Sound famliar?
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Presse Med 2001 Mar 10;30(9):452-9
[Article in French]
Kemoun G, Defebvre L.
Service de Neurologie et Pathologie du Mouvement, Hopital Salengro, CHRU F 59037
Lille.
A WELL INFORMED DESCRIPTION:
The parkinsonian posture is generally described as a stooped one. At the
beginning of the disease, the gait troubles remain moderate; gradually the
gait is composed of small steps without a wide base; the patient tends to
run after his centre of gravity by accelerating the step (festination
phenomenon). Difficulties occurs for starting up (delay of gait
initiation), for about-turn or for clearing obstacles. Kinetic jammings and
standing around (freezing) can last several seconds and be responsible for falls.
POSTURAL INSTABILITY, A MAJOR SYMPTOM IN PARKINSON'S DISEASE:
This symptom is little improved by therapies and is responsible for
serious disability. Postural instability induces a disequilibrium and is
partially due to a simultaneous antagonist muscles contraction and to the
impossibility of modifying postural responses to changing support
conditions. The passive viscoelastic properties of muscles and tendons
constitute a first line of defence against the disequilibrium and
contribute to postural stability in the case of medium disturbances.
Automatic and voluntary postural responses which come into play in the case
of major disturbances can also be impaired (delay or defect of the
responses).
GAIT INITIATION FAILURE ARE FREQUENT:
They result from an increase of the postural phase and a decrease of the
propulsion forces, depending on a deficit of the postural anticipation
mechanisms and also the sequential organization and the integration of two
different motor programs, postural and locomot or. They can be controlled
partially with sensory stimuli, notably visual inputs.
DATA CONCERNING STABILIZED WALKING AND ITS
PATHOPHYSIOLOGY REMAINS TO BE CLARIFIED:
Spatial and temporal parameters are impaired: speed, step length and swing
phase are reduced, while cadence increases to compensate these troubles.
These modifications are the consequence of an incapacity to produce
internal marks to generate regular steps. When the parkinsonian patient is
supplied with external marks, these parameters can be normalized. From a
pathophysiological point of view, gait disorders could result from
defective central integration of proprioceptive information during movement
within the basal ganglia, associated with a visual perceptive deficit
linked with a retinal dopaminergic cells dysfunction and finally from an
impairment of the proprioceptive feedback of the load receptors in the leg
extensor muscles.
PMID: 11285785 [PubMed - indexed for MEDLINE]
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Ray Strand
Prairie Sky Design
-----------------( on the Edge of the Prairie Abyss )---------------
when the sky is clear
the ground is visible
49/dx PD 2 yrs/40? onset/retired
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