Gait, Balance and Falls – PDF expert briefing

On Tuesday I took part in Parkinson’s Disease Foundation expert briefing on Gait, Balance and Falls in Parkinson’s disease.

1. Gait (walking) problems in Parkinson’s:

  • Slow walking, difficult to keep up with people in the community
  • Short, shuffling steps (step length gets smaller)
  • Foot drags or catch (uneven surface i.e. sidewalk, rug)
  • Arms swing less (one side more than other)
  • Initiating walking
  • Difficulty changing directions
  • “hypokinesia” in parkinson’s – SMALL movements (handwriting, steps, armswing) … translates to small, shuffling steps in PD
  • freezing (i.e., difficulty initiating walking (getting going), and turning “feet glued to floor”)
  • weakness due to lack of message from brain to muscles (driving muscles, especially extensors) … contributes to small movements, slowness
  • rigidity causes reduced mobility in joints (stiffness) *spine, hips … limits your ability to stand up straight (read more about posture HERE)

What does this mean?

Well, greater trouble with walking means emerging disability (Shulman Movement Disorders 2010; 25(1) S131-135)

Thus, we want to ID walking problems as soon as possible to prevent onset of disability over time.

By improving walking ability in Parkinson’s we can :

  • slow progression of disability
  • keep people active, improve speed
  • increase size of movements (steps, armswing), turning ability

But, how do we do this?

  • Practicing walking can improve walking
  • Cueing replaces internal cueing mechanism (loss of automatic abilities due to dopamine decline) with external cues (metronome, music/beat/tempo, flashing light, vibration) to initiate gait  (Nieuwboer, 2007)

Examples of cueing training include:

  • Metronome/music improves coordination, timing, speed and efficiency
  • Pedometer to monitor steps (give you feedback on your progress and helps with goal setting)

2. Fall in Parkinson’s

  • 80% of falls in Parkinson’s occur at home during walking, standing and/or transferring (i.e., from sitting to standing)

What to do about falls?

  • Be active & stay active … reduce disability and optimize independence and quality of life!
  • Go to physical rehabilitation EARLY and throughout the disease  progression (it’s also never too late to start a walking/balance program!)
  • Seek of a Parkinson’s-specific physical therapist …  like Parkinson Wellness Recovery (PWR!) clinician training with Dr. Becky Farley PhD MS PT
  • Walk more! Do this by setting goals (use a pedometer to keep track) and use music/tempo
  • Start a balance & strengthening program *try chair pose (see HERE), which targets strength, balance and transfers!
  • Reduce your fall-risk by :widening base of support (especially when picking things up), stop multi-tasking, reduce the clutter in your home,  and keep journal to identify fall patterns

try CHAIR POSE for balance, strength and transfers! (www.satyaliveyoga.com.au)

If you are interested, the full presentation slides are available HERE: PDF Expert Briefing Slides. Go get moving and bring some balance into your life. much love.

PS. Want more expert briefings? Check out Coping skills for Parkinson’s care partners !