Falls, gait and posture abnormalities in advanced Parkinson’s disease

•Falls occurred  late in the progression of the Parkinson’s disease. Falls at the onset of the disease is a “red flag” , suggesting the diagnosis of Parkinson-Plus conditions such as PSP (progressive supra-nuclear palsy).
•Falls in Parkinson’s disease occur at the same time than the concentration/attention decreases, than the posture is poor with the trunk bent forward and the gait has deteriorated
•The capacity of attention of the patient can be decreased by the antiparkinsonian drugs (which can cause daytime sleepiness) or by the beginning of the cognitive decline.
•The posture of the patient can be very abnormal and be responsible of unsteadiness and neck-back pain. The trunk , and sometimes the neck are bent forward, and not always corrected when lying down. Neuro-physiotherapy is essential to  correct the posture.
•The gait, typically described with the French expression ” marche a petit pas”, becomes over the years slow, laborious with small steps, and freezing episodes when going through doors, narrow passage or just when people are around.
•The automatic pattern of gait which consists of  lifting up and putting forward alternatively each leg is disrupted. The feet are glue on the floor, the patient can’t transfer his weight from one leg to the other leg. Half-turn is source of inevitable falls as the patient put himself in a spiral; the shoulders are already turned when the feet are still magnet on the floor in the direction of the previous trajectory. On the other hand, when the patient try to walk, he runs after his gravity centre, accelerates and ends up by falling forward ((festination).
• Again neuro-physiotherapy is essential to retrained the patient for walking.
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