Falling is a major problems for persons with Parkinson's. Parkinson's
has been called the "falling sickness", and one theory is that
unexplained falls represent one of the earliest clinical symptoms of
PD. (this is uncommon and may indicate the parkinsonian-plus syndrome
PSP). Dopamine therapy is generally not helpful for persons who fall.
It is not understood why this is so! Physical therapy may be
beneficial in the reduction of falls in PD.
A great deal has been written about the causes of falls both for
"healthy" older adults and for those with PD. Falling is a
multifactorial phenomenon. There are many causes of falls in persons
with PD. Among them are:
1. Postural instability
2. Orthostatic hypotension
3. Motor fluctuations
4. Freezing and festination
5. Dementia & other neurologic deficits
6. Environmental factors
About 80-90% of hip fractures in older adults are due to falls. Fewer
that 10% occur before the fall, maybe as a result of osteoporosis. Hip
fractures are also an increasing problem in the PD population. Some studies
report a nine-fold increase in hip fracture risk among persons with
parkinsonism. There is also a very high rate of mortality and
complications after hip replacement operations.
A great deal has been written about the positive effect of Physical
Therapy for persons with PD, however little has been reported about the
efficacy of group training in the amelioration of falls in persons
with PD. Persons respond well to balance training. These improvements
bring about decreases in the total number of falls and changes in the
strategies which persons use to keep their bodies from falling.
Strength training is also beneficial in the reduction of falls in
persons with PD. Persons with PD may have a high potential to improve
balance, gait and strength through group training.
(To be continued)
Mark Hirsch
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