Movements used during turning and factors influencing the way in which people with Parkinson's Disease turn

Abstract

In this thesis, a tool with which to describe turning, the Standing Start 180° Turn Test (SS-180) was developed and used to describe how people with and without PD turned to walk from a standing start.  Seventy descriptors of turning were identified from five sources (including the literature).  These were reduced to a shortlist of 20 considered important and measurable from video, from which the SS-180 was designed.  Participants turned in each direction during the SS-180 and Turning Steps, Time, Type and Quality were rated.  The video-based SS-180 was validated against a laboratory-based ‘gold standard’ and test-retest stability, intra- and inter-rater reliability was established.

Thirty-three healthy adults (median age 40 years) took part in the first (laboratory-based) study.  Turning took a median 2.5 Steps in a median 1.5s.  Toward (36%) and Pivotal (33%) Turn Types were common;  Quality was maximal (five/five) for all but one turn.  Seven people with PD (median age 77, median PD duration eight years) took part in a preliminary (laboratory-based) study.  Turning took a median six Steps, 3.9s.  Incremental (71%) Turn Types were common;  Quality was sub-maximal in most cases.  Twenty-three people with PD (median age 68, median PD duration four years) and ten age-matched controls (median age 70) took part in the main (home-based) study.  Participants with PD turned in a median 3.8 Steps, 2s;  Incremental (64%) Turn Types were common.  Controls turned in fewer Steps and faster (P<0.01) demonstrating different Turn Types (P<0.05).  Dysfunctional turning was common among the samples of people with PD recruited.  Balance control, age and PD severity were the key correlates of the SS-180.  Directional Asymmetry was a feature of the way people with PD turned:  28% demonstrated a two Step difference turning each direction (v none of the participants without PD).  People with PD who took five or more Turning Steps in the freely chosen direction were likely to demonstrate dysfunction when turning in the opposite direction (positive prediction value was 79% in this study).

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