Concurrent arm swing-stepping (CASS) can reveal gait start hesitation in Parkinson’s patients with low self-efficacy and fear of falling
Movement incoordination, freezing of gait, fear of falling, low self-efficacy, and multi-tasking can all contribute to falls in Parkinson’s disease. How these multi-factorial risks interact in individual patients remain poorly understood.
Concurrent arm swing-stepping is a simple motor test in which subjects are first asked to swing their arms before being instructed to initiate the secondary task of leg stepping-in-place. We postulated that in patients with multiple fall risks, sensorimotor impairments in upper- and lower-limb movement control can render concurrent arm swing-stepping a demanding dual task, thereby triggering gait hesitation. A total of 31 subjects with Parkinson’s disease were enrolled in the study.
It was found that concurrent arm swing-stepping induced hesitation primarily in Parkinson’s disease patients with low fall-related self-efficacy and a fear of falling. By contrast, concurrent arm swing-stepping led to limb incoordination in both patients and in healthy elderly controls. The calculated specificity and sensitivity of the concurrent arm swing-stepping test was 100 and 42 % for hesitation and 12 and 77 % for incoordination.
These results suggest that the concurrent arm swing-stepping test can be used in conjunction with conventional psychometric assessments to facilitate multi-factorial assessment of potential fall risk.
KeywordsParkinson’s disease Hesitation Freezing Gait Fear Falling
Thanks to the Canadian Institutes of Health Research, Alberta Innovates-Health Solutions, MITACs, Parkinson Alberta Society, Drs Ranjit Ranawaya and Sarah Furtado and the Movement Disorders Clinic-Alberta Health Services, and to the following Brazilian agencies: National Council for Scientific and Technological Development (CNPq) and Coordination for the Improvement of Higher Education Personnel (CAPES). We would also like to thank Natalie de Bruin and Dr. Lesley Brown for help with control data.
Conflict of interest
On behalf of all the authors, the corresponding authors state that there are no conflicts of interest.
- 19.Chomiak T, Cihal A, Clark T, Ranawaya R, Hu B (2013) Concurrent arm swing-stepping (cass) test for dual task-related movement incoordination and hesitation in Parkinson’s disease. J Parkinson’s Dis 3(Supp 1:88)Google Scholar
- 21.Greenberg SA (2011) Assessment of fear of falling in older adults: the falls efficacy scale-international (fes-i); best practices in nursing care to older adults. The Hartford Institute for Geriatric Nursing, New York University, College of Nursing, New YorkGoogle Scholar