Losing your balance and preventing falls is part of daily life for those with Parkinson’s 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.
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 Parkinson’s disease. Several factors associated with Parkinson’s disease contribute to a loss of balance and falls.
The degeneration of the grey nuclei neurons characteristic of Parkinson’s 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 (ex. a freezing episode during which you are thinking about the strategy to get out of it, or someone calling out your name) can cause a loss of balance.
The stooped posture resulting from a loss of postural reflex shifts the center of gravity forward, which increases the likelihood of falling forward, especially during freezing episodes.
The contraction of the extensor and flexor muscles makes patients vulnerable to loss of balance and falls. The rigidity of certain leg muscles can also contribute to the loss of balance that leads to backward falls.
Maintaining balance during unexpected position changes and movements requires rapid adaptation.
The feet muscles that control balance and the muscles in the pelvis and legs that allow you to change position (ex. throwing a leg forward) are slower in people with Parkinson’s disease.
Patients’ ability to anticipate new positions is also reduced. For example, when initiating walking (taking a step), the lateral movement of the body towards the leg in action is insufficient to shift the weight of the body. In this case, the slowness of preparatory adjustments leads to hesitation in initiating the movement or to freezing, especially in bigger steps. Levodopa intake and external clues can help these preparatory adjustments.
This is also associated with weakened muscles, so make sure to stay active and exercise daily.
A decreased range of motion, such as in arm swings or step length, contributes to a decreased ability to maintain balance and can lead to falls.
To maintain balance, your brain must process information from the eyes, the sensory nerves and the vestibular apparatus that controls balance from our ear.
People living with Parkinson’s disease have a poor perception of the movements of different body parts and their sense of positioning of each body part is not as accurate as it used to be. For example, people find it more difficult to feel a slope in the ground. This is mainly due to muscle sense and inner ear stimulation.
Patients then compensate for this deficit by overconfidence in the visual signals to which they are exposed.
Parkinson’s disease can cause hypotension, especially during changes of position. Sudden drops in pressure can lead to dizziness, loss of balance, and eventually to falls.
Some medication, such as levodopa in the first months, can contribute to lowering blood pressure. Speak to your neurologist and pharmacist.
Medication effectiveness varies throughout the day, so you may feel that your medication is no longer working at certain times. These are called off periods, during which you may be at greater risk of losing your balance.
Exercise and physiotherapy can help you better control freezing episodes, turn without difficulty, walk more normally and improve your balance.
During the sessions, the physiotherapist will help you work on your balance by suggesting, for example, exercises to maintain your balance on one foot (with assistance), extend your range of motion or improve flexibility.
You can implement several strategies in your daily life to improve your balance:
Here are some other ways to reduce your risk of falls:
The STAND UP! program was specifically designed to improve balance and reduce the risk of falls for people over 65 years of age. It is a safe, personalized and free program offered by healthcare professionals.
Ask your local CLSC where the STAND UP! program closest to you is located.
Physical activity is the only treatment available to improve balance. Personalized activities help you increase your range of motion and develop postural strategies that compensate for loss of balance.
There is no medication to directly improve balance, but your neurologist can review your Parkinson’s medication dosages to increase your mobility and natural postural adaptation. Your doctor can also review the medications you are taking and reduce the doses of those that cause low blood pressure or dizziness.
You need to reduce the dangers that could cause your loved one to fall in their immediate environment, such as at home.
It is difficult for people living with Parkinson’s disease to do several things at the same time, so don’t try to maintain a conversation when you walk with your loved one. This increases the risk of falls.
If you notice that your loved one is falling more frequently, discuss the use of a walking stick, cane or walker. This equipment increases support points and reduces balance loss.
Loss of balance and falls are symptoms that usually appear in the later stages of Parkinson’s disease and become more frequent as the disease progresses. This is due to the degeneration of other systems in the brain that manage the body’s cognitive and perceptual functions.
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