Physiotherapy: the ultimate placebo.
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Humans↗
Biomedical subjects
Emma Stack
Publications and source records attributed to Emma Stack.
Postural instability during reaching tasks in Parkinson's disease.
BACKGROUND AND PURPOSE: Reaching, like turning and rising from sitting, is an activity commonly associated with falls by people with Parkinson's disease. We set out to: (a) identify how people with moderate and severe Parkinson's disease performed high and low reaches and (b) to explore in detail the standard functional reach (functional reach) test and the fall histories of those who appeared unstable when reaching. METHOD: In this cross-sectional study, people with moderate or severe Parkinson's disease (Hoehn and Yahr Grade III or IV) were video-recorded at home, reaching above shoulder height and below knee level. Blinded observers rated stability, alignment, foot position, floor contact, use of support and reach type. Functional reach was also measured and participants were interviewed about falls. RESULTS: Of 51 participants, 33 (65%) had moderate Parkinson's disease and 18 (35%) severe. A greater proportion of the latter used support when reaching high (p = 0.029) and aligned forward when reaching low (p = 0.015); otherwise, strategies were similar across groups. Six people (all with severe Parkinson's disease) appeared unstable when reaching: they had a shorter functional reach than the others (median 10 cm versus 18 cm; p = 0.042) and had fallen frequently (median five falls in a year), although rarely when reaching. CONCLUSIONS: Reaching tasks challenge postural stability in severe Parkinson's disease. People who appear unstable when reaching are likely to be repeat-fallers and at risk of further falls during more demanding activities. Research should address whether discouraging potentially destabilizing manoeuvres (such as squatting and toe-standing) and promoting safety-enhancing strategies (such as using support and facing forward), with or without balance retraining, reduces the risk of falling among people with severe Parkinson's disease.
Accidental Falls↗
Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers.
OBJECTIVES: To describe the frequency and circumstances of falls among a community sample of people with stroke and to compare characteristics of fallers and nonfallers. DESIGN: Cross-sectional, observational study. SETTING: Community. PARTICIPANTS: Forty-one community-dwelling people with stroke (26 men, 15 women; mean age, 69.7 +/- 11.6y), of which 23 had right-hemisphere infarction, 16 left-hemisphere infarction, and 2 had a brainstem lesion. Time since onset of stroke ranged from 3 to 288 months (mean, 50mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Standardized tests were used to measure mobility, upper limb function, activities of daily living (ADL ability), and mood. Information about fall events was collected by using a questionnaire. RESULTS: Twenty-one participants (50%) were classed as fallers, of whom 10 had fallen repeatedly. No significant differences were found between fallers and nonfallers on any of the measures used. However, those who had 2 or more falls (n = 10) had significantly reduced arm function (P = .018) and ADL ability (P = .010), compared with those who had not fallen or experienced near falls (n = 5). Loss of balance, misjudgment, and foot dragging during walking, turning, and sit to stand were reported by fallers as the suspected causes and activities leading to falls. CONCLUSIONS: The high risk of falling among people with stroke was evident in this community-based sample. Repeat fallers had greater mobility deficits and significantly reduced arm function and ADL ability than those who did not report any instability.
Accidental Falls↗