“Most important thing in life is learning how to fall.”
― Jeannette Walls, Half Broke Horses
There are many reasons people with Parkinson’s fall so it’s important to identify the cause correctly in order to solve the problem and prevent fractures and hospitalizations which only increase mortality and disability.
Every patient can experience all these factors at one time or another but is important to note that there is usually one predominant cause which must be addressed if hope to continue mobility and maintain independence.
I believe the reason why sometimes patients don’t seem to get better is because we tend to lump all the causes together and assume that is all due to PD so we don’t get to the root cause. I hope that this will help you guys find the best treatment for your falling issues.
One of the reasons patients fall is due to freezing. There you are walking and suddenly your feet are stuck to ground as if super glue had been added to the bottom of your soles. Now you can’t move stuck and there you go down like a log because the center of gravity has shifted forward. How to combat this problem?:
1) Increase Parkinson’s medicines- especially since under medication can cause severe muscle rigidity making legs feel weak and difficult to pick up during normal stride.
2) Physical therapy
3) Visual aids- shoes with laser, laser canes, striped floors…
4) A
uditory aids- listening to marches or metronomes
Second reason why people with PD fall is due to loss of balance. There are many causes for this from neuropathies to decrease visual acuity and everything in between.
- It is important to note the time and quality of balance issues such as;
- Is the balance loss sudden?
- Does it happen when you first start walking?
- Does it occur after you have been walking for a while?
- Does it occur in confined spaces?
- Does it happen when light is dim?
- Does it occur after going to the bathroom?
- Is the room or you spinning?
- Do you feel light headed or swimming headed?
- Is it related to dyskenesias?
- Does it happen in uneven terrains?
- Does it occur when medicine wear off?
- How do you improve this problem?
As you can see this is a more intricate problem than the first one and requires a good detailed history in order to find the right solution. In order to lead the doctor in the right direction and minimize the guess work is for you to take the initiative and answer these questions.
1) Make sure visual and auditory acuity is good
2) Rule out neuropathies caused by b12 deficiency and diabetes among other things
3) If starts at the onset of gait – make sure not orthostatic – check the blood pressure sitting and standing if drops more than 10 mmHg when standing then you have a problem – few solutions …arise slowly from sitting, elevate one leg when standing use Ted hose, use meds for low blood pressure (e.g. northera, proamantine) if orthostatic symptoms are severe. Consult cardiology to rule out cardiac disease particularly if blood pressure unstable or if fall or pass out after going to bathroom.
4) Physical therapy – especially Tai-chi, walking on sand, water aerobics in water, walking backwards, and yoga help core balance also improve posture which may contribute to stoop ness causing increase likelihood to fall.
5) Adjust or increase meds- these can help with vision, dyskenesias, and actual balance- in case of Azilect.
6) Make sure hearing is intact and not causing the imbalance problem.
7) Klonopin (clonazepam) for swimming head. May also require vestibular therapy
8) Walking devices especially for uneven terrain
9) If balance problem not cause by any of above but due to PD – I have found Azilect to work great for this issue.
10) If posture is a significant problem besides therapy consider using a back brace or Botox injections if dystonia is involved.
11) Declutter your commonly used living spaces.
12) Make sure walking area is well lit particularly at night.
Third reason why people fall is impulsiveness and getting in a hurry while standing, turning, and walking
1) Physical therapy.
2) Occupational therapy
3) Aricept (donepezil) – studies have shown improvement in falls due to improving impulsivity not balance necessarily.
references:
Donepezil May Reduce Parkinson’s-Related Falls – Medscape – Oct 08, 2010
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all rights reserved – Maria De Leon MD
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