Written by: Dr. Caitlin A. Bender, OTD, OTR/L
Each year around 60% of people with Parkinson’s Disease experience a fall. This can range from minor injuries, to serious hospitalizations which can have a lasting impact on mobility and overall independence. Understanding how Parkinson’s Disease can impact balance and implementing steps to decrease your fall risk can maximize safety and help to maintain your independence.
Reasons for Falls in People with Parkinson’s Disease
Walking changes
Shorter, slower or shuffling steps can affect balance or lead to tripping.
Balance issues
Parkinson's disrupts some of the natural movements and reflexes that maintain upright posture and balance.
"Freezing"
Described as feeling like the feet are stuck to the floor, freezing can be triggered by doorways, turns, stress or meds wearing off. Not everyone experiences this, but those who do are at a higher risk of falling.
Low blood pressure
Parkinson's affects the autonomic system, which can cause drops in blood pressure, particularly when standing up. Symptoms of low blood pressure, such as fatigue, dizziness or lightheadedness, can impact balance.
Medication side effects
Medications, including those prescribed for PD, can cause side effects like sleepiness and confusion, which can result in falls.
Muscle weakness
PD symptoms can make it harder to keep moving, which can weaken leg and core muscles and impact balance. Fear of falling can add to this issue.
Thinking changes
Parkinson's can affect focus, making multitasking — already challenging — even trickier. Walking while distracted may lead to falls.
Vision and perception issues
Parkinson's can cause blurry or double vision and difficulty judging distances. These changes can affect spatial awareness and balance. Though not directly linked to PD, hearing loss can also affect balance.
Strategies for Reducing Falls
Check with your doctor:
Review medications. Your doctor can adjust medications to reduce fall risks or better manage PD symptoms.
Check blood pressure. Medications and PD can lower blood pressure and may cause falls. Watch for orthostatic hypotension — a drop in blood pressure that happens when standing up. Talk to your doctor about strategies and medications.
Screen for hearing and vision changes and other conditions that could affect movement or balance. Your doctor may refer you to specialists for further evaluation.
Safe movement:
Take your time with movements like sitting, standing or turning corners.
Widen your stance and take bigger steps for more stability.
Keep frequently used items within easy reach.
Keep hands free and limit distractions and multitasking while walking.
Consider using fall detection technology like a medical alert system.
Ensure DME such as walkers, rollators, canes, etc. are proper height and used safely.
Home safety:
Decrease clutter. Place furniture so that you have wide walkways and can move around easily. Decreasing clutter in your physical space not only reduces tripping hazards but can also reduce freezing and mental clutter, allowing for greater focus and calm.
Install lever handle door knobs instead of circular knobs for easier opening.
Install grab bars throughout your home. (If possible, seek advice from an occupational therapist (OT) on proper placement first.)
Make sure chairs in the house are stable (not on wheels), have arm rests and are the adequate seat height to make standing up and sitting down easier. (Your feet should be able to touch the floor and your legs and hips at about a 90 degree angle so you can stand easily.) Avoid purchasing sofas and arm chairs that are soft and low as they are difficult to get up from.
If using a wheelchair or rollator, always lock brakes after each use.
Arrange your furniture to avoid multiple turns or maneuvers to access areas used every day as this is where you are most likely to fall.
Be sure a communication system is in place and easily accessible in every room and hallway that you use.
Consider a doorbell that offers a camera view so you can see who is at the door.
Have a copy of important medical information listed on the fridge where first responders can access it quickly in case of emergency.
Consider getting a service dog that can help you with freezing of gait at home and elsewhere.
If you exercise at home, make sure you have plenty of space to do your exercises.
Utilize voice activated music devices (Alexa, Google Home, etc.) to assist with breaking from a freeze.
Make sure hallways and stairways are well-lit and use extra lighting to reduce shadows on steps.
Eliminate abrupt changes in surfaces (i.e. carpet to hardwood) because they can be a tripping hazard.
Use painter’s tape to mark proper foot placement for routine tasks or to guide foot placement through doorways and around corners that might otherwise cause freezing.
Put a bedside commode next to the bed. This is ideal if you struggle to move easily upon waking.
Consider elevating the head of the bed in order to reduce large drops in blood pressure with change in position from supine to sitting.
Install a stable, purpose-made seat or bench in your shower.
Make sure all bathtubs, showers floors and exits from the shower are non-slip.
Staying active:
Head rotations
Works on neck mobility, visual tracking, and vestibular systems by scanning the environment through turning head left and right.
Sit to stands
Works on functional mobility, leg strengthening, and safety awareness.
Weight shifting from heel to toe
Works on balance, proprioception, and safety awareness.
Bird dog march and hold
Works on gait, balance, and coordination by marching and holding one leg up off the ground while reaching the opposite side arm above head.
References
Aragon, A., & Kings, J. (2010). Occupational Therapy for People with Parkinson’s Disease: Best Practice Guidelines.
Davis Phinney Foundation. (n.d.). fall prevention Archives. https://davisphinneyfoundation.org/tag/fall-prevention/
Fall prevention in Parkinson’s. (n.d.). Parkinson’s Foundation. https://www.parkinson.org/library/fact-sheets/fall-prevention
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