Choreographing life-experiences of balance control in people with Parkinson’s disease

Abstract

Background: Parkinson's disease (PD) is a devastating neurodegenerative disorder. Reduced balance is one of the cardinal symptoms of PD, predisposing people living with PD to experience difficulties with the execution of tasks and activities, as well as hindering their involvement in meaningful life areas. The overarching aim of this study was to explore how deficits in balance control manifest in everyday life and how it is managed by people with PD (PwPD). Methods: Qualitative description was used as methodology, and in-depth interviews were conducted with 18 participants, between the ages of 46 to 83 years, with mild to severe PD. Interview transcripts were analyzed using qualitative content analysis, following an inductive approach. Results: One theme emerged from the analysis: Increased planning-choreographing life. Within this overarching theme, two categories were identified, namely Limitations in mobility and New restricted functioning in everyday life, each with 3-4 sub-categories. The categories described how PwPD handled decreased balance control in their everyday life by using motor and cognitive strategies as a consequence of not trusting their body's capacity to control balance. Activities in everyday life, as well as the ability to partake in leisure and social activities were profoundly affected. Conclusion: People with mild to severe PD used strategies to handle decreased balance and they choreographed their lives around their individual current state of mobility and balance. The knowledge gained from this study can be used to develop targeted interventions addressing the nuances of balance deficits in everyday life.

Visuomotor control of walking in Parkinson’s disease: Exploring possible links between conscious movement processing and freezing of gait

“…Previous research has shown that PD in general (i.e., not only PD+FOG) is associated with greater conscious processing of walking movements [33,34]. On this basis, the overall group results presented here may well be similar to visual search behavior in people with PD who do not experience freezing in daily life; particularly if these behaviors are indeed a consequence of and/or required to engage in conscious movement processing (as suggested above).…”

“…Specifically, people with PD+FOG seem to rely more strongly on visual information to process ongoing stepping movements [12], a control strategy which likely reflects increased conscious processing of movement [12,31,32]. People with PD generally report an increased use of conscious movement strategies to regulate walking movements [33,34], particularly when walking in complex environments necessitating effective visuomotor control [34]. Such conscious movement strategy likely reflects a potentially adaptive mechanism employed to overcome the loss of movement automaticity [35].…”