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A theoretical framework for addressing fear of falling avoidance behavior in Parkinson’s disease

Landers, Merrill R. and Nilsson, Maria H. LU orcid (2023) In Physiotherapy Theory and Practice 39(5). p.895-911
Abstract

Postural instability in Parkinson’s disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to... (More)

Postural instability in Parkinson’s disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.

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author
and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
balance, falls, gait, neurorehabilitation, Parkinson’s disease, physiotherapy
in
Physiotherapy Theory and Practice
volume
39
issue
5
pages
895 - 911
publisher
Taylor & Francis
external identifiers
  • pmid:35180834
  • scopus:85125418010
ISSN
0959-3985
DOI
10.1080/09593985.2022.2029655
language
English
LU publication?
yes
id
21794425-5e35-403c-a779-9e2a645ab155
date added to LUP
2022-04-19 14:09:02
date last changed
2024-06-16 21:30:30
@article{21794425-5e35-403c-a779-9e2a645ab155,
  abstract     = {{<p>Postural instability in Parkinson’s disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.</p>}},
  author       = {{Landers, Merrill R. and Nilsson, Maria H.}},
  issn         = {{0959-3985}},
  keywords     = {{balance; falls; gait; neurorehabilitation; Parkinson’s disease; physiotherapy}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{895--911}},
  publisher    = {{Taylor & Francis}},
  series       = {{Physiotherapy Theory and Practice}},
  title        = {{A theoretical framework for addressing fear of falling avoidance behavior in Parkinson’s disease}},
  url          = {{http://dx.doi.org/10.1080/09593985.2022.2029655}},
  doi          = {{10.1080/09593985.2022.2029655}},
  volume       = {{39}},
  year         = {{2023}},
}