Falls And Parkinson’s Disease

A Search For Sharpness

But it is the angles and sharpness of brain waves that could hold the key to detecting Parkinsons, according to the new studys findings, which appear in the journal eNeuro.

While working on his doctorate at the University of California, San Diego, fellow study author Scott Cole, Ph.D., realized a potential link between the disease and sharp brain waves.

Using EEG readings taken from 15 Parkinsons patients and 16 healthy individuals, the team honed in on the unfiltered waves.

The raw signals go up and down like sine waves but with more asymmetry, explains Swann, adding, The steepness the slant turns out to be important in Parkinsons patients.

Indeed, the team noticed that Parkinsons patients who were not taking medication had a sharper peak at the top of their brain wave, compared with the bottom.

Finding that a noninvasive method such as an EEG could be a promising diagnostic tool may have important consequences for the future of the disease. The team is hoping that doctors and researchers can use the test to track changes related to Parkinsons in the brain over the years.

We dont know yet whether this approach will be better, but it could provide easily obtained brain measurements that would be helpful and possibly used in tandem with clinical observations and other EEG measurements, notes Swann.

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Parkinsons Disease And Movement Disorders Center

Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.

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Parkinsons Disease: Preventing Falls & Maintaining Balance

This printable webpage recommends working with your doctor to ensure your medications and/or DBS are optimal and consulting with a physical therapist to assess your walking and balance. In addition it provides two lists of daily fall prevention: 1) How to prevent falls from common hazards around the home and 2) Tips for maintaining balance.

Walking With Parkinsons: Freezing Balance And Falls

Parkinsons disease can change the way a person walks. Movement Symptoms like stiff muscles, rigidity and slow movement make it harder to take normal steps. In fact, short, shuffling steps are a common sign of PD, as is freezing, the feeling that your feet are stuck to the floor, for people with mid-stage to advanced PD.

On their own, these changes are distressing enough. But add the fact that Parkinsons affects balance and they also become dangerous, putting people with PD at risk of falling. The good news is that with exercise and physical therapy, people with PD can improve their balance. What can you do to minimize freezing and avoid falls? Read on to find out.

The following article is based on the latest research and a Parkinsons Foundation Expert Briefings about Parkinsons-related freezing, balance and falls hosted by Fay B. Horak, PhD, PT, Professor of Neurology at the Oregon Health & Science University, a Parkinsons Foundation Center of Excellence.

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Stages And Symptoms Of Parkinsons Disease

Parkinson’s disease progresses over time and affects individuals at differing rates. The earliest Parkinson’s symptoms are often subtle and sporadic. Every now and then, a person may notice a tremor, slight staggering gait, or have trouble getting up from a chair and pass it off as a symptom of aging. Other Parkinson’s symptoms like occasional depression, insomnia, constipation, and loss of smell may be so amorphous and general that they are brushed off as a temporary nuisance.

In many cases, it takes a family member or friend pointing out that the individual is speaking softer than usual or moving their arms in a stiff manner to make the patient aware of changes that are taking place in their body. At this early stage, a patient might want to consult their physician and start treatment before the disease progresses to its later stages with more crippling symptoms.

What Are Some Strategies To Prevent Falls In Pd Patients

In this 4-minute video Dr. Bastiaan Bloem recommends preventing falls in those with Parkinsons disease with a multi-disciplinary approach. He outlines specific tasks for a neurologist, physical therapist, occupational therapist and rehabilitation specialist. When prevention of falls is not possible protective measures should be installed around the home, learn to use a walking aid properly or even wear a helmet.

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Ways To Reduce The Risk Of Falling

There are several steps people living with PD can take to reduce their risk of falling, including:

• Talk to your doctor about your risks. Your doctor can assess your personal risk and can help you manage your medications and any side effects. Medications may need to be adjusted or switched up.
• Exercising regularly helps maintain strength, improve stamina, improve balance, and reduce the risk of falls. Exercises that challenge your balance are especially beneficial, and research has shown that exercise that requires your attention, concentration and focus on activity and movement may also be neuroprotective protecting the nerve cells from damage and possibly slowing the progression of PD.
• Make modifications to your home. There are several adaptations that can be made in your home to make falls less likely, such as removing throw rugs, ensuring wide pathways through furniture, and adding non-skid mats and grab bars to showers and bathtubs.
• Use a walking aid.Canes or four-wheeled walkers offer stability for people with PD.
• Learn ways to overcome freezing episodes, such as walking in beat to music or a metronome. Some people also find it helpful to move from side to side before stepping forward.
• Work with a physical therapist or occupational therapist.Physical and occupational therapists can provide exercises to help keep you mobile. Occupational therapists also can suggest adaptations and modifications to the persons environment.1,3-5

Falls And Common Household Hazards

If you or a loved one has Parkinson’s disease, here are tips for preventing falls around the home:

• Floors. Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its accustomed place.
• Bathroom. Install grab bars and nonskid tape in the tub or shower. Use nonskid bath mats on the floor or install wall-to-wall carpeting.
• Lighting. Make sure halls, stairways, and entrances are well lit. Install a night light in your bathroom or hallway. Make sure there is a light switch at the top and bottom of the staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
• Kitchen. Install nonskid rubber mats near the sink and stove. Clean up spills immediately.
• Stairs. Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it may be helpful to arrange most of your activities on the lower level to reduce the number of times stairs must be climbed.
• Entrances and doorways. Install metal handles on the walls adjacent to doorknobs of all doors to make it more secure as you travel through the doorway.

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Loss Of Balance And Falls In Parkinsons Disease

Losing your balance and preventing falls is part of daily life for those with Parkinsons disease. With time, almost every person suffers from postural instability, but you have some control over the severity of balance issues and the frequency of falls.

Parkinsons disease significantly affects gait. The motor symptoms of the disease, such as rigidity, freezing and changes in posture disrupt the sense of balance and can lead to falls.

Nearly two-thirds of people living with the disease have fallen in the past year, and half of these cases resulted in injuries. Fortunately, there are many resources that can help you improve your balance and prevent these falls.

Balance is the control of body weight distribution and is a normal reflex in people without Parkinsons disease. Several factors associated with Parkinsons disease contribute to a loss of balance and falls.

Loss of balance reflex

The degeneration of the grey nuclei neurons characteristic of Parkinsons disease causes a loss of balance. Posture control then becomes managed by the cerebral cortex, or the thinking part of our brain. Balance therefore becomes a conscious and voluntary process rather than an automatic reflex.

Any external disturbance while managing your balance can cause a loss of balance.

Why Is Fall Prevention So Important

Oftentimes a fall will cause no injury or a mild, easily reversible injury, however, sometimes a fall can cause moderate to significant injury.

In addition to the fall itself potentially causing a fracture or head injury, the fall could possibly result in an ER visit, hospital stay, or surgery, which can sometimes set off a series of events that has the possibility of worsening a persons PD even more substantially. Hospitalizations can interfere with medication timing, contribute to simultaneous infection, precipitate hallucinations, and increase confusion. Each of these setbacks can spawn additional setbacks which can contribute to the worsening of PD overall. In addition, immobilization after a fracture can interfere with exercise and physical therapy goals. For all of these reasons and more, it is important to do all that you can to reduce the chance of falls.

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Maximize Your Mobility With Fall Prevention

In this 20-minute lecture physical therapist, Heather Knight, explains different factors that play into our individual risks for falls, like tripping hazards, changes in walking surfaces and poor lighting, as well as what you can do to make your home safer to reduce your risk of falling and to strengthen movement.

Comparison Between Fallers And Non

Table 1 shows the differences in demographic and historical data between fallers and non-fallers. It should be noted that one subject reported 500 falls in the year before assessment otherwise, the range would have been 0100. Fallers had longer disease duration than non-fallers and were more likely to describe previous falls.

Table 1

Historical data and falls among 101 patients with Parkinson’s disease

Table 2 shows the differences between fallers and non-fallers in disease severity and other rating scales. There is a strong association between disease severity and the risk of falling. This is particularly true with an MHY rating > 2.5 and with higher UPDRS subtotal II , subtotal III , or total UPDRS score. Cognitive impairment was also associated with increased GDS or PDQ = 8 and a risk of falls. One subject had an MMSE of 0 otherwise, the range would have been 1530.

Table 2

Disease severity and rating scales

Although there was no association between a worse shoulder pull and falling, there was an association between an increased number of falls and a positive shoulder pull, using the positive pull as the independent variable in a Mann-Whitney U test .

Table 3

Physiotherapy assessment and falls

Different sample sizes are quoted for the cardiovascular and autonomic assessments owing to different entry criteria and withdrawals. In these cases fractions and percentages are quoted . None of the cardiovascular or autonomic data were associated with falling.

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The Route To Better Walking

The good news for people with PD is that with exercise and physical therapy it is possible to cope better with freezing, turn and walk more normally and improve balance. Through practice and sessions, a physical therapist can help people with PD avoid tripping by helping them learn to take larger steps. Additionally, joining an exercise class tailored to people with PD can help. If you take levodopa, be sure to exercise while it is working the drug helps your body learn and remember motor skills.

Tricks that can help overcome freezing:

• Walk to a regular beat to help prevent freezing. Try a metronome.
• Take large, voluntary marching steps.
• Step over an imaginary line or laser pointer.
• Work with a therapist to find the solution that works best for you.

People respond differently to audio, visual or sensory cues. Dr. Horak and her team are testing a device that provides sensory feedback vibration on the foot to stimulate automatic stepping.

Another consideration for people who have freezing is anxiety, a common PD symptom. People who have anxiety experience freezing more often. It is a vicious circle being anxious about freezing can trigger it. Treating anxiety may help freezing.

Multicomponent And Multifactorial Interventions

Multicomponent interventions were investigated for people with MS and PD in one systematic review each . No significant effect of multicomponent interventions was identified for people with MS or PD on number of fallers. However, there was moderate evidence identified for the effectiveness of a multicomponent intervention comprising of physiotherapy and falls-self management education at reducing falls rate among people with PD .

Two systematic reviews for people with stroke included a multifactorial intervention , however, this intervention was primarily comprised of exercises and so was included in the analyses for exercise-based interventions in these reviews.

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How To Prevent Falls From Common Hazards

• Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
• Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
• Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
• Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
• Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
• Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

Rates Of Falls And Recurrent Falls In Parkinson’s Disease

Fourteen of the studies recorded fall rates using the gold-standard method of a falls diary, calendar or postcard . Several studies recorded falls via conducting telephone interviews at set intervals, ranging from monthly to three monthly or six monthly intervals. Other studies utilized responses to regular mail queries , monthly outpatient follow-up sessions , or medical record observation .

The proportion of participants who fell at least once during the reporting periods was highly variable , ranging from 35% to 90% , with an average of 60.5%. Recurrent fallers accounted for between 18% and 65% of participants and made up a large proportion of the fallers, ranging from 50% up to 86% of fallers .

The rate of falls per recurrent faller per year was found to be high, ranging from 4.7 to 67.6 falls per recurrent faller per year . An example of the very high rate of falls experienced by some individuals is reported by Goodwin et al. , where one participant fell 577 times in 20 weeks, which is approximately equivalent to 1500 falls in 1 year.

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Improving Balance Issues And Preventing Falls In Parkinsons

• People living with Parkinsons disease are twice as likely to fall compared to people without Parkinsons.
• There are a variety of reasons people with Parkinsons are at high risk of falling, including bradykinesia, vision changes, fatigue, and rigidity.
• Exercise, physical therapy, and medical interventions can help people with Parkinsons find solutions to balance issues and falling.

As people age, their risk of falling increases. However, people with Parkinsons disease experience twice the risk of falling as compared to their peers, with about 60 percent of people with the condition falling every year. There are different motor and nonmotor symptoms of Parkinsons disease that contribute to a loss of balance and an increased risk of falling.

As one member of MyParkinsonsTeam wrote, I have fallen at least a dozen times, and thankfully, have not broken anything. Another member said, A good day is one without falls.

As Parkinsons disease progresses, so does the possibility and fear of falling. However, not all people with Parkinsons will experience falls. While individuals with Parkinsons are at an increased risk of falling, there are many methods for preventing these accidents and their resulting injuries.

Further Testing In Parkinsons

In other situations, where perhaps the diagnosis is not as clear, younger individuals are affected, or there are atypical symptoms such as tremor affecting both hands or perhaps no tremor at all, further testing may help. For example, imaging can play a role in differentiating between essential tremor and Parkinsons. It can also be important to confirm what is initially a clinical diagnosis of Parkinsons prior to an invasive treatment procedure such as surgical DBS

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