Chomiak Taylor, Pereira Fernando V, Clark Terry W, Cihal Alexandra, Hu Bin
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1AC60 HRIC, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada,
Aging Clin Exp Res. 2015 Aug;27(4):457-63. doi: 10.1007/s40520-014-0313-0. Epub 2015 Jan 11.
Movement incoordination, freezing of gait, fear of falling, low self-efficacy, and multi-tasking can all contribute to falls in Parkinson's disease. How these multi-factorial risks interact in individual patients remain poorly understood.
Concurrent arm swing-stepping is a simple motor test in which subjects are first asked to swing their arms before being instructed to initiate the secondary task of leg stepping-in-place. We postulated that in patients with multiple fall risks, sensorimotor impairments in upper- and lower-limb movement control can render concurrent arm swing-stepping a demanding dual task, thereby triggering gait hesitation. A total of 31 subjects with Parkinson's disease were enrolled in the study.
It was found that concurrent arm swing-stepping induced hesitation primarily in Parkinson's disease patients with low fall-related self-efficacy and a fear of falling. By contrast, concurrent arm swing-stepping led to limb incoordination in both patients and in healthy elderly controls. The calculated specificity and sensitivity of the concurrent arm swing-stepping test was 100 and 42 % for hesitation and 12 and 77 % for incoordination.
These results suggest that the concurrent arm swing-stepping test can be used in conjunction with conventional psychometric assessments to facilitate multi-factorial assessment of potential fall risk.
运动不协调、步态冻结、害怕跌倒、自我效能感低以及多任务处理都可能导致帕金森病患者跌倒。这些多因素风险在个体患者中如何相互作用仍知之甚少。
同时进行摆臂踏步是一种简单的运动测试，首先要求受试者摆动双臂，然后再指示他们开始腿部原地踏步的次要任务。我们推测，在具有多种跌倒风险的患者中，上肢和下肢运动控制中的感觉运动障碍会使同时进行摆臂踏步成为一项要求较高的双重任务，从而引发步态犹豫。共有31名帕金森病患者参与了这项研究。
发现同时进行摆臂踏步主要在与跌倒相关的自我效能感低且害怕跌倒的帕金森病患者中引发犹豫。相比之下，同时进行摆臂踏步在患者和健康老年对照组中均导致肢体不协调。同时进行摆臂踏步测试计算出的犹豫的特异性和敏感性分别为100%和42%，不协调的特异性和敏感性分别为12%和77%。
这些结果表明，同时进行摆臂踏步测试可与传统心理测量评估结合使用，以促进对潜在跌倒风险的多因素评估。
