Falls, gait and balance in neurorehabilitation

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Falls, gait and balance in neurorehabilitation

Falls in the elderly are a major health problem. Approximately 30% of community-dwelling elderly over the age of 65 fall at least once a year and 6% of these falls result in fractures. These figures
become even worst in populations with neurological disease such as Parkinson’s disease (PD). This patient population has an even higher risk of falls, with annual incidence of 60–80%, at least twice that of the general elderly population. The consequences of falls in the elderly are severe: Falls often lead to disability, fear of falling, depression and social isolation, and loss of confidence in the ability to walk safely.
Most falls occur during walking and not surprisingly, gait impairment has been associated with an increased risk of falls. With ageing, elderly individuals generally walk more slowly, with shorter
strides, decreased arm swing and longer double limb support times. Many of these age-associated changes in gait are exaggerated further among elderly fallers and even more in patients with PD.
Until recently, gait and balance were essentially perceived as automated, biomechanical processes and falls were largely viewed as a failure of these motor mechanisms. Work over the past decade
or so has, however, underscored the strong connection between balance, gait and falls, on the one hand, and cognitive function, on the other hand.
A large number of scientific studies investigating the effectiveness of physical therapy protocols to improve gait and balance problems in patients with PD have been published so far, and to date,
data are consistent in supporting the overall efficacy of rehabilitation intervention. On the other hand, the effect on fall risk seems to be small and the reported changes are focused on motor
aspect with limited long-term retention.
Thus, recent evidences suggest that in order to obtain long term retention of the results obtained, and thus promoting motor learning processes, physical therapy interventions should move toward task specific motor cognitive combined approaches. In this view, physiotherapy intervention might represent a gateway to promote a more functional recovery, focusing on both the physical and cognitive domains to decrease the risk of falls and empower safe community ambulation and function.