Although clinical rating scales and simple timed tests of motor function are widely used to assess motor response to therapy, gait analysis may provide an alternative measure of this response. We studied 15 patients with PD complicated by motor fluctuations, first to determine changes in temporal and spatial gait parameters following levodopa, secondly to assess the stability of repeated gait measures and timed tests in "off" and "on" states, and thirdly to determine the use of gait analysis in the assessment of the dopaminergic response. Gait analysis (velocity, stride length, cadence, and double limb support), clinical rating scales (modified Webster scale and Hoehn and Yahr stage), and timed tests of motor function (hand tapping and stand-walk-sit time) were performed before ("off") and after ("on") a levodopa challenge. Stride length and gait velocity increased following medication whereas cadence and double limb support did not. Most gait measures and the stand-walk-sit time were stable over three consecutive trials in both "off" and "on" states. Of the gait measures, only cadence in the "off" state changed significantly whereas the tapping count improved with repeated trials in both "off" and "on" states. Changes in stride length, gait velocity, and tapping count following levodopa correlated with changes in clinical rating scales following treatment. Measurement of gait parameters provides a reliable, objective alternative to rating scales and timed tests in assessing the dopaminergic response in patients with PD and motor fluctuations.

Future studies should ascertain whether our screening protocol is appropriate, and a longer-term follow-up should examine the relationship between UD recommendations and prevention of complications.

Introduction:  Visual impairment is common in older people, and is a risk factor for falls and hip fractures, reduced independence and quality of life. Objectives:  To assess the prevalence and causes of visual impairment in an aged care ward, and to evaluate whether routine eye assessment, and referral to an eye specialist was worthwhile to detect patients with low vision that could be correctable. Method:  Clinical eye examination of 100 consecutive inpatients and review of medical records. Patients with a new diagnosis of visual impairment were referred for ophthalmology or optometry assessment. Results:  The prevalence of low vision was 36% and the prevalence of blindness was 9%. There were 18 patients referred for specialist review, three patients were recommended a new treatment but only two received treatment. Conclusion:  Visual impairment was prevalent. Although refractive error and cataracts were common, in only a few cases did detection and specialist referral lead to improved visual outcomes.

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