Falls in Parkinson Disease: Beware the Short, Slow Step (P1.026)

OBJECTIVE: To determine if step length influence falls in Parkinson Disease (PD) patients. BACKGROUND: Falls are major cause of disability in PD. The objective of this study is to determine if short step and slow step velocity can cause falls. DESIGN/METHODS: We did retrospective analysis of 460 PD patients seen at Muhammad Ali Parkinson center. Demographic and clinical information collected include age, duration of PD, medications, Unified Parkinson Disease Rating Scale (UPDRS)scores, gait length and velocity, incidence of freezing of gait, and occurrence of serious fall. Results: Of the PD patients, 204 (50.5[percnt])fell and 200 (49.5[percnt])did not fall. Of the 204 fallers, 71 (34.8[percnt]) fell more than once. Fallers were significantly older than non fallers ( 72.6±5.8 versus 66.9±6.1 years) and fallers had PD significantly longer (9.3±3.7 versus 5.4±2.2 years), significantly higher ( worse)UPDRS motor scores (29.3±10.9 versus 18.9±8.3),significantly higher ( worse)UPDRS axial scores (9.2±3.5 versus 5.1±2.7),significantly shorter steps (0.45± 0.09 versus 0.60±0.13 meter), and slower velocity (0.75±0.21 versus 0.90±0.31 m/s) compared with non fallers. Fallers were also significantly more likely to have freezing of gait ( 21.1[percnt])than non- fallers ( 10.5[percnt]) ( OR, 2.28;95[percnt] Confidence Interval, 1.30-3.99; p<0.004. Among 204 fallers, 84[percnt] were on levodopa and among 200 non-fallers, 80[percnt] were on levodopa. CONCLUSIONS: In our study, fallers took significantly shorter and slower steps than non-fallers. This "cautious" gait may be an inappropriate adaption to impaired balace. Small and short steps may create a "mismatch" between the speed and displacement of the upper versus the lower body, resulting in the upper body "tipping over" and the patient falling. Education, exercise, and gait and balance training that focuses on increasing step length and velocity may reduce falls. Disclosure: Dr. Deep has nothing to disclose. Dr. Lieberman has nothing to disclose. Dr. Shafer has nothing to disclose.