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
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 !