Can falls be prevented in Parkinson’s disease?

Typical idiopathic Parkinson’s disease (PD) presents with unilateral tremor, rigidity and limb bradykinesia. The disease is manageable with symptomatic treatment for several years before gait, postural and other symptoms develop. The term lower body parkinsonism was introduced to refer to parkinsonian syndromes marked chiefly by gait disturbance, with minimal or no upper limb difficulties.¹ Lower body parkinsonism is thought to be a disorder of vascular origin that affects non-dopaminergic brain areas responsible for locomotion.² The same regions are involved (at least in part) in the later stages of idiopathic PD.³ The principal locomotor deficit associated with parkinsonian syndromes is considered to be impaired generation of the postural shifts that mediate changes from one steady state posture or movement to another.

In the early stages of typical PD, falls are uncommon, although some gait abnormalities manifest early.⁴ Patients use voluntary control of gait to …