Abstract
Our purpose was to investigate if accommodating plantar flexion contractures will improve postural alignment, patient perceived stability, and balance in individuals with Parkinson’s disease (PD), and the correlation of plantarflexion (PF) contractures and the Falls Efficacy scale (FES). This was a single session pretest posttest study with subject as their own control. We recruited a convenience sample of 32 participants with PD who could independently ambulate 20 feet without assistive devices. The Institutional Review Board approved the study, and informed consent was obtained from all participants prior to their participation. The outcome measures included: sagittal plane posture photo, verbal numeric rating of perceived stability, 1-minute recording of double leg stance on an interface pressure map, functional reach test (FRT) and the Falls Efficacy Scale (FES). The intervention was the use of bilateral Adjust-a-Lift heel lifts worn inside the participants’ shoe. Assigned heel lift thickness was based on PF contracture severity, determined via passive talocrural dorsiflexion measurement. Photographic posture analysis was completed with free image measurement software. Sway measurements were taken of center of gravity tracing with Tekscan software. Statistical analysis included Paired t-tests for outcome measures and Pearson product correlation between the FES and PF contracture data. We found significant changes (p<.05) in increase in height (mean 1.00 cm), an anterior translation of the pelvis (mean 2.3cm), a more upright trunk angle (mean 1.37 degrees) and a more upright head angle (mean 2.61 degrees). Perceived stability significantly increased (mean 0.75) and functional reach significantly decreased (mean 2.22cm). Significant correlations (r=0.36–0.50) were found between the degree of PF contracture and the total scale score as well as reported fear of falling for questions that required walking on the FES. This study showed accommodating PF contractures with heel lift intervention significantly improved postural alignment and perceived stability, but decreased participants’ functional reach.
Highlights
Parkinson’s Disease (PD) is a progressive, neurodegenerative condition that reduces the basal ganglia’s dopamine production in the substantia nigra.[1]
Our purpose was to investigate if accommodating plantar flexion contractures will improve postural alignment, patient perceived stability, and balance in individuals with Parkinson’s disease (PD), and the correlation of plantarflexion (PF) contractures and the Falls Efficacy scale (FES)
This study showed accommodating PF contractures with heel lift intervention significantly improved postural alignment and perceived stability, but decreased participants’ functional reach
Summary
Parkinson’s Disease (PD) is a progressive, neurodegenerative condition that reduces the basal ganglia’s dopamine production in the substantia nigra.[1] Dopamine is an important neurotransmitter for multiple body functions including movement proficiency. Fall prevention is a critical topic in the PD population as falling is responsible for 30% of PD hospital admissions.[4] A recent study estimated that people with PD are 2–9 times more likely to fall, 50% of the PD population report falls, and 30% of those falls result in injury.[2] postural instability has been identified as an independent predictor of falls and a third of people with PD develop
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