Objective: To describe a patient with advanced PD who noted improved balance and fewer falls while using a novel belt attachment for his assistive device.

Background: Postural abnormalities and episodic gait dysfunction, including propulsive gait, are important risk factors for falls in PD, which affect 45-68% of patients annually [1]. There is increasing evidence that impaired processing and integration of sensory stimuli, particularly proprioceptive input, plays a critical role [2,3]. Interventions that improve trunk posture result in secondary improvements in balance, gait speed, and fall frequency [3]. Because repeated training is needed to maintain these benefits, interventions that are easily incorporated into daily life are desirable.

Method: Case report.

Results: A 66 year-old man with PD since 1991 s/p bilateral subthalamic DBS in 2006 was referred for PT due to near daily falls. Propulsive gait with progressive trunk flexion was the most frequent trigger for falls, which were typically forward. Falls had not improved with adjustment of levodopa or DBS, and occurred despite use of a rolling walker. He underwent an individualized PT program incorporating neuromuscular re-education, gait training, balance/vestibular retraining and family education. A custom walker attachment was added near the end of the program due to ongoing propulsion-related falls. The attachment consisted of a mobilization belt attached to the front of the walker, encircling the patient to rest against the low back. After completing PT the patient continued to use the attachment most of the time. Use of the belt was associated with subjective improvements in posture, balance, confidence, and ADL self-performance. Fall frequency was dramatically reduced, with falls now occurring only at home while not using the belt. Repeat PT assessment one year later confirmed improvements in mobility and balance rated by Berg balance score (49 vs. 44), single leg balance (2-3s vs. 0s), tandem stance (18s vs. 1s), and static and dynamic standing balance (fair vs. poor).

Conclusion: We describe a patient with advanced PD who experienced improved balance and fewer falls while using a customized walker belt attachment. The mechanism of action is unknown, but may relate to proprioceptive stimulation or postural reeducation. This observation will be further explored in a single-center pilot study of feasibility and preliminary efficacy.

References: [1] Pelicioni PHS, Menant JC, Latt MD, Lord SR. Falls in Parkinson’s Disease Subtypes: Risk Factors, Locations and Circumstances. International Journal of Environmental Research and Public Health 2019;16:2216. [2] Feller KJ, Peterka RJ, Horak FB. Sensory Re-weighting for Postural Control in Parkinson’s Disease. Frontiers in Human Neuroscience 2019; 13:126. [3] Capecci M, Serpicelli C, Fiorentini L, et al. Postural Rehabilitation and Kinesio Taping for Axial Postural Disorders in Parkinson’s Disease. Archives of Physical Medicine and Rehabilitation 2014;95:1067-75.

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