Pre-habiliation is about stopping falls before they begin, and it’s always the best option. There is enough research and evidence to know that we should be exercising whether we have Parkinson's or not. But what can we do once we start to fall, what is freezing and how can we protect ourselves from injury?  

Falls are caused from a multitude of reasons, and those with certain neurological conditions may be more at risk.  However, today we are going to specifically look at Parkinson's disease, and focus on the risk of falls, impaired balance and why this may be happening. By addressing the reasons falls occur, you can reduce the number of falls you are having and  prevent further falls. 

Some of these reasons include, freezing, reduced muscle strength, postural hypotension, cognitive decline, fear of falling, reduced postural responses, and environmental hazards. 

If you are experiencing falls the best place to start is with using a ‘Falls Diary’.  This is a useful tool to identify when falls are occurring and in what situation.  For example, is it often when getting up to the toilet at night, or are you tripping over the front step, or could it be that you are falling in the kitchen when you turn around too fast?  By noting these in your Falls Diary, this can help you to identify where you need to focus your falls prevention. To help support falls prevention, click here to access your own copy to complete.  

For those with Parkinson’s, you may have experienced a period of Freezing.  This is when there is a delay or complete inability to initiate a movement, most notably seen with walking. This could be when a person cannot take a step on first moving or when turning.  It can also happen when rolling in bed or getting out of a chair. 

The reason freezing occurs is not well understood, however we have a number of strategies which can be very useful to manage this.  This includes gait retraining, use of cueing, which is external or internal cues that help you overcome freezing episodes, and counting or having lines on the floor. Specific practice and exercises help with freezing as well. 

Muscle weakness in Parkinson's is related to the impaired activation of the muscle itself, however as the disease progresses and we become more sedentary we can get secondary muscle weakness. Keeping strong muscles in your bottom, thighs and ankles is important, as are targeted exercises to maintain good balance and good postural control.
 
Fear of falling, can potentially lead to more falls.  I often talk about the ‘cycle of falls ‘ and how a fall can subsequently lead to a fear of falling.  This can then result in reduced activity levels, lack of confidence and reduced mobility, exacerbating the issue.  A great way to overcome the fear, and regain control, is to break the cycle and improve confidence around mobility.  Learning how to get up of the ground, improving muscle strength and challenging your balance are key ways to feel stronger physically and confident in different situations. 

Other medical conditions, such as Postural hypotension, which can be related to your Parkinson's can have an impact on your balance, as can medications. It pays to have regular reviews with your GP to make sure all your medications are needed and that your Parkinson's medication is at its optimum.
 
Cognitive decline can have an impact of falls, as you may not be aware of your environment or how you are moving within your environment. We know exercise is one of the most beneficial tools to help with cognitive abilities, as is learning new activities and brain training can also be implemented. Continued practice from diagnosis of key movement strategies such as sit to stand and stand and turn can help maintain function with cognitive decline. Therefore practical neuro active exercises can help to prevent further issues, and maintain current levels of activity. 

As Physiotherapists, another important aspect in falls prevention is Balance Retraining.  This is completing specific exercises and activities to improve balance, and to retrain balance, which means we need to stress and challenge the internal balance systems.  Just think how a baby learns to walk – it is through repeated stepping and falling down that they learn to move, as our brain and body use a feedback loop to make adjustments to keep us upright against gravity.  So when we retrain our balance we target specific individualised exercises that challenge a persons’ balance at the correct level to lead to better improvements. 
 
Falls prevention is important as this contributes to your health, wellness and independence.  There is help available, so if you need help or would like to chat for advice, call Sarah on:  (09) 424 3254  or e-mail:  [email protected]

In this blog we outline the difference, between general cardiovascular exercise which we class as Neuro passive exercise and Neuro Active exercise which we recommend for you to manage your Parkinson’s disease.
 
It’s now widely documented that when living with Parkinson’s you need to keep active and exercise. As a blanket statement for wellbeing that is fantastic. But what does it actually mean to be active? And what type of exercise do you need to do?
 
Often, we hear “I exercise every day and I am very active”. That’s is a great start! You should congratulate yourself on having a healthy lifestyle that supports your metabolic system and wards off heart and lung disease. But often this active lifestyle isn’t enough to slow down the progression of Parkinson’s.
 
What we have come to realise is that exercise needs to be Neuro Active. Simply put; Neuro active exercise is exercise that promotes not only brain health but also creates neuroplasticity. The brains ability to rewire and make new connections, opening dormant pathways.
 
SO what is the magic formula?
 
Thomas gardens every day, potters around in his shed, mows the lawns and keeps his property tidy. He doesn’t sit down much but might have a short nap in the afternoon. Overall, he remains mobile and “active”. The problem is that his movements will still be done on a smaller scale than normal, unless he is conscious and planned with how he moves every time he moves.
 
And what about Brendan, he goes to the gym four days a week, he is on the bike doing a gentle cycle for 10 minutes and then does weights for 30 minutes. This is helpful to build strength in his muscles. However, we know that with Parkinson’s there is not a primary problem of weakness, yes you get secondary issues with weakness because you are not moving properly and more sedentary. So what if we treated the primary reason, the fact that the brain is not activating the muscles through the correct range or with enough force?
 
Bronwyn walks every day on her local beach for about 30 – 45 minutes at a reasonable pace.  However, she has noticed that she is walking shorter distances than she has in the past. Bronwyn has a great exercise behavior pattern, but this is still not helping her maintain her desired level of function. With Parkinson’s as the condition develops the brain recalibrates itself, movements become smaller and slower and it takes more time to walk along the beach.
 
If you see yourself in these made up cases, then please don’t stop what you are doing! Just make it work better for you. It is important that you maintain an active lifestyle but to change your brain your activities need to be neuro active.
 
As Physiotherapists we aim to teach patients the principles to be neuro active and how to put these into everyday life. We help you make the changes needed to slow down the progression of Parkinson’s. We show you how your activity choices need to be very deliberate and this can take a lot of hard work and effort.
 
This ‘hard work’ is more than just exercising. Its about committing to a new way of life that you need to control and keep working at it 24 hours a day. Unfortunately, Parkinson’s doesn’t take a day off, so to be neuro active in all parts of your life you need to be working at it constantly. This may seem like a lot of hard work, but it is achievable when you are willing to go to any length to slow down the progression of your disease and live your best life!
 
When we prescribe exercise programs, we incorporate seven core principles;
 
Power – Moving big and forcefully
High Effort – each movement needs to be at an 80% effort level to obtain the correct output and make brain changes
Challenging – Exercises need to challenge you both physically and cognitively to stimulate brain changes
Specific – The exercise you do needs to be specific to your impairments, working on what is hard for you will make the most changes that are going to improve your life. It also needs to be adapted to your body and specific injuries or health concerns.
Salience – The exercises must bring meaning to your life and your reason for exercising
Fun – You can put the principles into your favorite routine once you know what you are doing, if you enjoy it you will stick with it.
Frequency – Exercise must be done daily, unfortunately with a progressive condition it doesn’t stop so you can’t.
 
Our role is to incorporate these principles into specific exercises, and work with you to help you recognize and self-reflect on how to put these principles into your daily life it is these little, deliberate and constant movement changes that create the change you too can have.
 
In addition to becoming more neuro active, it is also recommended that you also participate in cardiovascular exercise that gets you out of breath. This type of whole-body exercise is thought to be Neuroprotective or Brain protective, potentially rther slowing down the progression of Parkinson’s.

​Our first recommendation is that you see a Physiotherapist skilled in managing patients newly diagnosed with Parkinson’s disease so you can partner with them and learn the skills you need to effectively manage your condition.