Falls, an ounce of prevention.....
Newborn infants demonstrate a fear of falling on the day they are born. When they feel the sensation of falling they throw out their arms and take on a “startled” look on their face in what is called The Moro Reflex. In other words, we have to learn to be afraid of spiders and snakes but the fear of falling is “hard wired” into our nervous system. Perhaps this is why the fear of falling is so strong in adults at risk for falls, such as a person with Parkinson’s (PWP) and it can easily grow to consume and paralyze a PWP’s ability to move and complete their activities of daily living (ADLs). Sadly many people become afraid to venture out of their home and become shut in, missing opportunities to socialize and to exercise, as they become consumed by the fear of falling.
Because of this instinctual fear of falling and because as adults we understand the danger of falls, the possibility of a life threatening (or lifestyle threatening) injury occurring, that so many of my patients tell me their primary reason for seeking Physical Therapy is to prevent falls.
Falls due to a “freeze”
Many PWPs have experienced “freezing” when they tried to begin to walk and suddenly found their feet stuck to the floor. Unfortunately, many freezes result in a fall. So what is a freeze and how can we avoid falling as a result?
Freezes occur when you cannot take weight off either foot. With every step we take it requires a 100% weight shift from one foot to another. Every last ounce of weight must be placed on one foot in order to lift the other. Leave one ounce behind and you cannot lift that foot and it will feel like it is glued to the floor.
Many PWPs have several strategies to overcome a “freeze”. The idea of marching in place and then proceeding forward allows you to shift your weight back and forth several times before trying to walk. A second strategy is to take a step back in order to move forward. The PWP will often find it possible to take a step back when moving forward is impossible and again it gives them the opportunity to set their weight shifting in motion before trying to walk.
A third strategy is to step over a line or an object – you may have seen canes with plastic wands or lasers that draw a line on the floor. By focusing on the line on the floor you are no longer focusing on your body and your difficulty with walking.
Exercises that promote weight shifting may help in the long term. Tai Chi, dancing and water aerobics all help the PWP develop a sense of weight shift and an ability to move.
What’s on your feet?
It’s very common for people who believe they are at risk for falls to buy shoes that have a lot of traction. Their thought is that they need to avoid slipping into a fall. Truth be told, these shoes often increase the risk of a fall in Parkinson’s. For the PWP the danger is more often that of “catching your toe” and being launched into a fall. Or that due to a freeze you will be unable to get you foot forward to catch yourself after you lean to begin walking.
What the PWP needs is a shoe “with a forgiving sole”; a sole that will allow the PWP to slide their foot forward just enough to catch themselves and prevent a fall. The best shoe is the old combination of leather sole and rubber heel. A well broken in leather sole with a rubber heel provides enough traction for most surfaces but when the PWP catches their toe the leather lets the toe slide through to still land in front and hopefully prevent a fall. Likewise during a freeze the leather sole may slide just enough to let the PWP keep their feet under them.
Unfortunately the leather sole with rubber heel combination now only occurs in dress shoes. In the absence of the leather sole a harder rubber and lower tread – or tread that is grooved front to back – may provide a forgiving sole. Some of my patients have taken shoes to cobblers to have leather soles installed while others have attached felt pads to the front few inches of their shoe.
Get rid of clutter
It’s hard enough to walk through open spaces with Parkinson’s Disease. This problem is compounded if the environment is tight or cluttered. Narrow passages between furniture in a household may cause the PWP to trip or block the advance of a cane or walker and cause a fall. A cluttered space can make it difficult for people with more advanced Parkinson’s to be able to visually select their path and cause them to misjudge the location of the edge of a chair or table. So clean out the clutter and make sure there is plenty of room to pass between furniture.
Occasionally it is better to sit
Many falls occur while completing ADLs. As much as I like to see people up and about, there are times when it is smart to sit. Putting a tub chair in your bath allows you to sit and prevent a fall in what may be the most unforgiving location for a fall in your house. And grab bars can help you rise from the tub or toilet (don’t ever grab a towel rack or soap dish). Sitting to dress prevents a fall at a time when you may be distracted and especially if you are temporarily blinded as you pull clothes over your head.
In the kitchen you can bring your cutting board to a table to sit while cleaning and chopping vegetables. And a bar stool may help you safely complete activities at the sink or on the counter.
Falls at night
In hospitals a majority of falls occur at night. People get out of bed to use the bathroom and they rise too quickly and become dizzy or they trip in the dark. Whenever you get out of bed it is wise to sit at the edge of the bed to let your body accommodate to being upright and even to pause after rising before walking away from the bed. Night lights than shine upon a clear path are an inexpensive way to avoid a costly fall.
In a future issue I will write about what to do in the event a fall occurs. But an ounce of prevention is worth a pound of cure. Exercise to promote weight shift and to have the strength to catch a fall. Dress with the right shoes, get rid of clutter, sit when necessary and listen to your physician about how your medications work and act on you.