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Parkinson's 'Freezers' Likely to Stumble

Thursday October 03, 2013

Nancy Walsh

MedPage Today - Patients with Parkinson's disease who experience symptoms of "freezing" -- being stuck in position while trying to walk -- also have significantly impaired balance, a researcher said here.

Patients with symptoms of freezing had significantly worse overall scores on the Balance Evaluation Systems test (BEST) (f=7.33, P=0.008) and on the Mini-BEST (f=12.26, P=0.001), reported Ryan P. Duncan, DPT, of Washington University in St. Louis, at the World Parkinson Congress.

"Many patients with Parkinson's disease experience freezing of gait. This is described as the feeling that the feet are temporarily glued to the floor when trying to initiate walking or making a turn, or while walking in narrow or crowded spaces," Duncan said.

"We also know that freezers tend to fall more than nonfreezers, and while we recognize that there are gait differences between freezers and nonfreezers, researchers have not yet standardized clinical balance assessments to determine if balance differs between these patients," he said.

Therefore, he and his colleagues assessed balance using three scoring systems while accounting for motor symptom severity, time since Parkinson's diagnosis, and age, and considered if specific differences in balance control could be detected between patients with and without freezing symptoms.

The BEST contains 36 items grouped into six sections measuring multiple aspects of balance and gait, and the Mini-BEST includes four of the six. The third assessment was the Berg Balance Scale (BBS), considered the gold standard for both Parkinson's and non-Parkinson's patients.

The BBS contains 14 components, focusing primarily on static balance.

On average, patients with freezing symptoms had worse motor symptom severity and longer disease duration.

Unlike the results on the BEST and Mini-BEST, no differences in balance were seen on the BBS between freezers and nonfreezers, "which suggests that the BBS may not be sensitive to balance differences in these two groups," he said.

Duncan and colleagues then considered whether the individual six sections of the BEST differentiated freezers.

For the first section, which addresses biomechanical constraints such as ankle strength and range of motion, there was no difference.

For section two, stability limits and verticality concerns during sitting and forward reaching, there was no difference.

In section three, which considers anticipatory postural adjustments such as while standing on one leg, no differences could be found.

But on the fourth section, postural responses such as compensatory stepping reactions, freezers had significantly lower scores (f=14.39, P<0.001).

On section five, sensory orientation such as standing on firm or foam surfaces with eyes open and closed, there were no differences.

And on section six, which assesses stability and gait such as while walking and making a pivot turn, worse results were seen for freezers (f=9.16, P=0.003).

"Because freezers may have deficits in postural responses and stability and gait, rehab clinicians might tailor their interventions to these areas to improve balance in patients with freezing problems," Duncan concluded.

This analysis also suggested that either the BEST or Mini-BEST could be used to assess balance in patients with Parkinson's disease, but the BBS may be inadequate, he noted.

The study was funded by the Parkinson's Disease Foundation and the National Institutes of Health. Duncan reported no conflicts of interest.

Walsh, N. (3 Oct 2013). MedPage Today. Parkinson's 'Freezers' Likely to Stumble. www.medpagetoday.com.

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