Dealing with falls

There are medications for Parkinson's that can cause a side effect of low blood pressure, which in turn can cause dizziness and increase the chance of falling. If you fall, you should ask the nurse or the doctor to check your blood pressure - both sitting and standing. The doctor may be able to recommend a drug to treat low blood pressure or dizziness, although this may be complicated by a conflict with Parkinson's drugs.
Some dizziness can be prevented. For example, when you get out of bed, let your legs hang over the side of the bed for a few minutes before you stand up, then stand up slowly. When you get up from a chair, pause for a few minutes before you start walking, until you feel stable.
Some Parkinson's drugs even worsen falls by causing dyskinesia and freezing. Again, it is important to tell the doctor if there are falls, so that he can check the medications you are taking and make changes if necessary.
The doctor may recommend physical therapy. The physiotherapist will be able to suggest exercises that will help you develop a good posture and walk, carry out weight transfers with confidence and maintain the flexibility of the muscles and joints - all of these help to reduce the chance of falling.

Who can help?
There are many things you can do to help yourself, but there are also experienced professionals who can provide helpful advice. Usually the family doctor will be the contact person who will refer you to other specialists. In hospitals that have a unit for the treatment of movement disorders, you can consult with nurses who specialize in Parkinson's disease or nurses who specialize in neurology, who have a lot of experience in dealing with falls. Ask your doctor for a referral.
It is also advisable to coordinate appointments with a physiotherapist or occupational therapist. The family doctor at the health fund will refer you to them. It's hard to generalize, but the following description generally lists the help you can get:

Physiotherapists, who treat specific problems related to:
• Posture
• Walking
• Balance and falls
• Transfers
• Reaching out and grasping

They will give you a training plan and strategies to deal with specific problems in everyday life. It is very important to exercise to prevent or reduce muscle stiffness, which reduces the chance of instability and falls. Good posture is important to maintain balance, and you may be recommended exercises that will help maintain or improve physical fitness and posture.
Physiotherapists can also train you or recommend exercises to your therapist and suggest effective ways to help you move, for example how to get out of bed safely, and how to prevent or reduce the chance of falling. If you have difficulty with these specific tasks, they can teach them different motor control strategies to make these tasks as easy and safe as possible.

If you fall frequently, a physical therapist can teach you different ways to get up off the floor and start moving, as well as help you regain your self-confidence. The following strategies may be helpful:
• Get up from lying on the floor
• Getting up from the floor after a fall

Occupational therapists can help you achieve maximum independence, no matter what your limitations or symptoms are. They can assess your daily and home routines and then suggest ways to make activities as safe and possible as possible. Sometimes small changes in the kitchen or the bedroom, for example, will make a big difference in mobility, quality of life and the chance of falling. They can also advise on aids, equipment and adaptations that may help, as well as suggest ways to improve the ability to carry out a particular task such as dressing or cooking.

Podiatrists - foot specialists
If you have a foot problem, the podiatrist will be able to advise how to reduce a limitation or problem that may be causing you to fall. They will also be able to recommend the most appropriate type of footwear to prevent falls.

How can you help yourself?
It is important not to let the fear of falling stop you from doing things, as long as you are aware of the situation. It is important to be active because it helps both your mobility and your independence, and doing the things you love keeps morale high. Try not to let falls limit your activity too much as this may negatively affect your quality of life.
The following information and practical suggestions may help you in your daily routine to reduce the chance of falling:

Muscles and posture
• Try to exercise daily and keep your muscles strong. Muscles need regular physical activity to prevent stiffness and weakness. If this happens, it will be difficult to return to being active. You may lose self-confidence, stop exercising and lose additional physical abilities. The result may be an increased risk of falls.
• Stretching and strengthening exercises can preserve mobility, which will reduce the chance of falling. Tai Chi is very helpful, as are other complementary therapies such as yoga, pilates, hydrotherapy, and the Alexander method that help preserve mobility.

• Lowering blood pressure - if you feel weak when you stand, sit on the edge of the bed or chair for a few minutes before you get up. Hold on to something stable until you are sure you are stable and start walking only when you feel safe.

• Hazards at home - reduce clutter so you have to deal with fewer obstacles when you walk. Place the furniture so that you can pass as easily as possible, and do not move furniture afterwards, so that the route remains familiar.
• Avoid rugs that are not glued to the floor or make sure they are glued well. A wall-to-wall carpet is usually better than loose carpets, although you should pay attention when choosing the carpet, because a certain shape can be confusing when walking. There are shapes that could actually help by providing a visual cue when walking, but others may create the impression that there is a step even when there is not. Two adjacent but different rugs can also cause confusion.
• Remove all loose wires or make sure they are hidden, for example behind furniture or close to walls.
• Make sure that the lighting is good, especially on the stairs, in the spaces and near all the entrances. Make sure there is a light switch at both the end and the beginning of the stairs, as well as a switch next to the bed in case you get up in the middle of the night.
• Stick colored masking tape on the edge of each step to make them more prominent and less smooth.
• Adhesive paper or colored plastic "steps" can be used in places where the pattern on the carpet is confusing, or in places where there is a greater chance of falling, such as in the doorway or on the stairs. Occupational therapists or physiotherapists (depending on the country you live in) will be able to advise where to place these types of visual aids.
• Install a railing on both sides of the stairs and keep frequently used objects close to you, to reduce the number of times you have to go up and down the stairs.
• Install a railing and anti-slip glue in the bathtub. Place non-slip mats on the bathroom floor if there is no carpet. Railings can also be installed near the toilets.
• In the kitchen, place non-slip mats next to the sink and oven, and immediately wipe up any spills.
• Replace or remove a swinging door that could knock you down.
• Invest in a wireless phone so you can use it wherever you are without the need to walk. You should choose a phone that is easy to use even when there is a tremor. If you go out alone, it is recommended to carry a mobile phone with you.
• It may be helpful to install an alarm system so you can call for help if needed. There are different types: some can be worn as a necklace or bracelet, others are caught in a shirt, and by pressing the button, medical personnel can be called if necessary.

A physical therapist can provide advice regarding specific walking problems, but the following tips may help both you and your caregivers and family members:
• When walking, concentrate on each step and reduce distractions. You may have to ask your companions not to talk to you while walking.
• Do not try to do two things at the same time, such as carrying something, talking on the mobile phone or watching TV while walking. The therapist and family members may need to be aware of this so they don't distract you.
• Force yourself to shake your hands back and forth while walking - this helps maintain balance.
• Consciously lift your legs and let them drag. With each step, place the foot on the floor and follow the toe.
• Try to walk with your legs a little wider and with bigger steps.
• Get into a uniform rhythm when walking. Try counting in your head with each step, singing, stepping over shapes and patterns, or just walking in place before you start walking. Make sure that you maintain an even pace and if you go to a fast pace, consciously slow down.
• If you freeze in place and someone is with you, they can help by placing your foot in front of your foot, so that you can step over their foot. Be sure to lift your leg high so you don't trip. The walking movement can help to start walking and may prevent tripping or falling. If you are alone, imagine an object in front of you so that you step over it.
• If you have to turn around, do so slowly. Do not spin in place as you may fall to the side. Instead, walk in a wide half circle. Try to imagine that you are walking around the numbers on the face of a clock. If you want to go back, don't go backwards. Instead, go in a wide semi-circle again.
• To change direction, look in the desired direction, wait a moment, orient yourself in space and then walk.
• If you have to carry something, take only small objects that will not disturb your balance and try to carry equal weight on both sides.
• Avoid wearing shoes with rubber soles or shoes with soles that have a particularly good grip, since these may cause your foot to "catch" on the floor and cause you to fall. You should also avoid loose slippers. Leather-soled shoes are considered more suitable for people with Parkinson's, although they can be slippery. Physiotherapists, occupational therapists or foot specialists will be able to recommend suitable footwear. Physiotherapists and occupational therapists will also be able to recommend padding for the waist (HIP PADS), which can help prevent cracks or fractures if you fall, as well as clothes in general.
• Walking aids may help if there is a balance problem, but they must be adjusted to your height. They may also be an obstacle and cause you to fall, so you should consult the physical therapist.

Hints
• It may have been necessary to use signs to move in daily activities. It is easy to get distracted while walking, which makes it difficult to concentrate. The steps get smaller and smaller until you literally drag your feet, or freeze in place. This tends to happen when trying to move around in a confined space, through doors or in crowded areas.
• Cues may help you concentrate so that it is easier to keep your feet steady and at an even pace.
There are different types of cues that use areas of the brain that are not affected by Parkinson's. These cues give information about the length and number of your steps.

Visual cues:
• Lines on the ground or at the end of stairs can help, since they help you step over them if stagnation is a problem, especially in doorways.
• Tape sticking to the threshold can help you concentrate and step through a threshold. You can also concentrate on marching (like soldiers).
• Shapes on a carpet or spaces between tiles or stones can help focus on the quality of your walk and maintain a constant step size.

Rhythmic cues:
A steady rhythm from a metronome or suitable music can help. The rhythm should be comfortable, with a rhythm that reminds you to lift your feet and walk. The pace can be adjusted to your location. For example, you may walk faster outside and slower indoors.
For owners of advanced phones (iPhone/Blackberry/Android) you can find a metronome application to install on the device, so that the metronome can also be used outside the home.

More strategies
You can practice certain movements in your head and concentrate on the sequence. For example, concentrating on placing the heel on the floor when the foot touches the floor - this will help with uniform steps. Imagine a line that must be crossed to deal with narrow entrances.

Translation: Beverley Berg-Yohanan
Date: 11.1.2011
From EPDA –
http://www.rewritetomorrow.eu.com/pdsymptoms/falls/treatment-and-management-of-falls/
For the use of the above section and its translation, the European Parkinson's Association (EPDA) should be thanked, to which the original rights belong.
www.epda.eu.com www.rewritetomorrow.eu.com