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Examining causes and contributors to falls in Parkinson disease (728.9)

The high incidence of falls in people with Parkinson disease (PPD) (>70% fall each year, 13% fall > once/week) is attributed to central nervous system damage that disturbs movement amplitude regulation and sensory processing. Despite this, PPD are capable of learning motor tasks with practice. Virtual environments are being developed to provide safe repetitive practice in an effort to decrease falls. To inform the development of these environments, we examined causes and contributors to falls from the perspective of PPD. Eleven men with mild to moderate PD completed a semi‐structured, mixed methods interview. Subjects rated environments on a scale from 1 (never difficult to walk or maintain balance) to 5 (always difficult), and descriptive statistics were calculated. They answered open‐ended questions about mobility and falls, and coding was used to categorize this data. The most difficult surface type was “Unreliable/Unstable” (e.g. loose gravel, mean=3.64), followed by “Irregular/Inconsistent” (e.g. cobblestones, mean=3.09) and “Angled” (mean=3.09). “Visual Factors” (e.g. glare, mean=3.09) were rated similarly. Multitasking and feeling rushed or worried were identified in open‐ended responses as common contributors to falls in the “Distracting” category (mean=2.91). “Obstacles” were rated as moderately difficult (mean =2.22), but were identified as a frequent concern and contributor to falls when fall history was examined. The most challenging scenarios combined several of these factors. With this knowledge, virtual environments that allow for motor learning through safe practice of challenging scenarios are being created. Future research is necessary to determine to what extent this virtual‐based learning will transfer to real‐world scenarios, and the dosage of practice necessary to achieve a functional decrease in falls in PPD.