Falls are common events in Parkinson disease (PD) but only a few prospective studies have focused on causes and consequences of falls in PD patients. The aim of the study was prospective analysis of direct causes and consequences of falls in PD patients in comparison to the control group. One hundred PD patients and 55 age-matched controls were enrolled in the study. The diagnostic workup in all patients included neurological examination, Unified Parkinson's Disease Rating Scale, magnetic resonance imaging, electroencephalography, ultrasonography, otolaryngological, ophthalmological and autonomic function examination. During 12 months of follow-up, falls were registered in both groups, direct causes were classified according to the St. Louis and Olanow classification, and consequences were established. Falls occurred in 54% of PD patients and in 18% of control subjects. Analysis of direct causes of falls revealed that sudden falls were the most common (31%), followed by episodes of freezing and festination (19.6%), neurological and sensory disturbances (mostly vertigo) (12%), environmental factors (12%), postural instability (11%), orthostatic hypotension (4%), and severe dyskinesia (3.6%); 6.19% of falls were unclassified; 22% of patients had the same etiology of subsequent falls. In PD patients, intrinsic factors were dominant, whereas in the control group intrinsic and extrinsic factors occurred with the same frequency. Every third fall intensified fear of walking. 34% of falls caused injuries; among them bruises of body parts other than the head were most frequent. Intrinsic factors are the most common causes of falls in PD. Every third fall intensifies fear of walking and causes injuries. Upadki są częstymi objawami choroby Parkinsona (ChP). Dotychczas jednak tylko w kilku badaniach oceniano przyczyny i konsekwencje upadków w ChP. Celem badania była prospektywna analiza przyczyn bezpośrednich oraz konsekwencji upadków u pacjentów z ChP w porównaniu z grupą kontrolną. Do badania zostało włączonych 100 chorych na ChP oraz 55 dobranych pod względem wieku osób z grupy kontrolnej. U wszystkich chorych przeprowadzono badanie neurologiczne, ocenę za pomocą Unified Parkinson's Disease Rating Scale, badanie za pomocą rezonansu magnetycznego, elektroencefalografię i ultrasonografię, badanie otolaryngologiczne i okulistyczne oraz badanie czynności autonomicznych. Podczas 12-miesięcznej obserwacji upadki rejestrowano w obu badanych grupach. Przyczyny bezpośrednie upadków podzielono zgodnie z klasyfikacją St. Louis i Olanowa, określano także konsekwencje upadków. Upadki wystąpiły u 54% chorych na ChP i 18% osób z grupy kontrolnej. Najczęstsze były upadki nagłe (31%), następnie epizody zamrożeń i dreptania (19,6%), zaburzenia neurologiczne i czuciowe (zawroty głowy) (12%), czynniki zewnętrzne (12%), niestabilność postawy (11%), niedociśnienie ortostatyczne (4%), nasilone dyskinezy (3,6%). Upadki niesklasyfikowane stanowiły 6,19%. U 22% chorych etiologia kolejnych upadków była jednakowa. U chorych na ChP dominowały czynniki wewnętrzne, a w grupie kontrolnej częstości czynników wewnętrznych i zewnętrznych były podobne. Co trzeci upadek nasilał lęk przed chodzeniem, 34% upadków powodowało obrażenia, najczęściej sduczenia. Czynniki wewnętrzne są najczęstszymi przyczynami upadków w ChP. Co trzeci upadek nasila lęk przed chodzeniem oraz powoduje obrażenia.

Idiopathic Parkinson’s Disease (PD) is a progressive condition with gait disturbance and balance disorder as the main symptoms. Previous research studies focused on the application of Rhythmic Auditory Stimulation (RAS) in PD gait rehabilitation. The key hypothesis of this pilot study, however, assumes the major role of the combination of all three Neurologic Music Therapy (NMT) sensorimotor techniques in improving spatio-temporal gait parameters, and postural stability in the course of PD. The 55 PD-diagnosed subjects invited to the study were divided into two groups: 30 in the experimental and 25 in the control group. Inclusion criteria included Hoehn & Yahr stage 2 or 3, the ability to walk independently without any aid and stable pharmacological treatment for the duration of the experiment. In order to evaluate the efficacy of the chosen therapy procedure the following measures were applied: Optoelectrical 3D Movement Analysis System BTS Smart for gait, and Computerized Dynamic Posturography CQ Stab for stability and balance . All measures were conducted both before and after the therapy cycle. The subjects from the experimental group attended music therapy sessions 4 times a week for 4 weeks. Therapeutic Instrumental Music Performance (TIMP), Pattern Sensory Enhancement (PSE) and Rhythmic Auditory Stimulation (RAS) were used in every 45-minute session for practicing daily life activities, balance, pre-gait and gait pattern. Percussion instruments, the metronome and rhythmic music were the basis for each session. The subjects from the control group were asked to stay active and perform daily life activities between the measures. The research showed that the combination of the three NMT sensorimotor techniques can be used to improve gait and other rhythmical activities in PD rehabilitation.The results demonstrated significant improvement in the majority of the spatiotemporal gait parameters in the experimental group in comparison to the control group. In the stability tests with eyes closed, substantial differences were revealed indicating improvement of proprioception (the sense of body position and movement). These findings suggest a new compensatory strategy for movement and postural control through the use of the auditory system.

Although Parkinson disease (PD) patients suffer falls more frequently than other old people, only a few studies have focused on identifying the specific risk factors for falls in PD patients. The aim of this study was to assess the incidence and risk factors of falls in a prospective study in comparison to a control group. One hundred patients with PD were recruited to the study along with 55 gender- and age-matched healthy controls. Both groups were examined twice; the second examination took place one year after the first one. Examination of the PD group included: medical history including falls, neurological examination, assessment of the severity of parkinsonism [Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England scale (S and E), Hoehn and Yahr scale (H and Y), Mini-Mental State Examination (MMSE)], Hamilton scale and quality of life scales (SF-36, EQ-5D) and Freezing of Gait Questionnaire (FOG-Q). In both groups falls were recorded over the 12 months. Frequent fallers are defined as having more than 3 falls a year. Over the year falls occurred in 54% of PD patients and 18% of controls. In a prospective study 28% of PD patients fell more frequently than in retrospective analysis. Frequent fallers were found in 20% of patients and in 7% of controls. Fallers showed higher scores in UPDRS, H and Y, S and E, MMSE, and Hamilton scale than non-fallers. Independent risk factors for falls were: age, previously reported falls and higher score in the FOG-Q. Falls in PD patients occurred three times more frequently than in controls. Independent risk factors for falls were: high score in FOG-Q, older age and presence of falls in medical history.

The motor function impairment resulting from a stroke injury has a negative impact on autonomy, the activities of daily living thus the individuals affected by a stroke need long-term rehabilitation. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. Innovative technologies used in rehabilitation allow one the possibility to enhance training throughout generated feedback. It seems advantageous to combine traditional motor rehabilitation with innovative technology in order to promote motor re-learning and skill re-acquisition by means of enhanced training. An environment enriched by feedback involves multiple sensory modalities and could promote active patient participation. Exercises in a virtual environment contain elements necessary to maximize motor learning, such as repetitive and diffe-rentiated task practice and feedback on the performance and results. The recovery of the limbs motor function in post-stroke subjects is one of the main therapeutic aims for patients and physiotherapist alike. Virtual reality as well as robotic devices allow one to provide specific treatment based on the reinforced feedback in a virtual environment (RFVE), artificially augmenting the sensory information coherent with the real-world objects and events. Motor training based on RFVE is emerging as an effective motor learning based techniques for the treatment of the extremities.

Huntington's disease (HD) is a neurodegenerative, progressive disorder of the central nervous system which causes significant gait and balance disturbances. This is a pilot study which aims to determine the effects of a physiotherapy programme with use of Proprioceptive Neuromuscular Facilitation (PNF) on gait and balance in HD patients. 30 HD patients aged 21–60 with genetically confirmed diagnosis participated in the study. Participants followed a 3-week-long PNF-based physiotherapy programme. Gait and balance were evaluated twice in each participant: first at baseline and then after the course of physiotherapy. The following methods were used for gait disturbances: Tinetti Gait Assessment Tool, Up and Go Test, Timed Walking Tests for 10 m and 20 m (TWT10m, TWT20m). Balance was assessed with use of Berg Balance Scale, Pastor Test and Functional Reach Test. There was a significant improvement in all measures of balance and gait. PNF-based physiotherapy is effective and safe in HD patients.

Objective: The aim of this study was to assess the effect of physical exercise on gait pattern disorders, based on three-dimensional gait analysis in the sagittal plane in a group of people with Parkinson’s Disease (PD). Methods: 32 subjects with PD (14 women and 18 men; age: 50-75 years) were qualified for the study which ran for 3 weeks and included 18 therapeutic sessions. 35 control subjects were included in the research (13 women and 19 men; age: 52-77 years). Gait analysis using the Vicon 3D system took place in the Biokinetics Laboratory. The research group were tested before and after treatment, the control group was tested once. Results: Comparing the average peak angle changes and average standard time results (%gait cycle) corresponding with angles of movement in the lumbar and cervical spine, elbow and shoulder joint, statistically significant changes were observed. The study results are indicative of differences in spatio-temporal parameters and angular changes of gait for both groups. After therapeutic treatment we observed improvement in the angular range of changes for thorax tilting, but there were no difference between the most affected and less affected side. For the cervical spine a significant reduction in flexion during dual support was observed. The angular range of changes for shoulder joint were significant only in less affected shoulder during the Initial Contact (F1), Terminal Stance (F4) and Terminal Stance (F8) phases of gait (p<0,05). After therapeutic treatment significant angle and setting changes for the most affected limb of the elbow joint occurred during the Initial Contact and Terminal Swing phases (F1, F8). In the Terminal Stance phase (F4) an increase in range of motion by about ±4° was observed (p<0,05). Conclusions: Exercise therapy slightly increased the range of movement in the examined joints of PD’s patients. Results of pathological walking patterns occurring prior to treatment improved after treatment and moved closer to the physiological gait pattern. Key words: Vicon 3D system, PD, gait, physical exercise