パーキンソン病の歩き方の理解と評価①

ひるけ (ATC)

歩き方の特徴や転ばないようにするにはどういう点を気を付ければ良いかなど､ペンシルバニア病院､ダン・アロンパーキンソンリハビリテーションセンターのHeather Cianci 先生からの教えをまとめました。

2026.06.29 公開

パーキンソン病歩行評価

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ノートテキスト

ページ1:

No.
Date
Common Gait Presentations
Common Deficits
Slowed absent automaic movements:
heel strike
Varm swing
-↓ Stride
ground reaction forces for
heel strike and toe off
↓
Slowed velocity
- Turning difficulty:
·Multi-step
Pivot
Cross-over <
Commonly
results in
a fall.
DV

ページ2:

-
Freezing of gait (FOG)
Festination
Can't
No.
Date
• stop!
The
-Retropulsion
0
can't
Stop!
- Slowed/absent righting reflexes.
- Narrow Base of Support (BOS)
- Center of Gravity (CDG) ant. to BOS
- environmental Scanning
- I time in double limb support.

ページ3:

No.
Date
Falls
-70% of Pts
/ year.
-50% of Pts
→
72/year.
head trauma
Caused by
fall
- hip fracture
Prevent fall
QOL
(3)

ページ4:

Gait Assessment
PD EDGE
No.
Date
-Evidence Database to Guide Effectiveness.
• Activity: - 6 min walk
-
- 10m. walk
-
Mini BEST Test
MDS-UPDRS (part 2)
- Functional Goit Assessment
- 5 time sit to stand
-Nine-hole
peg Test
•Participation: - PDQ-8/PDQ-39
•Specific constructs:
Fear of
ADL
- Freezing of gait quationnaire
-Parkinson's fatigue scale
falling-ABC scale
Dual
Task
Time up and go (cognitive)
4

ページ5:

No.
Date
Gait observation
trunk
- Reciprocal arm swing rotation
-Stride length
-Heel strike
Nervous about falling,
gaze the floor
- Head position & eye direction?
end too forward?
Teaning to one side?
- Posture
- BOS (wide / narrow?
problems with
Scissoring?
-Triggers of freezing
✓ Where?
- Various surfaces
When? (first step, turning, etc
Te)
-the
patient is able to correct
the episode of FOG?
- Various areas
-Catch the patient Unaware.
⑤

ページ6:

No.
Date
Timed Up and Go (TUG)
•
Good tools because: /s
- Initiation of gait.
Can Trigger FOG
-Pressure of being timed.
Turns.
Can reassess the patient's techniques.
for freezing prevention/break and
turns.
Cognitive
"Can make it harder = Dual tasking.
eg). Counting backwards.
by s
50, 47, 44.....
4
PD-specific norms:
TUG
12 sec.
- TUG (Cog.) - 14.7 sec.
-TUG (manual) -13.2 sec.
5cm
(coccying a glass)
11
3m..
Perform TUG!
especially for young
↓
onset PD.

ページ7:

No.
Date
TUG (variation).
• Cognitive S. Naming items in a group
Canimals, cars, desserts, etc)
Serial Subtraction.
[6]
Motor
5. Carrying a glass of water
·Buttoning a coat
Cognitive. · Dialing a mobile phone.
+
Motor.

ページ8:

No.
Date
Tinetti Balance and Gait (risk of fall)
-Score: 19~24/28 = moderate risk
<19/28
=
high risk
FOG Questionnaire (FOG-Q)
•Assesses FOG severity
10m - Walk Test.
-perform both: comfortable speed.
and
the fastest speed.
>>
0
2
10m
12
14
10m/speed = result.
59). 10m/8 sec = 1.25 m/s.

ページ9:

No.
Datel
Functional Gait Assessment (FGA)
-including: turning head
walking backward
wolking eyes
closed
etc...
unmask the
す
deficits common
in PP.
Better ability to detect fall
FGA TUG.

ページ10:

Turning
1800
•Mild PD = 2.5 sec. /4.5 steps
Severe PD = 3.2 sec/5.6 steps
TO
To test Turn :
Right/
0
→
wide
open / small crowded spaces
-Static position
- On command
-
-
- Dual task
Around objects
360 Turn in place
(as quickly as possible.)
turn x 2
Most effective way
to provoke FOG.
turn xa sin random order
To