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.
Doctors subsequently referred her to a physical therapist to build her confidence on her feet, and they also gradually stopped her Parkinson's medications. Her ability to walk unassisted continued for the six months the team followed her progress.
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.