Parkinson’s and Falling [Avoid falling and injuries!]

Parkinson’s and falling, unfortunately, go hand in hand.

Most patients with Parkinson’s disease have some imbalance. In uncomplicated Parkinson’s disease, falls are less common.

But:

  • If you have recurrent falls or
  • If you are falling backwards, Parkinson’s disease may not be the right diagnosis.

If you do have Parkinson’s disease, adequate treatment helps you move properly. This prevents falls.

In addition, a few general measures may also help to prevent falls and avoid serious injuries.

Let us learn more.

How do we maintain our balance?

When the joints in your legs move, the nerves in your legs send signals to the spinal cord, from where they go to the Brain.

If this system is working, then the Brain knows *exactly* where your legs are, even when your eyes are closed!

This ability is called “Joint Position Sense”.

boots 181744 1280
“Joint position” signals going from the ankle joints to the brain are very important for balance.
Nervous system diagram
There are many nerves in the arms and legs (blue). These send joint position signals to the spinal cord (red), which in turn sends them to the brain (pink). A problem anywhere in this pathway can cause problems in maintaining balance.

A second device is important as well:

Our inner ears contain tiny circular canals filled with fluid.

When your head moves, the liquid inside these canals moves, and the ears immediately send signals to the brain, informing it of this movement.

InnerEar
The internal ear has delicate canals filled with fluid which detect head movement.

Finally, your eyes.

This one is obvious.

When you tend to fall, you can see that you are falling.

The eyes almost instantaneously send this information to the Brain, so that corrective action can be taken.

pxfuel.com
Our eyes send signals to our brain almost instantaneously.

The Brain is supposed to act immediately when it gets signals from any of these organs (joints/ears/eyes) that you are going to fall down.

These reflex movements are called “Postural reflexes”.

With this understanding, let us see now why we fall.

Why do patients with Parkinson’s disease fall?

In simple terms, patients with Parkinson’s disease fall down because of 3 reasons: Poor input, Poor postural reflexes, Freezing.

1. Poor input:

This problem is often overlooked.

When thinking about Parkinson’s and falling, we need to remember that Parkinson’s patients can also have other diseases.

Let us say you have a problem with your eyes. Everything is blurred.

Now, you start to walk.

But…. your brain is not getting any input. It does not know where your limbs are! So, you become unsteady!

eyeglass 2589290 1920
Proper eyeglasses enable you to see clearly and reduce falls.

So:

  • Problems in your joints, muscles or leg nerves – e.g. Diabetes, Vitamin D deficiency
  • Problems in your spinal cord – e.g. compression, vitamin B12 deficiency
  • Problems in your ears – e.g. infections
  • Problems in your eyes – e.g. improper glasses, cataracts

Increase the risk of falling tremendously. This is true even if you do not have Parkinson’s disease!

But let us look at 2 reasons specific to Parkinson’s disease:

2. Poor postural reflexes:

Let us say your brain is getting all the inputs it needs.

It now knows where your limbs are.

But in Parkinson’s disease, the brain becomes slow. For unclear reasons, it does not respond to these inputs immediately.

This problem is called “Poor Postural Reflexes”.

Poor postural reflexes: The brain is slow in processing inputs and outputs needed for balancing.
Poor postural reflexes: The brain is slow in processing inputs and outputs needed for balancing.

Let’s imagine you catch your foot in the carpet.

When you start to fall, your brain is too slow to take corrective measures. It does nothing. So you fall.

This is one of the reasons for Parkinson’s and falling.

3. Freezing:

When walking, you may sometimes feel like you are stuck to the ground.

This is called “Freezing”.

If this happens suddenly, your upper body may continue moving and you may fall forwards.

FallingForwards
If your movement problems are incompletely treated, you can “Freeze” suddenly while walking and fall forwards.
Is freezing really the reason for falling?
Some people believe that “freezing” while walking can lead to falls. In contrast, other people believe that the freezing before falling is an erroneous reflex by the Brain, which is just trying to prevent a process of falling which has already started happening. Regardless of what comes first, it is clear that making movements more rapid with proper treatment helps to prevent falls.

So, how can you prevent falls?

The first step is to identify why you are falling.

The relative contribution of these factors to falling is different in different patients.

Thoughtful collaboration with your neurologist should help to identify your most critical problems. We will look at each of these things in detail, one by one.

If you have Parkinson’s and falling backwards, a very important possibility arises. Your doctor should carefully examine you for signs of PSP.

PSP is described in another article [Click here].

 

Sherlock
Careful examination & collaboration usually identifies 1-3 critical problems causing falls.

 

Prevent a drop in Blood Pressure on standing

When you get up suddenly from a chair or bed, your blood rushes into your legs.

This causes blood pressure to drop. You may become light-headed & fall.

This is called Orthostatic Hypotension. It is very common in Parkinson’s disease.

You can read more in another article, but here is a quick summary:

Prevent Orthostatic Hypotension
1. Avoid medications that may worsen this problem.

2. Drink enough water

3. If your doctor agrees, slightly increase salt in your diet

4. Stand up gradually

5. Exercise & develop better muscle tone

6. Ask your doctor for medications.

Adequate sensory input

A neurological examination can test the input organs (nerves, spinal cord, ear, eyes).

For example, your may ask you to close your eyes and move your big toe up and down. If you are unable to tell whether it is up or down, it indicates there is something wrong with your “joint position sense”.

Your neurologist may ask you do some tests:

 

Tests to check sensory organs (input)
1. Nerve conduction studies

2. MRI of the spine

3. Blood tests – Vitamin B12, Folic acid, E & Copper, Syphilis & HIV

4. Ear examination

5. Eye examination

Adequate treatment of Freezing

You can fall down if you have sudden “freezing” while walking. You can also fall if your body’s corrective movements occur too late or too slowly to prevent a fall.

Therefore, adequate treatment of your movements so that slowness (bradykinesia) and freezing while walking are treated is absolutely essential in preventing falls.

Medications used to treat movement problems are described in a different set of articles. It is important to select these judiciously. In most cases, the best medication happens to be levodopa.

LevodopaToDopamine

Once it enters the Brain, Levodopa is converted into Dopamine.

Training your Brain

YES! This can be done.

Think about the time when you learnt to ride a bike. As you kept practising, it became automatic.

In the same way, balance training can prevent falls.

Multiple studies have proven this. You can take my word for it. You could also read these 2 studies, to extinguish any residual excuses!

Any exercise is better than no exercise.

However, exercise methods that focus on balance, e.g. Yoga or Tai Chi can be more helpful to improve your balance (Hackney 2008 and Roland 2013).

I believe these traditional methods help in instability.

Their low-impact nature and emphasis on balance is especially interesting.

Screenshot 20200305 150737 01
Yoga and Tai Chi can improve your balance & prevent falls.

What changes should I make to my home?

Remove all loose-fitting rugs or unstable pieces of furniture that you can trip over.

Excessive clutter or furniture can cause Freezing. So, make sure your home is as tidy and clutter-free as possible.

Patients frequently fall in the bathroom. Take the measures below to avoid falls.

LivingRoom
This living room looks nice. But removing the rug, and the low tables in the centre would help to prevent freezing and falls.

 

Make these changes to your home
1. Remove rugs.

2. Reduce furniture & clutter.

3. Avoid using the bathtub.

4. Use anti-skid rugs in the bathroom.

5. Sit down while taking a bath.

6. Install support rods to help you get up.

Make sure any support rods you install are firmly attached and rounded.
If possible, install support rods to help you to get up from your commode and after taking a bath.

How can I prevent injuries after falling?

Make sure your furniture is not sharp. You can buy foam padding for corners online.

Even more importantly make sure that your bones are adequately dense so that they do not break if you fall. This can be done by measuring the bone density using a test called a DEXA scan.

DexaScan
A DEXA scan measures bone density. If your bones are not adequately dense, they can break easily.

The medical term for less dense bones is “Osteoporosis”. Bones can be made denser and stronger by giving you medications.

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

Send Message


NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

4.6 87 reviews

  • Avatar Paras Prabhu ★★★★★ 6 months ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Dr Shobha Sankhe ★★★★★ a month ago
    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
  • Avatar shrruti khanna ★★★★★ a month ago
    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
  • Avatar Prashant Purohit ★★★★★ a month ago
    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
  • Avatar Sanjay Pradhan ★★★★★ 7 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar N N ★★★★★ 10 months ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Manish Ranjan ★★★★★ 10 months ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar Pinakin Shah ★★★★★ 8 months ago
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ 10 months ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ a year ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you

2 thoughts on “Parkinson’s and Falling [Avoid falling and injuries!]”

    • I hope you found this information useful, Ms. Maya.
      – Dr. Siddharth Kharkar

      Reply

Leave a Comment

India Today Magazine - 2021Noted as one of the best Neurologist in Mumbai

Good Neurologist in Mumbai