The patient came into the doctor's office in a wheelchair,
weighted down by a diagnosis of Parkinson's disease, taking
medication for the disorder and insisting she was unable to stand or
walk. Thirty minutes later, after jogging down the hallway, she
strolled out the door.
No Parkinson's patient was she. Rather, she was a perfect
example of a person with "fear of falling gait," said neurologist
and Parkinson's expert Roger Kurlan, M.D., of the University of
Rochester Medical Center. Kurlan has seen enough cases of the
condition, where a person is so afraid of falling that the mind
actually affects the ability to walk, that he wrote about the
disorder in the September issue of Cognitive and Behavioral
Neurology to cue other physicians about the condition.
In the case reported in the journal, Kurlan describes an
elderly woman who had an increasingly difficult time walking. The
difficulties began shortly after her husband died, when she tripped
and fell, breaking a wrist and bruising her leg. Her inability to
walk led her doctor to diagnose Parkinson's disease, and she was
prescribed the Parkinson's medication levodopa to treat her
symptoms. Despite treatment, she ended up in a wheelchair, unable to
walk, and she was sent to Kurlan, an expert in movement disorders
like Parkinson's.
A thorough physical exam turned up nothing abnormal, but the
woman refused to try to stand up on her own, even pushing herself
down into her chair as Kurlan and a nurse tried to convince her to
attempt to stand up. With enough persuasion, though, and with
several people available to help her up, the woman finally did rise.
At first she took short, tentative steps, sure that she was
going to fall. Upon hearing that she did not appear to have
Parkinson's or any other serious neurological condition, however –
and that her problem was psychological, reflecting her fear of
falling – the woman's bearing improved markedly. With more
encouragement and offers of help, the woman began walking around the
room and even jogging down the hallway.
Kurlan estimates that he has seen at least 30 patients with
"fear of falling gait" over the years, and that most neurologists
who treat Parkinson's disease have seen such patients too, though
not a lot has been written about the condition. People who have
Alzheimer's disease or who have had several strokes also sometimes
have a similar disorder, he said.
The abnormal gait sometimes begins, as it did with this
patient, shortly after a fall, though many patients have never
fallen but are literally paralyzed by the fear that they might fall.
Patients shuffle or slide their feet along the floor and hold onto
something constantly for support. Soon the abnormal gait itself
becomes a problem, even to the point that a person doesn't walk for
months or years.
"The results can be pretty dramatic when psychogenic gait
disorders are treated appropriately," said Kurlan, professor of
Neurology and a scientist in the Center for Aging and Developmental
Biology. "People literally come in in a wheelchair, and walk out of
the office after one appointment. It's very satisfying as a
physician to treat this condition. Symptoms often reverse quickly."
Kurlan said most patients are thrilled to learn that their
problems walking have more to do with their mind than their bodies.
In his experience about half of such patients walk out of his office
when the appointment is over, though for many the hard work –
working out psychological problems through ongoing counseling – is
just beginning.
A psychogenic gait disorder is similar to other neurological
symptoms that have their roots in causes that have nothing to do
with a patient's physical health, Kurlan said. Some patients
experience hysterical blindness – they think they can't see – when
there is absolutely nothing wrong with their eyes or their nervous
system, for instance. Other people at times can feel weak, or can
even lose their ability to speak – and all these symptoms can
sometimes be due to the mind, not the body. Usually, treatment that
focuses on the patient's psychological well-being helps ease
symptoms.
"For a lot of patients, we simply help them get over their
fear of falling by getting them into physical therapy and getting
them more confident about being on their feet. Some patients never
get over the fear, though, and they spend the rest of their lives
not walking."
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I
think, therefore I fall