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Author: search.filters.author.Diego KaskiSubject: search.filters.subject.anxiety

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    Case Report: Acute Onset Fear of Falling and Treatment With “Cognitive Physical Therapy”
    (2021)
    CASTRO ABARCA, PATRICIA BERNARDITA  
    ;
    Shree Vadera
    ;
    Matthew James Bancroft
    ;
    Joseph Buttell
    ;
    Diego Kaski
    <jats:p>Fear of falling (FoF) is prevalent in older adults, especially those with previous falls, and typically starts insidiously. We present a 78-year-old woman with an abrupt onset FoF and no history of falls, balance problems, vertigo, oscillopsia, psychiatric or psychological issues to account for this. These cognitive changes led to a behavioural alteration of her gait that became slow and wide-based, with her gaze fixed on the floor. She began a tailored program of “Cognitive Physical Therapy (CPT)” combining cognitive behavioural therapy (CBT) and physical rehabilitation. 1 month later her 6 m walk time and steps were reduced by a 25 and 35%, respectively, and the stride length increased by 34%, with further improvement 2 months later. We postulate that the abrupt onset of symptoms triggered a central shift toward postural hypervigilance and anxiety, suppression of anticipatory (feed forward) postural adjustments (APA) leading to FoF. CPT improved objective gait parameters related to FoF and reduced postural anxiety suggesting that early diagnosis and prompt treatment may avoid chronic symptoms and social isolation.</jats:p>
    Scopus© Citations 11  1
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    Priming overconfidence in belief systems reveals negative return on postural control mechanisms
    (2022)
    CASTRO ABARCA, PATRICIA BERNARDITA  
    ;
    Efstratia Papoutselou
    ;
    Sami Mahmoud
    ;
    Shahvaiz Hussain
    ;
    Constanza Fuentealba Bassaletti
      3Scopus© Citations 9
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    Dissociated motor learning and de-adaptation in patients with functional gait disorders
    (2020)
    Denise Lin
    ;
    CASTRO ABARCA, PATRICIA BERNARDITA  
    ;
    Amy Edwards
    ;
    Akila Sekar
    ;
    Mark J Edwards
    <jats:title>Abstract</jats:title> <jats:p>Walking onto a stationary platform that had been previously experienced as moving generates a locomotor after-effect—the so-called ‘broken escalator’ phenomenon. The motor responses that occur during locomotor after-effects have been mapped theoretically using a hierarchal Bayesian model of brain function that takes into account current sensory information that is weighted according to prior contextually-relevant experiences; these in turn inform automatic motor responses. Here, we use the broken escalator phenomenon to explore motor learning in patients with functional gait disorders and probe whether abnormal postural mechanisms override ascending sensory information and conscious intention, leading to maladaptive and disabling gait abnormalities. Fourteen patients with functional gait disorders and 17 healthy control subjects walked onto a stationary sled (‘Before’ condition, five trials), then onto a moving sled (‘Moving’ condition, 10 trials) and then again onto the stationary sled (‘After’ condition, five trials). Subjects were warned of the change in conditions. Kinematic gait measures (trunk displacement, step timing, gait velocity), EMG responses, and subjective measures of state anxiety/instability were recorded per trial. Patients had slower gait velocities in the Before trials (P &amp;lt; 0.05) but were able to increase this to accommodate the moving sled, with similar learning curves to control subjects (P = 0.87). Although trunk and gait velocity locomotor after-effects were present in both groups, there was a persistence of the locomotor after-effect only in patients (P &amp;lt; 0.05). We observed an increase in gait velocity during After trials towards normal values in the patient group. Instability and state anxiety were greater in patients than controls (P &amp;lt; 0.05) only during explicit phases (Before/After) of the task. Mean ‘final’ gait termination EMG activity (right gastrocnemius) was greater in the patient group than controls. Despite a dysfunctional locomotor system, patients show normal adaptive learning. The process of de-adaptation, however, is prolonged in patients indicating a tendency to perpetuate learned motor programmes. The trend to normalization of gait velocity following a period of implicit motor learning has implications for gait rehabilitation potential in patients with functional gait disorders and related disorders (e.g. fear of falling).</jats:p>
      20Scopus© Citations 24
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    Scopus© Citations 25  3