Balance problems are a frequent complication of Parkinson’s disease (PD) and they can lead to falls. A fall can result in a life-altering injury requiring nursing home placement or, even worse, a life-threatening injury that can result in death! Making adjustments to your home to prevent falls as well as practicing strategies to maintain your balance are two important issues for the individual with PD to address.
Falling in your home can be prevented by adhering to the following recommendations. Remove or firmly secure all throw rugs. Minimize clutter to provide adequate walking space between furniture. Avoid using extension cords but, if necessary, they should be secured to the floor with tape. Outdoor lights and indoor nightlights can ensure a well-lighted home in the evening. Using strategically placed light switches and lamps can help provide adequate lighting for negotiating your home at dusk or during the night. Stairs should have rails on both sides. Arrange your activities to reduce the amount of times that you must use the stairs. Wipe up all spills immediately.
Falls in the bathroom can be especially harmful because the surfaces that you would fall on or against are hard (e.g. tub, sink, toilet, and tile floor). Use an elevated toilet seat and/or safety rails or install an elevated toilet to assist standing. Towel racks and toilet tissue holders are not secure enough to provide adequate support when assistance is required to stand from a low surface. Firmly mount grab-bars on the walls to assist you with getting in and out of the tub or shower. The bathtub or shower should be equipped with a non-skid surface (e.g. decals, tape or a mat). Consider extended lever handles on faucets to make them easier to turn. If your balance is significantly impaired, use a shower chair or, for even more security, tub bench. Installing wall-to-wall carpeting in your bathroom will prevent slipping on a wet floor.
You can reduce the possibly of a fall by enhancing your ability to balance. Keep at least one hand free at all times. Use a backpack or fanny pack to carry things. Even though my mom does not have PD she does have balance issues. She cleverly transports items by placing them in a bag with handles so that she can carry them with one hand. Carry lighter loads and make several trips to accomplish a particular task. Consciously swinging your arms and focusing on lifting your feet while walking will help your balance and prevent tripping. Standing with your feet shoulder width apart increases your base of support and also your ability to balance. Minimize distractions by performing one task at a time. Plan ahead and become aware of what movements will be necessary to accomplish a desired activity. After a plan is made, concentrate on the movements you are performing and deliberately execute the desired motions pausing for at least 15 seconds before changing positions. If you become “frozen” or experience an increase in rigidity try to visualize stepping over an object. Freezing most often occurs when you are approaching an object (e.g. chair, bed, toilet, or doorway). Focusing on or thinking about what movements are necessary to accomplish your task can reduce the severity of this symptom. Talking to your feet (i.e. say right, left, right, left, and so on…) may also reduce shuffling or “getting stuck”. When trying to turn around, use a “U-turn” technique instead of pivoting sharply.
Even if all of these recommendations and suggestions are followed, an individual with PD still is at risk for a fall. Therefore, some general safety guidelines are advised: (1) avoid fatigue; if you feel tired, stop your activity and rest, (2) write emergency numbers on stickers and place them on all phone receivers, (3) keep a cordless or cell phone in your pocket at all times. Remember the old adage, “an ounce of prevention is worth a pound of cure.”
Good luck with your exercise program! If you have any questions email Dr. Mackarey at email@example.com.
Janet Caputo, PT, OCS, is a physical therapist specializing in the management of orthopedic and sports injuries with a special interest in vestibular rehab and falls prevention at Mackarey Physical Therapy in downtown Scranton. She is presently a completing her doctor of physical therapy degree at the University of Scranton.
Read Part I of III in this series on exercise and Parkinson's Disease.
Read Part II of III