Fall's, Freezing and Parkinson's

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:  sarah@hibiscusneurorehab.co.nz