Parkinson's Disease and Fall

Wulf and colleagues through their study managed to determine and examine the generalizability of the attention focus effect to balance in older adults with Parkinson ’s disease. They recommended for external focus of attention by the victims and outlined other methods which required one to focus internally on movements and postural alignment (Wulf, 2009).

The study shows that people with Parkinson ’s disease vary considerably according to their rate of progression, impairments, activity limitations and quality of life. Therefore, there is need for every person to be assessed individually so that the physical therapist can provide a tailored program which is fit for the patient’s needs. Physical therapy goals need to be adapted to ensure that the patient receives the appropriate interventions at each particular time. This study becomes relevant to health care practice since it provides physical therapists with the proper knowledge to handle patients at different stages of the disease. This is because the needs vary at each progressive stage. For instance, the needs of a person at stage I on the Hoehn and Yahr scale are different from those of the one at stage IV.  At stage I, the person experiences mild slowing and under scaling movements while at stage IV one experiences loss of balance, falls, hypokinesia, dyskinesia and dystonia.

Falling was seen as a major risk factor of persons with Parkinson’s disease. Therefore, the study sought to determine the effects of forcing patients to adopt an external focus of attention rather than an internal one. It showed that the external focus of attention was the most suitable for patients in early to mid stage of the disease. This is because their cognition and capacity of motor skill learning have not been compromised yet. The study further shows that for the people at Hoehn and Yahr stage II and III, their focusing attention on external cues on a support surface disk in motion would reduce their postural sway. This supports the fact that people with Parkinson’s disease can improve their performance through attending to key aspects of action sequence or motor task.

 Wulf’s study gives satisfying recommendation. It produces same argument as the one given by Canning et al. Canning et al argues that when the patients divided their attention in competing tasks, it results to poor performance in the task whose attention is deteriorated.   

The study was conducted through a within-participant design that was used to account for potentially substantial individual variations in balancing capabilities. Though the report has beneficial recommendations, it involves some controversial matters. Firstly, Wulf and colleagues aims at constraining the postural responses to people with Parkinson’s disease. Instead, they should aim at increasing the variability of performance in order to promote the adaptability of the patients which would prevent them from falling.

Secondly, there are unsatisfying issues concerning the type of motor task which Wulf and colleagues selected for analysis. There appears to be no difference between the internal focus and control conditions according to Wulf’s study which could probably be due to the novel nature of the task and the inadequate study samples they used.  The basal ganglia regulate the performance of well-learned and sequential motor skills. Therefore, performance of simple movements is less affected as compared to goal-directed activities as Wulf stated.

During the study, only a sample of 14 people was used which is too small to make a conclusion on the issues affecting all the patients suffering from Parkinson’s disease. Moreover, among those who were tested, there were no one who was mildly affected; No one in Hoehn and Yarh stage I. There was also no one who was severely affected; No one in Hoehn and Yarh Stage V (Hoehn, 1967). This resulted to examining patients who had mostly the same characteristics.

Work Cited

Wulf G, Landers M, Lewthwaite R, Töllner T. (2009).External focus instructions reduce postural instability in individuals with Parkinson disease. Phys Ther.89:162–168.

Hoehn MM, Yahr M. Parkinsonism.(1967).Onset, progression, and mortality. Neurology.17:427–442.

 

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