Simulation, safety and surgery

Objective: Falls, with serious injuries, are a major problem in Parkinson disease (PD). In this study, the influence of body bradykinesia on falls in PD was investigated. Background Bradykinesia is a complex consisting of slowness of movement (also called bradykinesia), hypokinesia (small or decreasing amplitude movement), and akinesia (inability to initiate movement). Bradykinesia (the complex) leads to motor tasks difficulties and its effect on falls in PD is unclear. Design/Methods: We assessed slowness of movement (bradykinesia) and hypokinesia in 103 consecutive non-demented PD patients in medication-on state, of them 17 had ≥ 3 falls per month (fallers). Hypokinesia was assessed by the time taken for waist bending (WB) ten times in the sitting position and bradykinesia was assessed by Unified Parkinson9s Disease Rating Scale (UPDRS) score (item 3.14). The t-test and chi-square tests were used to compare appropriate variables and a logistic regression model was constructed to predict sensitivities and specificities. Results: Fifty-one patients had a bradykinesia score of ≥ 2 and 52 of 103 patients took more than 21 seconds (mean time taken across subjects) to complete WB ten times. The 17 fallers had a higher UPDRS motor score. A significantly higher number of fallers had a bradykinesia score of ≥ 2 (88.2%) and had a WB time > 21seconds (76.5%). Bradykinesia predicted falls with 88.2% sensitivity and 72.1% specificity and WB time predicted falls with 76.5% sensitivity and 55.8% specificity. The combination of WB time and bradykinesia predicted falls with 76.5% sensitivity and 82.6% specificity. Motor UPDRS scores, WB time, and bradykinesia were improved by medication in 10 patients who underwent medication-on/off testing. Conclusions: Falls can be predicted by a combination of bradykinesia and hypokinesia. As both respond to dopaminergic drugs (and deep brain stimulation) both these should be considered in managing patients with falls. Disclosure: Dr. Lieberman has nothing to disclose. Dr. Krishnamurthi has nothing to disclose. Dr. Santiago has nothing to disclose. Dr. Dhall has received personal compensation for activities with Teva Pharmacuticals as a speaker. Dr. Moguel-Cobos has nothing to disclose. Dr. Sadreddin has nothing to disclose. Dr. Husain has nothing to disclose. Dr. Salins has nothing to disclose. Dr. Pan has nothing to disclose. Dr. Dhanani has nothing to disclose.