How People with Parkinson's Disease Describe their Difficulties in Turning

Abstract

Background: 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 turningand 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 participats 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.