Objective: To demonstrate a novel approach to preventing falls in Parkinson’s disease (PD) that improves anticipatory postural adjustments facilitating a more accurate moving base of support during multi directional stepping.

Background: Falling is a common occurrence in PD patients and little is known on motor cost deficits exacerbating this risk. Therefore, it is imperative to continue exploring new interventions. For example, a multi-sensory approach along with a self-producing metronome could improve loss of subjective effort responsible for foot placement inaccuracy during reactive and planned stepping.

Method: According to this intervention, we first determined the proper stance where the individual felt most stable when reaching past arm’s length. We then provided gesturing visual cues along with sounds that are congruent with goal directed motor behavior. This visual audio motor interaction facilitated foot placement accuracy of changing amplitudes of the moving base of support. The use of staccato notes on the repositioning foot prevented foot drag. Individuals would also set the metronome to a specific rhythm where the base displacement amplitude changed recurrently within one movement cycle. These cycles require a consistency in effort output as well as accuracy of foot placement.  The observations reported herein were made by a fitness professional within a clinical setting.

Results: We present three cases of PD patients all displaying slowness of movement during protective stepping, delayed step initiation, and impaired balance control during postural perturbations. Our results were an increase in proprioceptive awareness, overcoming loss of subjective effort, and improved self-correction strategies. Individuals also improved their understanding of weight transfer, foot positioning, and pelvic control in multi planar movement following a unique intervention routine developed by one of the authors (DS).

Conclusion: These cases illustrate the need for a rehabilitative fall prevention technique that addresses motor cost deficits in PD for quicker reactive stepping and more accurate foot placement. This mechanism of action of the phenomenon we are witnessing and reporting here could be similar to what’s been described as Kinesia Paradoxa. Further investigation would be beneficial for developing future exercise and rehabilitation tools for PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/preventing-falls-in-parkinsons-disease-by-re-educating-reactive-and-planned-foot-placement-accuracy-through-a-multi-sensory-approach-3-cases/