Helping Those With Advanced Parkinson's Disease
Oct. 3, 2001 -- People with advanced Parkinson's disease move slowly and often "freeze" in mid-step, which can cause falls. In general, walking aids, or walkers, can help make users more stable and prevent falls, but researchers don't know how useful they can be for people with this disease.
The results of a small study being presented at the American Neurological Association meeting this week in Chicago suggest that when helping these people with their walking, there are some careful choices to be made. Using a walker actually increases the number of times people freeze and makes the sticky spots last longer. But when it's necessary to use a walker to lower fall risk, devices with wheels are best because they don't seem to impair the user as much as the unwheeled varieties.
In Parkinson's disease, the brain's nerve cells progressively die. With healthy people, the cells produce a chemical called dopamine that helps direct muscle activity. As brain cells are lost, parts of the person's body, such as a resting hand, often have a shaky, quivering movement called tremor.
Muscular rigidity is another problem. As it progresses, people find it more difficult to start moving. Walking slows, and affected people do what doctors call "freezing," which is a hesitation in walking that can cause patients to slip and possibly fall, says Esther Cudo, MD, visiting assistant professor of neurology at Rush-Presbyterian-St. Luke's Medical Center in Chicago.
As their symptoms get worse, people with Parkinson's disease commonly use walking aids. But there has been no organized study looking at whether walkers help patients move more easily or safely, she says.
Cudo studied 19 people with Parkinson's disease; 14 were still mentally sharp, but five were not and had what doctors call dementia. Each participant was asked to rise from a chair, walk through a doorway, walk a straight path, pivot, and return. Each person walked the path three times, first unassisted, then using a standard (unwheeled) walker, then using a wheeled walker.
Researchers found that compared to unassisted walking, standard and wheeled walkers slowed walking time significantly. Freezing was no better when walking aids were used.
"This pattern was the same in patients with and without dementia," Cudo tells WebMD.
However, in comparing wheeled and unwheeled walkers, the wheeled types provided both groups of patients with more advantages, she says. "There was less freezing time and walking was a little faster" than with the standard walker.
Walkers also seemed to offer patients the steadiness they needed, says Cudo. "In spite of patients' slowness in movement, nobody fell using a walker, which suggests that walkers do offer maximum stability."
Others say that this study is helpful, but more research is needed. "It's an important research piece, because it looks at a milestone in Parkinson's disease that we can't treat effectively with medications, namely, balance problems," says Ira Shoulson, MD, professor of neurology at the University of Rochester in Minnesota.
While Cudo's study is the first to shed light on this issue, "It's too small a study to make over-arching types of conclusions that this applies to all," Shoulson tells WebMD. "It's a good first step."