrate a mild degree of ataxia.[1,2,3,4,5] these problems are often mild, in some patients, they are marked.[6]. Individuals with balance disorders often deliberately restrict physical activity, travel, and social commitments to avoid the potential consequences.[7,8] They may reduce or eliminate normal daily activities, thereby lessening their quality of life, in order to avoid the potential for falls. In this way, loss of balance confidence, itself, is a potential source of disability.[7] There are surprisingly few data on functional gait in ET, and none directly comparing ET to Parkinson’s disease (PD) or dystonia cases. We further stratified ET cases based on a range of disease characteristics of a priori interest (e.g., greater total tremor score, presence of cranial tremor), hypothesizing that these would co-vary with extent of functional gait difficulty
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