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! (

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 !