ALEXANDRIA, VA, March 26, 2009 - Patients with Parkinson disease may
be able to improve their postural stability by directing their attention
to the external effects of their movements rather than to the movements
of their own body, according to a study published in the February 2009 issue of
Physical Therapy, the scientific journal of the American
Physical Therapy Association (APTA).
Adults with Parkinson disease are at greater risk for posture and
balance impairments. These conditions may lead to falls, resulting in
head injuries and fractures, which can end with hospitalization and
further mobility limitations. Approximately 90 percent of people with
Parkinson disease will fall at some point during their
lives.1 In the past 12 months, two-thirds of patients with
Parkinson disease reported a fall.2
According to physical therapist researcher and APTA spokesperson
Merrill Landers, PT, DPT, OCS, who also worked on this study, "of the
major motor signs of Parkinson disease, postural instability is the
least responsive to medication. It is crucial that physical therapists
continue to develop effective rehabilitation strategies to address this
issue."
Lead researcher Gabriele Wulf, PhD, and her team observed 14 adults
with idiopathic Parkinson disease as they balanced on an unstable
surface (an inflated rubber disk) under three attentional focus
conditions -- external focus, internal focus, and a control
condition.
Patients were instructed to either focus on reducing movements of the
rubber disk (external focus) or movements of their feet (internal
focus), or they were not given attentional focus instructions (control
condition). The results were consistent with previous findings on
attentional focus, which showed that directing attention to the effects
of an individual's movement on the environment (external focus) improved
postural stability, compared with internal focus and control conditions,
during standing for individuals with Parkinson disease.
"In the past 12 years or so, numerous studies have been done - many
of them involving healthy adults learning sport skills – and it
has consistently been found that individuals perform and learn motor
skills more effectively when they are instructed to adopt an external
focus. Other studies have shown that those advantages generalize to
people after stroke as well as to the rehabilitation of ankle sprains,
for example. This is a very reliable effect, and the current study
demonstrates that persons with Parkinson disease benefit from an
external attentional focus as well," Wulf explained.
"Findings from this study not only have the potential to enhance the
rehabilitation strategies of physical therapists working with patients
with Parkinson disease, but may ultimately give patients with postural
instability more control over their lives through the use of strategies
that help them manage their own balance safely and effectively," said
Rebecca Lewthwaite, PhD, of Rancho Los Amigos National Rehabilitation
Center, a co-author on the study.
Physical therapists are highly-educated, licensed health care
professionals who can help patients reduce pain and improve or restore
mobility - in many cases without expensive surgery or the side effects
of prescription medications. APTA represents more than 70,000 physical
therapists, physical therapist assistants, and students of physical
therapy nationwide. Its purpose is to improve the health and quality of
life of individuals through the advancement of physical therapist
practice. In most states, patients can make an appointment directly with
a physical therapist, without a physician referral. Learn more about
conditions physical therapists can treat and find a physical therapist
in your area at www.moveforwardpt.com.
1Koller WC, Glatt S, Vetere-Overfield B, Hassanien R.
Falls and Parkinson's disease. Clin Neuropharmacol. 1989:
12:98-105.
2Ashburn A, Stack E, Pickering AM, Ward CD. A
community-dwelling sample of people with Parkinson's disease:
characteristics of fallers and non-fallers. Age Ageing.
2001;30:47-52.