Pei-Yi Choua, Shu-Chun Leeb
a Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan
b Centre of Human and Aerospace Physiological Sciences, School of Biomedical Sciences, King's College London, London, UK
More than half of people with Parkinson's disease (PwPD) report difficulty when turning, which has significant implications for their risk of falling. Turn steps, turn time, turn type, and turn quality are key elements that could be observed in a video-based clinical assessment. This assessment could be carried out at home with video cameras that are simple to operate and easy to obtain. A laboratory-based examination investigates quantitative and kinematic data, such as the onset time of the head, trunk, pelvis, and leg, and the amplitude of angular rotation and relative rotation angles between different segments of the body in both the roll and yaw planes. PwPD take more steps, have a longer turn time, and use less efficient turn types, such as delayed onset, incremental, and larger turning-arc turn types, to complete a turn than unaffected individuals. They display instability, use of support, lack of ground clearance and lack of continuity during a turn. Poor intersegmental coordination and slower and smaller rotations of the head, trunk, and pelvis are also observed in turning. Increased postural tone, axial rigidity and loss of intersegmental flexibility may contribute to an en bloc turning strategy. Impaired motor planning, bradykinesia, and freezing make it difficult for PwPD to switch from one motor program (turning) to another (walking). Clinicians should examine patients' turning capacity during a routine movement evaluation and note any complaints about difficulties in turning. Testing of turning tasks needs to be done on both sides and related to real-life experience. Therapists should assist PwPD to find adaptive strategies, such as home modification and compensatory strategies while turning. Rehabilitation programs should focus on enhancing balance training and axial mobility.
Falls; Parkinson's disease; Physiotherapy; Turning