Fear of falling gait affects many people's ability to walk

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Fear of falling gait affects many people's ability to walk

http://www.medicalnewstoday.com/medicalnews.php?newsid=31731

The patient came into the doctor's office in a wheelchair, weighted

down by a diagnosis of Parkinson's disease, taking medication for the

disorder and insisting she was unable to stand or walk. Thirty

minutes later, after jogging down the hallway, she strolled out the

door.

No Parkinson's patient was she. Rather, she was a perfect example of

a person with " fear of falling gait, " said neurologist and

Parkinson's expert Kurlan, M.D., of the University of Rochester

Medical Center. Kurlan has seen enough cases of the condition, where

a person is so afraid of falling that the mind actually affects the

ability to walk, that he wrote about the disorder in the September

issue of Cognitive and Behavioral Neurology to cue other physicians

about the condition.

In the case reported in the journal, Kurlan describes an elderly

woman who had an increasingly difficult time walking. The

difficulties began shortly after her husband died, when she tripped

and fell, breaking a wrist and bruising her leg. Her inability to

walk led her doctor to diagnose Parkinson's disease, and she was

prescribed the Parkinson's medication levodopa to treat her symptoms.

Despite treatment, she ended up in a wheelchair, unable to walk, and

she was sent to Kurlan, an expert in movement disorders like

Parkinson's.

A thorough physical exam turned up nothing abnormal, but the woman

refused to try to stand up on her own, even pushing herself down into

her chair as Kurlan and a nurse tried to convince her to attempt to

stand up. With enough persuasion, though, and with several people

available to help her up, the woman finally did rise.

At first she took short, tentative steps, sure that she was going to

fall. Upon hearing that she did not appear to have Parkinson's or any

other serious neurological condition, however - and that her problem

was psychological, reflecting her fear of falling - the woman's

bearing improved markedly. With more encouragement and offers of

help, the woman began walking around the room and even jogging down

the hallway.

Doctors subsequently referred her to a physical therapist to build

her confidence on her feet, and they also gradually stopped her

Parkinson's medications. Her ability to walk unassisted continued for

the six months the team followed her progress.

Kurlan estimates that he has seen at least 30 patients with " fear of

falling gait " over the years, and that most neurologists who treat

Parkinson's disease have seen such patients too, though not a lot has

been written about the condition. People who have Alzheimer's disease

or who have had several strokes also sometimes have a similar

disorder, he said.

The abnormal gait sometimes begins, as it did with this patient,

shortly after a fall, though many patients have never fallen but are

literally paralyzed by the fear that they might fall. Patients

shuffle or slide their feet along the floor and hold onto something

constantly for support. Soon the abnormal gait itself becomes a

problem, even to the point that a person doesn't walk for months or

years.

To treat the disorder, persuading patients to try to walk and

convincing them they can is crucial. Physical therapy is also useful

to improve the person's balance and ability to walk, and to build

their confidence. Kurlan said the treatment is similar to that for

any " psychogenic gait disorder, " where the condition of a patient's

mind, not any physical cause, affects the patient's ability to walk.

" The results can be pretty dramatic when psychogenic gait disorders

are treated appropriately, " said Kurlan, professor of Neurology and a

scientist in the Center for Aging and Developmental Biology. " People

literally come in in a wheelchair, and walk out of the office after

one appointment. It's very satisfying as a physician to treat this

condition. Symptoms often reverse quickly. "

Kurlan said most patients are thrilled to learn that their problems

walking have more to do with their mind than their bodies. In his

experience about half of such patients walk out of his office when

the appointment is over, though for many the hard work - working out

psychological problems through ongoing counseling - is just

beginning.

A psychogenic gait disorder is similar to other neurological symptoms

that have their roots in causes that have nothing to do with a

patient's physical health, Kurlan said. Some patients experience

hysterical blindness - they think they can't see - when there is

absolutely nothing wrong with their eyes or their nervous system, for

instance. Other people at times can feel weak, or can even lose their

ability to speak - and all these symptoms can sometimes be due to the

mind, not the body. Usually, treatment that focuses on the patient's

psychological well-being helps ease symptoms.

" For a lot of patients, we simply help them get over their fear of

falling by getting them into physical therapy and getting them more

confident about being on their feet. Some patients never get over the

fear, though, and they spend the rest of their lives not walking. "

University of Rochester Medical Center

http://www.urmc.rochester.edu