title: Concurrent arm swing-stepping (CASS) can reveal gait start hesitation in Parkinson's patients with low self-efficacy and fear of falling.
abstract: BACKGROUND
  Movement incoordination, freezing of gait, fear of falling, low self-efficacy, and multi-tasking can all contribute to falls in Parkinson's disease. How these multi-factorial risks interact in individual patients remain poorly understood.
  
  
  METHODS
  Concurrent arm swing-stepping is a simple motor test in which subjects are first asked to swing their arms before being instructed to initiate the secondary task of leg stepping-in-place. We postulated that in patients with multiple fall risks, sensorimotor impairments in upper- and lower-limb movement control can render concurrent arm swing-stepping a demanding dual task, thereby triggering gait hesitation. A total of 31 subjects with Parkinson's disease were enrolled in the study.
  
  
  RESULTS
  It was found that concurrent arm swing-stepping induced hesitation primarily in Parkinson's disease patients with low fall-related self-efficacy and a fear of falling. By contrast, concurrent arm swing-stepping led to limb incoordination in both patients and in healthy elderly controls. The calculated specificity and sensitivity of the concurrent arm swing-stepping test was 100 and 42 % for hesitation and 12 and 77 % for incoordination.
  
  
  CONCLUSIONS
  These results suggest that the concurrent arm swing-stepping test can be used in conjunction with conventional psychometric assessments to facilitate multi-factorial assessment of potential fall risk.
authors.affiliation: Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1AC60 HRIC, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada, tgchomia@ucalgary.ca.
authors.forename: Taylor
authors.initials: T
authors.lastname: Chomiak
authors.forename: Fernando V
authors.initials: FV
authors.lastname: Pereira
authors.forename: Terry W
authors.initials: TW
authors.lastname: Clark
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cihal
authors.forename: Bin
authors.initials: B
authors.lastname: Hu
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D002170:Canada; D005080:Exercise Test / Q000379:methods; D005239:Fear; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D020377:Self Efficacy