Turning difficulties associated with Parkinson's Disease (PD)

Stack, E., Ashburn, A. and Rassoulian, H. (2002) Turning difficulties associated with Parkinson's Disease (PD). Movement Disorders, 17 (Supplement 5), S115. (doi:10.1002/mds.10351).

Abstract

Objectives: To describe how healthy adults turn 180°, evaluate the associations with age and balance control (Functional Reach, FR) and compare the 180° turns of people with PD.
Background: Dysfunctional turning, associated with freezing and injurious falls in PD, is a poorly understood axial impairment and difficult to manage. Appropriate research methods continue to develop. The Standing start 180° Turn Test (SS-180) necessitates performing two walking turns: the first in an Unspecified Direction (DU Turn), the second in the opposite direction (DS Turn).
Methods: Sixteen healthy ‘younger’ adults (age 21–39 years, median 32), 15 healthy ‘older’ adults (age 40–83, median 52) and 7 people with PD (age 63–85, median 77; median Hoehn and Yahr grade III) performed the SS-180 in a gait laboratory. Three-dimensional motion analysis and video were used to rate steps and time taken, ’turn-type’ and distance covered when turning.
Results: Healthy adults performed DU Turns in (median) 2 steps, 1.5 sec, covering a distance equivalent to 55% of their height; 39% used toward-type turns (direct advance to target while turning). DS Turnstook 3 steps, 1.6 sec, covering a distance of 58%; 42% used pivotal-typeturns (broad-based turn initiating advance to target). When direction was specified, the older group turned more slowly than the younger group (P 0.010) and used different turn types (P 0.040). FR correlated with steps taken in the DU (P 0.003) and DS Turns (P 0.011) and with time taken in both turns (P 0.000). Additionally, in the younger group, better balance correlated with a greater distance covered in the DS Turn (P 0.043). The PD group steps, times, turn types and distances covered were all significantly different to those ofthe healthy groups. They performed the DU Turn in (median) 7 steps, 4.2 sec, covering a distance equivalent to 4% of their height and the DS Turn in 5 steps, 4.0 sec, covering a distance of 3%: 71% used incremental-type turns (on-the-spot before walking). Discontinuity and instability when direction was imposed could be predicted from the DU Turn.
Conclusions: The ability to turn is determined partly by age, partly by balance (a potential target for physiotherapy). Differences in turning associated with PD could be compensatory to perceived instability. The SS-180 identified those at risk of freezing and falling when turn-direction was imposed; developed further, it could be used to evaluate interventions, screen for fall-risk or even support a diagnosis.

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