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10 October 2005
Fear Of Falling 
The current issue of the journal Cognitive and Behavioral Neurology details an affliction that appears to be striking more and more elderly people. Roger Kurlan, of the University of Rochester Medical Center, describes an elderly woman who had an increasingly difficult time walking. The difficulties began when she tripped and fell, breaking a wrist and bruising her leg. Her inability to walk led her doctor to diagnose Parkinson's disease but despite treatment with the medication levodopa, she ended up in a wheelchair, unable to walk, and was consequently sent to Kurlan, an expert in movement disorders like Parkinson's. The woman refused to try to stand up on her own, but after some persuasion, and with several people available to help her up, the woman finally did rise. She took short, tentative steps, sure that she was going to fall. Upon hearing that she did not appear to have Parkinson's or any other serious neurological condition, however - and that her problem was psychological, reflecting her fear of falling - the woman's bearing improved markedly. With more encouragement and offers of help, the woman began walking around the room and even jogging down the hallway. She was subsequently referred to a physical therapist to build her confidence on her feet, and the Parkinson's medications were stopped. Kurlan says he has seen at least 30 patients with "fear of falling gait" over the years. The abnormal gait sometimes begins, as it did with this patient, shortly after a fall, though many patients have never fallen but are literally paralyzed by the fear that they might fall. Patients shuffle or slide their feet along the floor and hold onto something constantly for support. Soon the abnormal gait itself becomes a problem, even to the point that a person doesn't walk for months or years. Kurlan said that people who have Alzheimer's disease or who have had a stroke also sometimes have a similar disorder. Treatment for the condition is similar to that for any "psychogenic gait disorder," where the condition of a patient's mind, not any physical cause, affects the patient's ability to walk. Usually, this involves persuading patients to try to walk and convincing them that they can. Physical therapy is also useful to improve the person's balance and ability to walk. "The results can be pretty dramatic when psychogenic gait disorders are treated appropriately," said Kurlan. "People literally come in in a wheelchair, and walk out of the office after one appointment. Kurlan said most patients are thrilled to learn that their problems walking have more to do with their mind than their bodies. "For a lot of patients, we simply help them get over their fear of falling by getting them into physical therapy and getting them more confident about being on their feet. Some patients never get over the fear, though, and they spend the rest of their lives not walking." Source: University of Rochester Medical Center
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