Parkinson’s Loss Of Balance

The Facts About Parkinsons Disease

Parkinson’s disease is a progressive neurogenerative disease that causes nerve cells in the area of the brain that controls movement to weaken and/or die. While healthy neurons produce a chemical called dopamine, which the brain needs a certain amount of in order to regulate movement, weakened neurons produce lower levels of dopamine. What causes these neurons to weaken is currently unknown.

Some patients with Parkinson’s disease also suffer from a decline in norepinephrine, a chemical that transmits signals across nerve endings and controls various functions, such as blood pressure and heart rate.

More than 10 million people worldwide are currently living with Parkinson’s disease and nearly one million will be living with the disease in the United States this year, according to the Parkinson’s Foundation.

Another View Of Parkinsons Progression

A newer theory of Parkinsons progression called Braak’s hypothesis suggests that Parkinsons may begin years before motor symptoms develop. According to Braaks hypothesis, loss of smell and digestive symptoms such as constipation are the earliest signs of Parkinsons, showing up many years before motor issues. While these early symptoms do not show up on an official Parkinsons stage yet, many researchers are working on ways to identify and treat Parkinsons earlier, even before stage one.

Condition Guide

To Prevent Falls Exercise

Exercise is the only intervention that significantly reduces a persons risk of falling, among older people without PD as well as people with Parkinsons. Research is beginning to show how exercise changes the brain for the better and can help people with PD gain back some of their automatic balance reflex.

In a study, Dr. Horak and her team asked participants with PD to stand on a quickly moving treadmill, until they began walking. Participants initially took too-small steps, but with one hour of practicing, they improved, taking bigger steps to stay balanced while walking.

Many kinds of exercise can improve a persons balance. Consider trying:

• Tai Chi: a moving meditation where movements involve shifting the bodys center of mass back and forth over the feet. Studies found fewer falls among people with PD who practiced Tai Chi three times a week.
• Dance: to dance tango, a person has to walk backward and sideways, take big steps and both follow and lead good ways for people with PD to practice balance control.
• Boxing: the rapid arm movements provide good balance training.
• Agility boot camp: completing different tasks in a series of stations can improve balance.

Tip: People with PD may have other medical issues that affect their ability to exercise, such as arthritis or neuropathy. Work with a physical therapist to find an exercise that suits your needs.

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Clinical Tests Of Balance

A number of clinical tests are available for testing balance in patients with Parkinsons disease. The Berg Balance Scale, the BESTest, the Tinetti Test, and the Timed Up and Go are commonly used in hospitals and long-term care settings. The Pull Test, part of the UPDRS, is also used to test postural reactions in those with PD.

The Berg Balance Scale

One of the most commonly used clinical tests of balance in people with PD is the Berg Balance Scale. The BBS, originally designed for use in the frail elderly, is a 14-item test that focuses on a variety of self-initiated tasks related to everyday function, such as sit-to-stand and functional forward reach. The Berg does not include tests of postural reactions or dynamic gait.

The Berg has excellent reliability and is somewhat correlated with severity of PD, as measured with the Unified Parkinsons Disease Rating Scale. However, the Berg is not necessarily a good predictor of falls in those with neurologic impairment . These particular limitations are important considerations when evaluating patients with mild neurologic deficits, who are easy to under-identify and therefore less likely to receive rehabilitation .

The Berg Balance Scale includes the following activities:

• Sit to stand

• Sensory orientation
• Stability in gait

Berg Test and Mini-Best Comparing Items by Difficulty
Berg Test item
	Sensory

The Tinetti Test

The first part of the tool, the Tinetti Balance Test, is scored on a scale of 0 to 16, and assesses:

How Is Parkinsons Disease Treated

There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.

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How Can We Reduce Mobility Constraints In People With Parkinsons Disease

Over the last few decades, neuroscience has been providing us with exciting new findings regarding the effects of physical exercise on neuroplasticity , neuroprotection and slowing of neural degeneration. In fact, it has been proven that physical exercise can improve brain function in people with neurological disorders.

Aerobic exercise, such as treadmill training and walking programs, have been tested on individuals with Parkinsons Disease and has been shown to improve gait and quality of life in general. However, the type of exercise chosen should take into account a specific program provided by a specialist. The exercise shouldnt, by any means, put the patients physical integrity at risk, especially if the patient is a senior. In order to address complex mobility issues in people with Parkinsons Disease, a therapist could incorporate tasks such as balance training into the patients rehabilitation. These are exercises that challenge sensorimotor control of dynamic balance and gait to improve mobility.

According to a study by Dr. Ergun Y. Uc, of the University of Iowa, the results suggest that

walking may provide a safe and easily accessible way of improving the symptoms of Parkinsons disease and quality of life.

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.

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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.

How Can Parkinsons Disease Affect Mobility And Sense Of Balance

The neurophysiology of Parkinsons Disease proves that it affects balance, gait, movement and can actually cause constraints on mobility. But what do we mean by mobility?

Mobility is a persons ability to move safely in a variety of environments in order to accomplish functional tasks.

Functional tasks like drinking a glass of water or eating can become a problem. And if we think about it, mobility is something we take for granted most of the time. We dont expect to lose it, and we dont expect to get a degenerative disease, such as Parkinsons. Therefore, being able to maintain good mobility is something of utmost importance as we age, and we must take preventive measures to delay mobility impairment as much as possible.

Mobility requires dynamic neural control, a sense of balance, and enough agility to be able to adapt to postural transitions as quickly as possible. What also concerns us today is the several types of mobility deficits caused by the progression of Parkinsons Disease. We need to understand what preventive exercises and preventative measures can be taken to minimize the risk of falls and injury.

Parkinsons Disease and fall prevention

While Parkinsons is not life-threatening, people may experience life-threatening complications, such as choking on food or falling over. We must help our elderly loved ones prevent falls at any cost so that suggested exercise programs can work effectively in combatting the effects of Parkinsons Disease.

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Why Does Parkinsons Disease Cause Postural Instability

Many of the motor symptoms of PD are caused by damage to the brains neurons that produce dopamine, the neurotransmitter that relays the message in the brain to produce smooth, purposeful movement. However, postural instability is not linked to reductions in dopamine and is believed to be the result of damage to other parts of the brain. While the exact disease process that causes postural instability is not precisely understood, one theory is that it may be due to damage of noradrenergic neurons, which are the nerve cells that produce the neurotransmitter norepinephrine.4

Cognitive And Psychiatric Symptoms

• depression and anxiety
• mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
• dementia a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there and believing things that are not true

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Symptoms Of Parkinson’s Disease

These common symptoms of Parkinson’s disease often begin gradually and progress over time:

• Shaking or tremor
• Poor posture
• Slowing of body movements

As the disease continues to progress, additional symptoms can occur such as slurred or soft speech, trouble chewing and/or swallowing, memory loss, constipation, trouble sleeping, loss of bladder control, anxiety, depression, inability to regulate body temperature, sexual dysfunction, decreased ability to smell, restless legs and muscle cramps.

Remaining In Control Over The Body

The subthemes controlling equilibrium and ability to stand, walk, and perform activities without falling tie together to form this main theme. When asked to describe how they perceived balance, participants described the concept of balance as being related to the ability to control ones equilibrium.

To keep the body in an equal weight so that you dont fall. That must be what balance is, that things are weighted equally in some way, so that you dont weigh over more to 1 side.

Figure 1

Overview of the analytical process from subthemes to overarching theme.

This control was described as a combination of automatic and voluntary processes entailing abilities such as coordination of body parts. Having equilibrium was also described in terms of being in an effortless state whereby you could carry yourself freely and not have to think ahead and prepare before challenging movements.

Balance, that to me is like being able to control your, your body, control your feet, being able to do things freely, walk normallystopping. Balance to me is a state where my symptoms are fairly perfectly alleviated, where the body is like balanced and walking works and I can lift things. Then I am in balance. Or well, hopefully.

Well, that you can do things like any normal person can do without like losing your balance. Thats the way it is. Like you can stand on 1 leg, be able to run, be able to walk, cycle.

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How Postural Instability May Appear

Patients with PD experience symptoms in varying severities, and with the progression of the disease, the severity of the symptoms changes over time. Postural instability may show up during a variety of activities, including:

• When rising from a chair
• When rising from bed
• While turning or pivoting, especially quick movements
• While standing upright1

Postural instability may be apparent at diagnosis, but it is more commonly seen and worsens as PD progresses. The inability to balance and recover from variations in movement often causes falls, which can lead to hospitalization or death in people with PD. Because of this, postural instability is one of the most distressing symptoms of PD and greatly diminishes the individuals level of mobility.2,3

Treatment & Management Of Loss Of Balance While Walking

Clinical history and physical examination helps to understand the possible cause of loss of balance while walking and vertigo. Investigations like x-rays, scans and blood tests may be ordered to rule out possible causes, based on the history.

Treatment for loss of balance while walking includes treating underlying balance disorders and medical conditions. Medications to control dizziness and other associated symptoms may be prescribed. Head injury, skull fractures, stroke or circulatory problems may require immediate medical care. Any medications, if found to be triggering the problem, are stopped and other alternatives may be considered by the physician.

Management of balance problems includes rest, which may be advised in most cases. Vertigo and loss of balance while walking can be managed by avoiding sudden movements or changes in posture. Make sure lighting conditions are good and avoid walking in the dark. Wear comfortable footwear to get better grip and avoid falling. Handrails at home, cane or walker may be used as appropriate. Gradual changes, moving slowly and having support at hand can to better deal help with the condition.

Written, Edited or Reviewed By:Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc.This article does not provide medical advice. See disclaimerLast Modified On: January 22, 2019

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Loss Of Balance While Walking Caused Due To Joint And Muscle Problems

As joints, supporting muscles and soft tissues play an important role in walking steadily, any conditions affecting the joints, muscles, ligaments and surrounding tissues can cause loss of balance while walking. Injuries to bones and soft tissues too can cause difficulty in walking with easy loss of balance and co-ordination. It may be more common when joints and muscles in the lower limbs are involved like hips, knees and ankles. Common conditions include cervical spondylosis, lumbar or back problems, spinal problems, arthritis, muscle strains, sprains or ligament and cartilage injuries, etc.

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.

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Balance Dysfunction In Parkinsons Disease

Antonio Currà

1Neurology and Neurophysiopathology, Sandro Pertini Hospital, Via Monti Tiburtini 385, 00157 Rome, Italy

2Institute of Neurology, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , Largo Daneo 3, University of Genova, 16132 Genova, Italy

3Academic Neurology Unit, A. Fiorini Hospital and Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Firenze, 04019 Terracina, Italy

4Neurosurgery Unit, Policlinico Umberto I, Department of Neurology and Psychiatry, Sapienza University of Rome, Via del Policlinico, 00161 Roma, Italy

5Neurology Unit, Policlinico Umberto I, Department of Neurology and Otolaryngology, Sapienza University of Rome, Via dellUniversità 30, 00185 Roma, Italy

6Academic Neurorehabilitation Unit, ICOT and Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via F. Faggiana 34, 04100 Latina, Italy

7INM Neuromed IRCCS, Via Atinense 18, 86077 Pozzilli, Italy

Abstract

1. Introduction

In the late stages of the disease, when the postural reactions begin to be impaired or inadequate , patients manifest abnormal dynamic postural control . This is a highly disabling symptom because it is poorly controlled by dopaminergic therapy if present early in the disease, a form of atypical Parkinsonism should be suspected .

2. Sensory Organization: Visual, Vestibular, and Somatosensory Inputs

6. Conclusions