Balance Difficulties Research Articles

Athletic Trainer Perceptions of Life-Work Balance and Parenting Concerns

Life-work balance may be one reason for retention concerns among athletic trainers (ATs), yet evidence does not exist to support the supposition. To assess the perceptions of ATs regarding life-work balance, specifically on parenting issues. Survey. Online survey at www.surveymonkey.com . A random sample of National Athletic Trainers' Association members (N = 9516) received the survey; 20.6% (n = 1962; male = 954, female = 816; age = 37 ± 10 years, experience = 13 ± 9 years) completed any portion of the survey. Most respondents worked in the college/university (34.5%, n = 657 of 1908) and secondary school settings (25.9%, n = 476 of 1908). A majority of participants (50.7%, n = 898 of 1770) were parents. We calculated frequencies and percentages and used Mann-Whitney U tests and Kruskal-Wallis tests to identify the differences between sexes and among job settings on life-work balance measures among parents. The questionnaire included 8 life-work balance items, 7 parenting challenge items, and 3 nonparent items. The results indicate that sex and setting significantly affected perceptions about parenting. Males articulated a stronger sense of difficulty in finding balance as a working parent (P < .001; 1.95 ± 1.98). Females felt more strongly than males that managing work and family was stressful (P = .04; 3.86 ± 1.13) and caused burnout (P = .004; 3.50 ± 1.24), and that their energy tended to fall short of their needs (P < .001; 3.74 ± 1.15). The decision not to have children was strongly affected by the work setting (P = .014; 3.37 ± 1.42). Both college/university (4.14 ± 0.85) and secondary school (4.03 ± 0.90) ATs would prefer to spend more time at home, as compared with ATs in other settings (P < .001). College/university ATs (P = .025; 3.17 ± 1.23) felt most strongly that their families were neglected because of work. In none of the settings did ATs feel that their employment settings were particularly tolerant of their parenting responsibilities (P = .027; 1.72 ± 1.97). Male and female employees had similar perceptions of life-work balance, but occupational setting may affect these perceptions.

Diffusion weighted MR imaging of 5-fluorouracil and oxaliplatin-induced leukoencephalopathy

A 55-year-old man treated with 5-fluorouracil and oxaliplatin for advanced sigmoid colon cancer presented with seizures, progressive gait and balance difficulties with frequent falls and slurring of speech. After three cycles of chemotherapy, brain magnetic resonance imaging using diffusion-weighted imaging clearly revealed the presence of high signal intensity in the deep white matter of the bilateral cerebral hemispheres, including the corpus callosum symmetrically. A diagnosis of acute leukoencephalopathy was made based on these findings. His clinical symptoms normalized after the discontinuation of the chemotherapy. Early detection of drug-induced leukoencephalopathy is important as the clinical symptoms can be reversed by early discontinuation of the causative drug. Diffusion-weighted magnetic resonance imaging is a useful modality for the early detection and definitive diagnosis of this characteristic encephalopathy.

Symptomatic Treatment in Multiple Sclerosis

Multiple sclerosis (MS) is a progressive and disabling neurodegenerative disease that primarily affects young adults. Despite significant therapeutic advances in the prevention of relapses, individuals with MS experience a variety of symptoms, most notably fatigue, spasticity, depression, gait and balance difficulties, and sexual dysfunction. These symptoms may interfere with activities of daily living and have a negative impact on quality of life. This review discusses treatment options for these symptoms.

Symptomatic Treatment in Multiple Sclerosis

Multiple sclerosis (MS) is a progressive and disabling neurodegenerative disease that primarily affects young adults. Despite significant therapeutic advances in the prevention of relapses, individuals with MS experience a variety of symptoms, most notably fatigue, spasticity, depression, gait and balance difficulties and sexual dysfunction. These symptoms may interfere with activities of daily living and have a negative impact on quality of life. This review discusses treatment options for these symptoms.

Functional Balance Assessment With Pediatric Balance Scale in Girls With Visual Impairment

To examine functional balance abilities in girls with visual impairment (VI) and to investigate the correlation between stabilography and clinical balance assessment using the Pediatric Balance Scale (PBS) in girls with VI. The PBS and stabilography were administered to 26 girls with VI aged 10 to 15 years. The association between PBS scores and sway parameters was examined using the Spearman correlation coefficient. The range of PBS scores was 47 to 56. Balance difficulties appeared in single-leg stance, tandem stance, and reaching forward. The PBS scores correlated with all but 2 sway parameters, with r values ranging from -0.18 to -0.58. Girls with VI present difficulties in upright stance when the size of the base of support is narrowed and in situations where the center of gravity approaches the edge of the base of support. There is a need to provide interventions to improve balance abilities in girls with VI.

A Study to assess the effectiveness of Nesting on Posture and Movements among Preterm Babies in Selected Hospitals at Mysore

Background: Preterm babies are the most vulnerable group to get adjusted to the new environment. Following birth, the first few months acts as a transitory period during which the baby adjusts from the aquatic to the aerial environment. As a result, the way in which baby is positioned throughout this time is very important and his posture dictates the level of his wellbeing. Promoting good positioning and encouraging opportunities for flexion can prevent the problems like motor coordination, balance and posture difficulties. The correct positioning will help the baby to develop good posture and improve muscle control. Method: In this study, a quasi-experimental control group pretest- posttest design was used and non probability convenience sampling technique was adopted to select 60 preterm babies, both in experimental and control group. Pilot study was conducted, the tool and study design were found to be feasible. Data were collected using structured observation checklist for posture and movement. An intervention, nesting was provided for the experimental group. The data were collected and analyzed using descriptive and inferential statistics. Results: The result of the study revealed that the significance of difference between the mean pretest and post test posture score which was statistically tested using paired 't' test and was found to be highly significant at 0.05 level of significance.(t(29) = 5.42 in post test 1, 46.14 in post test 2 and 56.82 in post test 3 ; (p < 0.05) and the significance of difference between the mean post test posture score between experimental and control group which was statistically tested using independent 't' test was found to be highly significant at 0.05 level of significance t(58) = 7.41, 7.89 and 8.49; (p < 0.05 ). The significance of difference between the mean pretest and mean post test movement score which was statistically tested using paired 't' test was found to be highly significant at 0.05 level of significance.(t(29) = 36.94 in post test 1, 15.59 in post test 2 and 22.80 in post test 3 ; p< 0.05 ) and the significance of difference between the mean post test movement score between experimental and control group which was statistically tested using independent t test was found to be highly significant at 0.05 level of significance. (t(58) = 8.12, 5.26 and 4.88 ; p < 0.05 ). The result shows that the posture and movement score had no significant association with their selected personal variables. Conclusion: Therefore, the study concluded that the nesting was an effective method to maintain the normal posture and movement of preterm babies.

Orexin receptor antagonists as therapeutic agents for insomnia

Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, or non-restorative sleep with impairment of daytime functioning. Currently, treatment for insomnia involves a combination of cognitive behavioral therapy (CBTi) and pharmacological therapy. Among pharmacological interventions, the most evidence exists for benzodiazepine (BZD) receptor agonist drugs (GABAA receptor), although concerns persist regarding their safety and their limited efficacy. The use of these hypnotic medications must be carefully monitored for adverse effects. Orexin (hypocretin) neuropeptides have been shown to regulate transitions between wakefulness and sleep by promoting cholinergic/monoaminergic neural pathways. This has led to the development of a new class of pharmacological agents that antagonize the physiological effects of orexin. The development of these agents may lead to novel therapies for insomnia without the side effect profile of hypnotics (e.g., impaired cognition, disturbed arousal, and motor balance difficulties). However, antagonizing a system that regulates the sleep-wake cycle may create an entirely different side effect profile. In this review, we discuss the role of orexin and its receptors on the sleep-wake cycle and that of orexin antagonists in the treatment of insomnia.

Effect of treatment for paediatric cancers on balance: what do we know? A review of the evidence

This review aims to explore the literature investigating balance outcomes in survivors of childhood cancer. A structured search of five databases resulted in 16 articles included in this review. Nearly all were classified as Level 4 evidence using the updated Oxford Centre for Evidence-Based Medicine Levels of Evidence. Balance abilities have been investigated solely in survivors of acute lymphoblastic leukaemia or central nervous system tumours. The literature tends to support the idea that survivors present with balance difficulties but the results need to be closely scrutinised. Several studies report results using the same experimental group, while other studies use balance outcome measures that have not had their psychometric properties assessed with this population. There are also few studies that evaluate dynamic balance abilities in survivors of paediatric cancers, which may be more influential on functional tasks. Furthermore, very few of the included studies investigate how the found balance deficits affect this population's daily lives, which would be necessary in order to determine if intervention should be geared towards this area. Directions for future research should also include multi-centred, clinically oriented trials to evaluate balance abilities in survivors of childhood cancers compared with healthy control subjects in order to strengthen the literature.

Adult-Onset Opsoclonus-Myoclonus Syndrome

BACKGROUND Little is known about adult-onset opsoclonus-myoclonus syndrome (OMS) outside of individual case reports. OBJECTIVE To describe adult-onset OMS. DESIGN Review of medical records (January 1, 1990, through December 31, 2011), prospective telephone surveillance, and literature review (January 1, 1967, through December 31, 2011). SETTING Department of Neurology, Mayo Clinic, Rochester, Minnesota. PATIENTS Twenty-one Mayo Clinic patients and 116 previously reported patients with adult-onset OMS. MAIN OUTCOME MEASURES Clinical course and longitudinal outcomes. RESULTS The median age at onset of the 21 OMS patients at the Mayo Clinic was 47 years (range, 27-78 years); 11 were women. Symptoms reported at the first visit included dizziness, 14 patients; balance difficulties, 14; nausea and/or vomiting, 10; vision abnormalities, 6; tremor/tremulousness, 4; and altered speech, 2. Myoclonus distribution was extremities, 15 patients; craniocervical, 8; and trunk, 4. Cancer was detected in 3 patients (breast adenocarcinoma, 2; and small cell lung carcinoma, 1); a parainfectious cause was assumed in the remainder of the patients. Follow-up of 1 month or more was available for 19 patients (median, 43 months; range, 1-187 months). Treatment (median, 6 weeks) consisted of immunotherapy and symptomatic therapy in 16 patients, immunotherapy alone for 2, and clonazepam alone for 1. Of these 19 patients, OMS remitted in 13 and improved in 3; 3 patients died (neurologic decline, 1; cancer, 1; and myocardial infarction, 1). The cause of death was of paraneoplastic origin in 60 of 116 literature review patients, with the most common carcinomas being lung (33 patients) and breast (7); the most common antibody was antineuronal nuclear antibody type 2 (anti-Ri, 15). Other causes were idiopathic in origin, 38 patients; parainfectious, 15 (human immunodeficiency virus, 7); toxic/metabolic, 2; and other autoimmune, 1. Both patients with N -methyl-D-aspartate receptor antibody had encephalopathy. Improvements were attributed to immunotherapy alone in 22 of 28 treated patients. CONCLUSIONS Adult-onset OMS is rare. Paraneoplastic and parainfectious causes (particularly human immunodeficiency virus) should be considered. Complete remission achieved with immunotherapy is the most common outcome.

A quick and easy-to-use clinical scale to assess balance in Parkinson&amp;#39;s disease

A quick and easy-to-use clinical scale to assess balance in Parkinson&#39;s disease Abraham Lieberman,1 Sara Dhanani,1 Rohit Dhall,1 Di Pan21Muhammad Ali Parkinson Center (MAPC) of Barrow Neurological Institute, St Joseph&#39;s Hospital and Medical Center, Phoenix, AZ, USA; 2Center for Health Information and Research, Arizona State University, Tempe, AZ, USABackground: Balance difficulty is a major contributor to falls in Parkinson&#39;s disease (PD). However, the new Movement Disorder Society Unified Parkinson&#39;s Disease Rating Scale (MDS-UPDRS) motor examination contains only one subtest &ndash; postural instability &ndash; and it is only 3% of the total that assesses balance. There are several balance scales, but they were not developed for PD and they do not complement the MDS-UPDRS. There is a need for a quick and easy-to-use balance scale in PD and one that complements the MDS-UPDRS.Methods: The Barrow Neurological Institute (BNI) balance scale was developed as a complement to the MDS-UPDRS and was used to evaluate the risk of falling in 53 PD patients. There were nine patients who fell three times per month (&quot;fallers&quot;). The BNI scale was compared with the widely used Tinetti scale. The Tinetti scale has 16 subtests; the BNI scale has five.Results: The nine fallers had a significantly longer PD duration, a higher MDS-UPDRS score, a higher (worse) BNI balance score, and a lower (worse) Tinetti score compared to 44 nonfallers. Fallers were significantly more impaired on the MDS-UPDRS subtest of postural stability and on the BNI scale. A BNI scale score &ge; 13 had a sensitivity of 100% and a specificity of 88.6% in identifying fallers, whereas a Tinetti scale score &le; 18 had a sensitivity of 55.6% and a specificity of 95.5% in identifying fallers. The BNI scale with five subtests is easier to perform than the Tinetti with 16 subtests.Conclusion: The BNI balance scale is more sensitive and specific in predicting falls than the Tinetti. It is a useful adjunct to the MDS-UPDRS.Keywords: balance, falls, Parkinson&rsquo;s disease, Tinetti scale

The Role of Energetic Cost in the Age‐Related Slowing of Gait Speed

To determine whether slow gait represents a compensatory strategy to reduce the energetic cost of walking with age. Cross-sectional analysis. Community-dwelling volunteers from the Baltimore Longitudinal Study of Aging (BLSA). Four hundred twenty community-dwelling persons aged 32 to 96 (mean 68.1±12.5) who underwent a physical examination, physical function testing, and energy expenditure assessment. Energy expenditure per minute (mL/kg/min) and per meter (mL/kg/m) during 2.5minutes of overground walking at customary speed and usual gait speed over 6m (m/s) were examined. General linear regression models were used to assess the relationship between customary walking energy expenditure and usual gait speed, adjusted for potential confounders including smoking, medical diagnoses, walking-related pain, and balance difficulty. Usual gait speed was slower with increasing age after age 65. Energy expenditure per minute during customary walking averaged 13.0±2.8mL/kg/min and was independent of age (ρ<0.01, P=.88). In contrast, energy expenditure per meter walked was progressively higher after age 65 (ρ=0.35, P<.001) and heightened after age 80 (r=0.57, P<.001), mirroring the observed pattern of usual gait speed. This relationship remained significant after adjusting for multiple impairments and comorbidities. These observations support the hypothesis that slower gait at older ages may reflect a compensatory action to offset the greater energetic cost of walking associated with aging and chronic conditions. Future studies should evaluate the specific mechanisms that contribute to this phenomenon as novel targets for clinical intervention.

S.P.44 Evaluation of a balance exercise programme in DM 1: A single-subject experimental study with 11 participants

The aim of this study was to evaluate the effects of an individualised balance exercise programme in patients with myotonic dystrophy type 1 (DM1). A single-subject experimental design was used: baseline, intervention and second baseline (ABA) with repeated assessments. Eleven DM1 patients with subjective or objective balance difficulties (outpatients) participated in a balance exercise programme with individualised exercises at the hospital-based physiotherapy department. The balance exercise programme was attended during 10 weeks (two sessions/week). Primary outcome measure was self-assessed balance confidence in three self-chosen activities, in which the balance was a problem. Secondary outcome measures were the Activities-specific Balance Confidence (ABC) scale, dynamic balance performance assessed with Step test and Timed Up and Go, together with Timed 10 m walk at maximum pace, isometric muscle force in leg muscles and number of falls. The most important findings were: 7/11 patients experienced a significant increase in balance confidence (>+2SD) in at least one self-selected activity, 9/11 scored a higher overall balance confidence in ABC scale (mean +13%, p = 0.014), and increased balance performance in Step test (mean +18%, p = 0.008). All patients deteriorated in the ankle dorsiflexor force (mean −17%, p = 0.003). The knee extensor force remained unchanged. The study showed that self-assessed balance confidence, as well as balance performance measured with Step test, is likely to increase following an individualised balance exercise programme in persons with DM1. It is important to note that distal muscles in DM1 patients are at risk of exhaustion during exercise, these patients therefore require close supervision when participating in these training sessions.

A Simple Question About Falls to Distinguish Balance and Gait Difficulties in Parkinson's Disease

ABSTRACTAlthough gait and balance difficulties often occur together in Parkinson's disease (PD) patients, it is believed that they are actually two separate symptoms. However, there are no simple tests to distinguish them. We have developed the self-administered Barrow Neurological Institute (BNI) question to distinguish between gait and balance issues in PD and it was tested in 102 consecutive PD patients. The responses were compared with those of the walking and balance question (item # 2.12) of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and the MDS-UPDRS motor examination and its subsets such as gait and postural stability (PS). Fifty-five patients reported balance difficulty on the BNI question and 64 reported walking and balance difficulty on the MDS-UPDRS question. Of the patients who reported balance difficulty on the BNI question, 74.5% had a PS score ≥2 and 25.4% fell at least three times per month. Of the patients who reported walking and balance difficulty on the MDS-UPDRS question, only 59.4% had a PS score ≥2 and only 10.9% fell three or more times per month. These statistically significant results suggest that the BNI question is better able to detect balance difficulty and its associated falls in PD and can be a supplement to the MDS-UPDRS or a stand-alone question to evaluate balance difficulty and its associated falls in PD.

A Modularized Two-Stage Charge Equalizer With Cell Selection Switches for Series-Connected Lithium-Ion Battery String in an HEV

In lithium-ion battery system for hybrid electric vehicle, charge equalizer is essential to enhance the battery life cycle and safety. However, for a large number of battery cells, a conventional equalizer has the difficulty of individual cell balancing and the implementation size problem as well as the cost. Moreover, it shows high voltage stress of electrical elements in the equalization converter due to the high voltage of battery pack. To improve these drawbacks, this paper proposes a modularized two-stage charge equalizer with cell selection switches. The proposed circuit employs the two-stage dc-dc converter to reduce the voltage stress of equalization converter. Contrary to conventional method, the proposed equalizer can achieve the individual cell balancing only through the cell selection switches. With the two-stage converter and the cell selection switches, the proposed equalizer leads to the great size reduction with lower cost which brings advancement of individual cell balancing in a large number of battery cells. In this paper, a prototype for 88 lithium-ion battery cells is optimally designed and implemented. Experimental results are presented to verify that the proposed equalization method has a good cell balancing performance showing the low voltage stress and small size with the lower cost.

Characteristics of falls in inpatient psychiatric units

Falls in inpatient psychiatric units are more frequent than in other age-matched unit types. We set out to explore factors associated with falls in inpatient units in a large metropolitan mental health service. Contributory factors, location, activity and outcomes were identified for 559 falls. Overall falls rates were also calculated. Falls rate was 1.25 per 1000 occupied bed days, with highest rates in psychogeriatric units. Almost 50% of falls were related to physiological factors, with balance or mobility difficulties accounting for 19% of all falls. Falls most frequently occurred in bedrooms, outdoor areas, corridors and bathrooms. The most common activity at the time of the fall was walking (41%) and transfers were associated with 17% of falls. Outcomes were evenly spread between no outcome and minor to moderate injury. No severe injuries were reported. Although falls may have been under-reported, this study establishes an analysis framework and baseline data for the monitoring of falls in inpatient psychiatric units in Australia.

E-016 Low cost, efficient, highly effective method for therapeutic arterial occlusion of the internal carotid or vertebral artery with flow control

Therapeutic internal carotid or vertebral artery occlusion is occasionally recommended for a variety of cerebrovascular diseases, including giant aneurysms, vessel ruptures, and arteriovenous fistulae. With the removal of detachable balloons...

The Transformation of Leave Policies for Work-Family Balance in Taiwan

This paper examines the development of leave policies in Taiwan in the 2000s. With the changes in gender roles, family patterns, and demographic structure, the Taiwanese government has implemented leave policy changes to respond to the difficulties in work-family balance and the declining fertility rate. The development of leave policies in Taiwan can be generally divided into two stages according to the dimensions of policy changes. At the first stage, the changes were mostly on provision and regulatory framework. The enactment of the GEEL in 2002 introduced several new regulations on employers to provide paternity leave, family leave, parental leave, and flexible working time arrangements. At the second stage, the dimension of policy change moved to the reallocation of financial responsibilities, particularly the implementation of parental leave benefit. There were two important factors which made the reallocation of financial responsibilities feasible in the second stage. Firstly, the launch of the Employment Insurance provided the financial resources for policy makers to convert existing institutions to meet new needs. Secondly, the growing concern for the low fertility rate in Taiwan strengthened the imperative to redistribute financial responsibilities in leave policies to address this problem. After the changes in the 2000s, the responsibilities of employers in providing leave arrangements have been expanded. The state also strengthened its role in regulation. In terms of the dimension of finance, a large percentage of financial responsibilities have been transferred from families to employers and the state, mainly through the adoption of existing social insurance schemes. Overall, the pattern of leave policies in Taiwan is transforming from the stress on family responsibilities toward more employer and state responsibilities.

Fractures among long‐term survivors of childhood cancer

Although reductions in bone mineral density are well documented among children during treatment for cancer and among childhood cancer survivors, little is known about the long-term risk of fracture. The objective of this study was to ascertain the prevalence of and risk factors for fractures among individuals participating in the Childhood Cancer Survivor Study (CCSS). Analyses included 7414 ≥ 5-year survivors of childhood cancer diagnosed between 1970 and 1986 who completed the 2007 CCSS follow-up questionnaire and a comparison group of 2374 siblings. Generalized linear models stratified by sex were used to compare the prevalence of reported fractures between survivors and siblings. The median ages at follow-up among survivors and siblings were 36.2 years (range, 21.2-58.8 years) and 38.1 years (range, 18.4-62.6 years), respectively, with a median 22.7 years of follow-up after cancer diagnosis for survivors. Approximately 35% of survivors and 39% of siblings reported ≥ 1 fracture during their lifetime. The prevalence of fractures was lower among survivors than among siblings, both in males (prevalence ratio, 0.87; 95% confidence interval, 0.81-0.94; P < .001) and females (prevalence ratio, 0.94; 95% confidence interval, 0.86-1.04; P = .22). In multivariable analyses, increasing age at follow-up, white race, methotrexate treatment, and balance difficulties were associated with increased prevalence of fractures among female survivors (P = .015). Among males, only smoking history and white race were associated with an increased prevalence of fracture (P < .001). Findings from this study indicated that the prevalence of fractures among adult survivors did not increase compared with that of siblings. Additional studies of bone health among aging female cancer survivors may be warranted.

A Case of Sleep Masturbation Related to Dopamine Agonist Therapy

To the Editor: Dopamine agonists are well known for precipitating compulsive behaviors, including pathological gambling, compulsive eating, compulsive buying, and hypersexuality1,2 as well as compulsive or repetitive weighing of oneself, card/video game playing, locking/unlocking doors, and dressing and undressing.3 With regard to hypersexuality, compulsive masturbation has been previously described in the literature.4,5 However, we are not aware of any cases of sleep masturbation (ie, masturbating while fully asleep) during dopamine agonist therapy. In the following case report, we describe an elderly man, on treatment with pramipexole for Parkinson’s disease, whose wife reported his unusual behavior of masturbating while fully asleep, which was temporally related to dopamine agonist therapy. Case report. Mr A, a 75-year-old white, married man with a history of hypertension, coronary artery disease, benign prostatic hypertrophy, diabetes, gastroesophageal reflux, and mild dementia, was prescribed losartan 50 mg/d, clopidogrel 75 mg/d, atorvastatin 80 mg/d, omeprazole 20 mg/d, and donepezil 5 mg/d. In early 2010, the patient began to experience balance difficulties, stiffness, and shuffling gait. He was evaluated by his primary care physician in October 2010, diagnosed with Parkinson’s disease, and referred to a neurologist. The neurologist prescribed treatment with pramipexole, which was initiated in March 2011 at 0.375 mg/d and titrated to 1.5 mg/d over a 2-week period. When the patient was seen by his primary care physician in May 2011, the Parkinson’s symptoms had considerably improved. However, the patient reported new-onset daytime compulsive masturbation that temporally paralleled his exposure to pramipexole. The patient’s spouse of 10 years, who accompanied him to the appointment, reported that the patient masturbated during sleep as well. The patient was advised to discuss this possible adverse effect of pramipexole therapy with his neurologist. When seen again by his primary care physician in July 2011, the patient had discontinued pramipexole in response to his neurologist’s recommendation. With the cessation of pramipexole, the behavior of sleep masturbation promptly and totally abated. Hypersexuality related to dopamine agonist therapy appears to affect a minority of patients. According to Voon and colleagues,6 in a sample of 297 patients with Parkinson’s disease, 2.4% reported drug-related hypersexual behavior. Likewise, after initiating dopamine agonist therapy for Parkinson’s disease, Bostwick and colleagues7 reported the prevalence of either hypersexuality or new-onset gambling at 2.6%. Therefore, while dopamine agonist–induced hypersexuality is uncommon, it appears to affect a significant minority of patients. Importantly, masturbation during sleep has been reported in various medical or psychological conditions, which this patient did not exhibit. For example, Guilleminault and colleagues8 examined 11 individuals with sleep-related atypical sexual behavior, including masturbation, and found associations with psychological symptoms such as guilt, shame, and depression. Schenck and colleagues9 reported sleep masturbation among individuals with parasomnias and sleep-related epilepsy. Because hypersexuality, including sleep masturbation, is an embarrassing symptom that may not be spontaneously reported by patients on dopamine agonist therapy or their significant others/families, we suggest that all patients be queried about various compulsive behaviors after initiating therapy with dopamine agonists. These socially disabling behaviors typically abate with dose reduction or discontinuation of the dopamine agonist.1

Fear of Falling and Coexisting Sensory Difficulties As Predictors of Mobility Decline in Older Women

Mobility decline, the coexistence of several sensory difficulties and fear of falling (FOF) are all common concerns in older people; however, knowledge about the combined effect of FOF and coexisting sensory difficulties on mobility is lacking. Data on self-reported FOF, difficulties in hearing, vision, balance, and walking 2 km were gathered with a structured questionnaire among 434 women aged 63-76 years at baseline and after a 3-year follow-up. Logistic regression models were used for analyses. Every third participant reported difficulties in walking 2 km at baseline. In cross-sectional analysis, the odds ratio for difficulties in walking 2 km was higher among persons who reported FOF compared with persons without FOF and the odds increased with the increasing number of sensory difficulties. Persons who reported FOF and who had three sensory difficulties had almost fivefold odds (odds ratio = 4.7, 95% confidence interval = 1.9-11.7) for walking difficulties compared with those who reported no FOF and no sensory difficulties. Among the 290 women without walking difficulties at baseline, 54 participants developed difficulty in walking 2 km during the 3-year follow-up. Odds ratio for incident walking difficulty was 3.5 (95% confidence interval = 1.6-7.8) in participants with FOF and with 2-3 sensory difficulties compared with persons without FOF and with at most one sensory difficulty at baseline. Older women who have several coexisting sensory difficulties combined with FOF are particularly vulnerable to mobility decline. Avoidance of walking as a result of FOF is likely to be reinforced when multiple sensory difficulties hinder reception of accurate information about the environment, resulting in accelerated decline in walking ability.