ISSUES OF PARTICIPATION AND PERCEPTION OF BALANCE CONTROL IN PATIENTS WITH PARKINSON'S DISEASE.

Abstract

Purpose/Hypothesis: Parkinson's Disease (PD) is a movement disorder that leads to balance and movement control difficulty and resultant falls. Individuals with PD often appear fatigued and lacking in motivation to participate in activities. The purpose of this study was to explore differences in endurance, strength, perception of activities and perception of balance control between those fallers seen in a Geriatric Gait and Balance Disorders clinic with PD and those without PD. Subjects: We performed a retrospective review of 355 charts from patients referred to the Geriatric Gait and Balance Disorders Clinic. Participants were referred to this clinic because of problems resulting in falls. Charts were randomly selected from a pool of over one thousand and divided into two groups. Group one consisted of subject charts with a primary diagnosis of Parkinson's disease. Group two included the rest of the charts with individuals referred to the clinic for multiple reasons. Individuals with cerebral-vascular conditions and other cognitive disorders were excluded from this review. Materials/Methods: Individuals participating in the Gait and Balance clinic receive a comprehensive evaluation before, during and after completion of the recommended training program. This evaluation consists of multiple assessment tools to explore physical and cognitive aspects associated with falls. For the purpose of this study we reviewed results from the MOS-36 survey, the Falls Efficacy Scale, the Frenchay activities index, the 2-minute walk test, and dynamometry measurements of ankle dorsi-flexion, ankle plantar-flexion, knee extension, and hip abduction. Independent samples t-tests were used to compare both groups. Significance levels were established at 5% (p<.05). Results: Individuals with Parkinson's Disease did not differ significantly from those without PD in tests of strength and endurance. Independent sample t-tests revealed no significant differences between groups in the 2-minute walk test (p=.13) and strength measurements (all measurements p>.05). The two groups were significantly different in the Falls-Efficacy Scale (p=.02). Inspection of the two group means indicate that the PD group scored significantly lower (60.2) than the Non-PD group (70.1). This difference was not seen in the Frenchay Activities Index (p=.12) or MOS 36 Index (p=.14). Conclusions: Results of this study indicate that fallers with PD and those without PD are similar in endurance, strength, perception of physical limitations and IADLs. Clients with PD scored significantly lower in their confidence for balance control. A “floor” effect is possible when you use the MOS 36 and Frenchay Activity Index in frail elders, and we plan to explore a different method of activity analysis in the future. Clinical Relevance: Clients with PD who have significant falling problems demonstrate less confidence in their balance control than other clients who have falling problems. The low self-efficacy could impact motivation and interest in exercise and activities.