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Walkers Pose Pluses and Minuses for Parkinson's

Walking aids slow patients, don't prevent 'freezing,' say researchers

TUESDAY, Oct. 2, 2001 (HealthDayNews) -- A new report sheds light on a vital but little-studied aspect of living with Parkinson's disease: walkers.

The study, to be presented today at the American Neurological Association's annual meeting in Chicago, finds that walkers slow patients down and don't prevent "freezing," the mid-stride pauses that often cause Parkinson's patients to topple over.

People with Parkinson's disease lose nerve cells in the brain area that controls muscle activity. As brain cells die, patients experience hand tremors as well as muscle rigidity and slowed movement. As the disease progresses, walking becomes a particular challenge with patients prone to falls and other balance problems as well as "freezing."

When patients have trouble walking and fall, "the first thing we do is give them a walker, and that's sort of the end of it. No one has really studied the problems or the benefits of walkers," says Dr. Abraham Lieberman, medical director of the National Parkinson Foundation and professor of neurology at the University of Miami. "A study like this is very important because it calls attention to the fact that a walker is not a universal answer."

The researchers, who included all faculty members at Rush Presbyterian-St. Luke's Medical Center in Chicago, had 19 Parkinson's patients navigate a mild obstacle course involving rising from a chair, walking through a doorway, walking along a straight path, pivoting and returning. Patients were tested using both wheeled and unwheeled (standard) walkers.

Although both types of walker reduced speed and sometimes even aggravated episodes of "freezing," they did prevent patients from falling. Walkers with wheels performed slightly better with regard to speed and freezing.

"What the walkers do is provide stability," says Joel Gerstel, executive director of the American Parkinson Disease Association in Staten Island, N.Y. "When somebody starts to freeze, they can have all the walkers in the world and nothing will help them. And nobody knows the reason for the freezing."

Lieberman says the problem is the design of the walkers. Many of his Parkinson's patients report less trouble pushing a cart at the grocery store than using a walker. When Lieberman investigated on his own, alternately pushing a regular cart and a smaller cart designed for children, he says he realized the height of the walker seemed to make the difference. He says the kiddie cart "was terrible" because it forced him to hunch way over.

"Not enough scientific thought has gone into the design of the walker," says Lieberman. "We've just thrown something together and said 'here.'" Most walkers -- and canes, for that matter -- are designed with low bars for people with orthopedic problems who need to take pressure off a joint. This is not necessarily what works for a Parkinson's patient. "In order for you to walk, your spine has to be straight because that gives you the leverage you need at your hip joint to take big steps. If you bend your spine, you have less leverage and you walk with shorter steps."

Another issue is wheels. Parkinson's patients who have lightweight walkers without wheels invariably pick them up when they turn a corner and often fall over as a result. Even when walkers have wheels, they usually are tiny and difficult to maneuver around a corner (unlike larger wheels on supermarket carts).

Obviously, the answer is not to provide Parkinson's patients with their own grocery carts but to find a walker designed with their specific needs in mind, he says.

Walkers definitely have a role, says Lieberman. If designed properly, they can provide a degree of stability and can prevent falls. "If you want to know the importance of a walker or stick, look at Moses," he says. "In pictures, he's got a walking stick so his spine is straight. If he was walking with a [smaller] cane, he'd still be in the Sinai."

What To Do

For more information on Parkinson's disease, which afflicts about half a million Americans, visit The National Parkinson Foundation or The American Parkinson Disease Association

For more information on the U-Step stabilizing walker featured on The National Parkinson Foundation Web site, visit U-Step Walker.

SOURCES: Interviews with Abraham Lieberman, M.D., medical director, National Parkinson Foundation and professor of neurology, University of Miami, Fla.; Joel Gerstel, executive director, American Parkinson Disease Association, Staten Island, New York; Oct. 2, 2001, presentation to American Neurological Association's 126th annual meeting in Chicago
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