The Leaning Tower of Pisa

30/8/18 The Leaning Tower of Pisa : timeline

2002 Onset of movement disorder
2004 Leaning over to the left just sitting on the sofa talking. Have to keep hitching myself back up
2006 Neurologist reports balance problems on my DLA form
2007 ‘unsteady gait’ - definitely feeling less stable when I try to stand still
2008 Balance deterioration. Got very distressed trying to walk after parking my bike. Too scared to get back on it.
Fall crouching talking to son keeled over backwards with no warning
Fall hit head on son’s bicycle parked in the middle of the living room - leaning to left when kneeling at my desk (get too uncomfortable sitting with akathisia)
Bought stick and tricycle.
2009 Nearly fell off chair just sitting talking to neurologist
2010 Get rollator. Fall going backwards on rollator as walking too slow.
Fall off tricycle in the road. Hurt myself. Gave it away.I saw a photo of myself on it. I seem to be leaning to the left.
2010 Get wheelchair .Freezing getting worse & legs buckling,.
2012 Bought recumbent trike (back is supported so can’t fall off) 2016 Get new walker & give wheel chair back. Too heavy for using on public transport.
2018 Fall negotiating the kerb with my walker .

Parkinson’s Disease N. P. Quinn F. A. Husain BMJ vol. 293 9 Aug.1986

The first prerequisite is the recognition of parkinsonism, which comprises two or more of the following signs: tremor, rigidity, akinesia, and postural abnormality (either flexed posture or impaired postural reflexes).

Chapter 6 Cardinal features of early Parkinson’s disease P.K.Pal, A. Samii & D.B. Calne (in Parkinson’s disease: diagnosis and clinical management S.A.Factor, W.J.Weiner Demos Medical Pub. 2002)

Impairment of postural reflexes and abnormality of gait usually occur about 5 years after the onset of IP, although sometimes earlier.

Reversible Pisa Syndrome in Parkinson’s Disease During Treatment With Pergolide A.Cannas, P.Solla, G.Floris, G.Borghero, P.Tacconi, A.Spissu Clinical Neuropharmacology: Sept.-Oct. 2005 – Vol. 28 - Issue 5 - p 252

The term Pisa syndrome or pleurothotonus refers to a dystonic syndrome characterized by tonic lateral flexion accompanied by slight rotation of the trunk in the sagittal plane, with a postural disturbance resembling the leaning tower of Pisa.

See link for article below:

Postural and Balance Disorders in Patients with Parkinson’s Disease: A Prospective Open-Label Feasibility Study with Two Months of Action Observation Treatment A. Santamato, M. Ranieri, N. Cinone, L. A. Stuppiello, G. Valeno, J. Laura De Sanctis, F. Fortunato, V. Solfrizzi, A.Greco, D. Seripa, and F. Panza Parkinsons Dis. 2015; 2015: 902738.

Postural instability is one of the cardinal manifestations of Parkinson’s disease (PD) and becomes a clinical concern in the middle-later stages, usually occurring after the onset of other clinical features.

Patients with PD have decreased stability during both static and dynamic motor tasks and the risk of falling represents a serious and disabling issue that affects daily life and personal autonomy and generally may not respond to dopaminergic treatment.

Up to 40% of PD patients with postural instability have multiple falls that predispose to injury, including wrist and hip fractures and the need for medical care. In addition, social isolation occurs because of the fear of walking.

…factors such as the impairment or loss of postural reflexes, disturbance in central sensory processing, inflexibility of postural reflexes, postural deformities, interactions of akinesia, bradykinesia, rigidity, and freezing of gait can contribute to imbalance in PD .

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