Balance and fear of falling in Parkinson's disease.

To assess internal consistency and validity of measures of balance (Berg balance scale, BBS), postural changes (postural changes scale, PCS) and fear of falling (fear of fall measure, FFM) in 70 ambulant Parkinson's disease (PD) persons, these instruments were matched with performance-based balance and mobility tests, and other clinical, functional and quality of life PD-specific measures. The BBS, PCS and FFM showed a good internal consistency, moderate to good inter-correlation, and a significant correlation with measures of both disability (UPDRS-ADL, Schwab and England scale) and--to a lesser extent--impairment/severity of symptoms (UPDRS-ME, Hoehn and Yahr Scale). Tandem Romberg, Single-Limb Stance, Functional Reach, and the Timed Up & Go test correlated slightly better with BBS than with PCS and FFM. This study shows that problems of balance and postural control in PD patients result from complex interactions between motor impairment, functional abilities and fear of falling.

[1]  M. Morris,et al.  Chapter 3 Interaction of the basal ganglia and supplementary motor area in the elaboration of movement , 1995 .

[2]  S. Fritz,et al.  Rating scale analysis of the Berg Balance Scale. , 2004, Archives of physical medicine and rehabilitation.

[3]  Johan F. Hoorn,et al.  Distributed cognition , 2005, Cognition, Technology & Work.

[4]  B. Wright,et al.  Best Test Design. Rasch Measurement. , 1979 .

[5]  B. Bloem,et al.  Postural instability and falls in Parkinson's disease. , 2001, Advances in neurology.

[6]  D. Streiner,et al.  Health Measurement Scales: A practical guide to thier development and use , 1989 .

[7]  Comorbid disorders and hospitalisation in Parkinson’s disease: a prospective study , 2004, Neurological Sciences.

[8]  Ann Ashburn,et al.  Developing methods to evaluate how people with Parkinson's Disease turn 180°: an activity frequently associated with falls , 2004 .

[9]  Neil B Alexander,et al.  Tests of Stepping as Indicators of Mobility, Balance, and Fall Risk in Balance‐Impaired Older Adults , 2004, Journal of the American Geriatrics Society.

[10]  J Howland,et al.  Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). , 1998, The journals of gerontology. Series B, Psychological sciences and social sciences.

[11]  Joseph Jankovic,et al.  Clinical gait and balance scale (GABS): validation and utilization , 2004, Journal of the Neurological Sciences.

[12]  P J Holliday,et al.  Psychological indicators of balance confidence: relationship to actual and perceived abilities. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[13]  A. Fugl-Meyer,et al.  The Falls-Efficacy Scale, Swedish version: does it reflect clinically meaningful changes after stroke? , 2002, Disability and rehabilitation.

[14]  B. E. Maki,et al.  Fear of falling and postural performance in the elderly. , 1991, Journal of gerontology.

[15]  J. Turner Third Symposium on Parkinson's Disease , 1970 .

[16]  Marjorie H. Woollacott,et al.  Motor Control: Theory and Practical Applications , 1995 .

[17]  R Iansek,et al.  Performance on clinical tests of balance in Parkinson's disease. , 1998, Physical therapy.

[18]  Fuzhong Li,et al.  Fear of falling in elderly persons: association with falls, functional ability, and quality of life. , 2003, The journals of gerontology. Series B, Psychological sciences and social sciences.

[19]  G. Kwakkel,et al.  Measuring gait and gait-related activities in Parkinson's patients own home environment: a reliability, responsiveness and feasibility study. , 2005, Parkinsonism & related disorders.

[20]  R. Walker,et al.  Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study , 2002, Journal of neurology, neurosurgery, and psychiatry.

[21]  M. Morris,et al.  Postural instability in Parkinson's disease: a comparison with and without a concurrent task. , 2000, Gait & posture.

[22]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[23]  Z. Schwab,et al.  Projection technique for evaluating surgery in Parkinson’s disease , 1969 .

[24]  F Franchignoni,et al.  Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females , 1998, Aging.

[25]  R. Fitzpatrick,et al.  PDQ-39: a review of the development, validation and application of a Parkinson’s disease quality of life questionnaire and its associated measures , 1998, Journal of Neurology.

[26]  R. Cumming,et al.  Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[27]  D. Glencross,et al.  Motor control and sensory motor integration : issues and directions , 1995 .

[28]  Ching-Fan Sheu,et al.  Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients , 2002, Stroke.

[29]  C. Marsden The mysterious motor function of the basal ganglia , 1982, Neurology.

[30]  M. Morris,et al.  Reliability of measurements obtained with the Timed "Up & Go" test in people with Parkinson disease. , 2001, Physical therapy.

[31]  Y. Lajoie,et al.  Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. , 2004, Archives of gerontology and geriatrics.

[32]  S. Fahn Unified Parkinson's Disease Rating Scale , 1987 .

[33]  K. Gill-Body,et al.  Determinants of balance confidence in community-dwelling elderly people. , 2003, Physical therapy.

[34]  C. Marsden,et al.  Recent Developments in Parkinson's Disease , 1986 .

[35]  W. D. De Weerdt,et al.  Development of an activity scale for individuals with advanced Parkinson disease: reliability and "on-off" variability. , 2000, Physical therapy.

[36]  M. Morris Movement disorders in people with Parkinson disease: a model for physical therapy. , 2000, Physical therapy.

[37]  N. Alexander,et al.  Task‐Specific Resistance Training to Improve the Ability of Activities of Daily Living–Impaired Older Adults to Rise from a Bed and from a Chair , 2001, Journal of the American Geriatrics Society.

[38]  M. Tinetti,et al.  Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. , 1994, Journal of gerontology.

[39]  S. Fahn Members of the UPDRS Development Committee. Unified Parkinson's Disease Rating Scale , 1987 .

[40]  T. Steffen,et al.  Testing functional performance in people with Parkinson disease. , 2005, Physical therapy.

[41]  M. Cole A cultural-historical approach to distributed cognition , 1993 .

[42]  Margaret Schenkman,et al.  Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease: A Randomized, Controlled Trial , 1998, Journal of the American Geriatrics Society.

[43]  The effect of physical therapy on balance of patients with Parkinson's disease , 2004, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[44]  Linda V Nyquist,et al.  Floor‐Rise Strategy Training in Older Adults , 2002, Journal of the American Geriatrics Society.

[45]  W. Burg,et al.  Abnormalities in postural reflexes and voluntarily induced automatic movements in parkinson patients , 1982, Clinical Neurology and Neurosurgery.

[46]  C. Velozo,et al.  Developing Meaningful Fear of Falling Measures for Community Dwelling Elderly , 2001, American journal of physical medicine & rehabilitation.

[47]  Christianna S. Williams,et al.  Characteristics Associated with Fear of Falling and Activity Restriction in Community‐Living Older Persons , 2002, Journal of the American Geriatrics Society.

[48]  P. Pasquetti,et al.  Effects of physical training on straightening-up processes in patients with Parkinson's disease. , 1999, Disability and rehabilitation.

[49]  J. Frank,et al.  Fear of falling and postural control in Parkinson's disease , 2003, Movement disorders : official journal of the Movement Disorder Society.

[50]  J. Hughes,et al.  Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[51]  S. Wood-Dauphinée,et al.  The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. , 1995, Scandinavian journal of rehabilitation medicine.