TAILIEUCHUNG - Chapter 024. Gait and Balance Disorders (Part 6)

Toppling Falls Some patients maintain tone in antigravity muscles but fall over like a tree trunk, as if postural defenses had disengaged. There may be a consistent direction to such falls. The patient with cerebellar pathology may lean and topple over toward the side of the lesion. Patients with lesions of the vestibular system or its central pathways may experience lateral pulsion and toppling falls. Patients with progressive supranuclear palsy often fall over backwards. Falls of this nature occur in patients with advanced Parkinson's disease once postural instability has developed. Gait Freezing Another fall pattern in Parkinson's disease and related disorders. | Chapter 024. Gait and Balance Disorders Part 6 Toppling Falls Some patients maintain tone in antigravity muscles but fall over like a tree trunk as if postural defenses had disengaged. There may be a consistent direction to such falls. The patient with cerebellar pathology may lean and topple over toward the side of the lesion. Patients with lesions of the vestibular system or its central pathways may experience lateral pulsion and toppling falls. Patients with progressive supranuclear palsy often fall over backwards. Falls of this nature occur in patients with advanced Parkinson s disease once postural instability has developed. Gait Freezing Another fall pattern in Parkinson s disease and related disorders is the fall due to freezing of gait. The feet stick to the floor and the center of mass keeps moving resulting in a disequilibrium from which the patient cannot recover. This can result in a forward fall. Gait freezing can also occur as the patient attempts to turn and change direction. Similarly the patient with Parkinson s disease and festinating gait may find his feet unable to keep up resulting in a forward fall. Falls Related to Sensory Deficit Patients with somatosensory visual or vestibular deficits are prone to falls. These patients have particular difficulty dealing with poor illumination or walking on uneven ground. These patients often express subjective imbalance apprehension and fear of falling. Deficits in joint position and vibration sense are apparent on physical examination. Interventions to Reduce the Risk of Falls and Injury Treatment Efforts should be made to define the etiology of the gait disorder and mechanism of the falls. Standing blood pressure should be recorded. Specific treatment may be possible once a diagnosis is established. Therapeutic intervention is often recommended for older patients at substantial risk for falls even if no neurologic disease is identified. A home visit to look for environmental hazards can be helpful. A .

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