Parkinsons disease Falls

Falls in Parkinson's disease can be prevented through regular assessment and risk evaluation. Tools like the POMA score assess balance and gait. Treating freezing of gait and postural hypotension is crucial. Deep brain stimulation may help in advanced cases.

Freezing of gait, cognitive impairment and postural hypotension are the main reasons for falls in Parkinson disease. Treatment should be directed towards fall prevention.

Fall Assessment:

All patients should be asked at least once a year about falls, frequency of falling, and gait difficulties during their clinic visit. Multi-factorial fall risk assessment should be performed for patients who report two or more falls per year, those who report difficulties with gait or balance and those who present to the emergency department because of their fall.

Performance Oriented Mobility Assessment (POMA):

Many tools are available including performance oriented mobility assessment (POMA) which is a scored instrument that assesses balance (nine items) and gait (seven items), using a scale from 0 to 2 (0 if most impaired performance, 1 if slight impairment, and 2 for independence). (2)

Preventing Freezing of Gait and Treating Postural Hypotension:

Attempts to prevent freezing of gaits and postural hypotension treatment will help to decrease fall frequency. (Please refer to autonomic neuropathy and freezing of gaits sections)

Deep Brain Stimulation for Fall Prevention:

Also, unilateral pedunculopontine nucleus deep brain stimulation seems effective in preventing falls in clinical trials for patients with advanced Parkinson's disease but that further evaluation of this procedure is required. (3)

References

1- Nilsson M, Eriksson J, Larsson B, et al. Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults. J Am Geriatr Soc 2016; 64:2242.

2- Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34:119.

3- Moro E, Hamani C, Poon YY, et al. Unilateral pedunculopontine stimulation improves falls in Parkinson's disease. Brain 2010; 133:215.