Ask an Expert: Naomi Casiro Discusses Balance and Falling in Parkinson’s
Naomi Casiro, BSc, MPT is a PWR! Certified Therapist, and the founder of NeuroFit BC. She started her career working as a personal trainer and lifestyle bootcamp instructor, and developed a passion for motivating people to get the most out of life through active, healthy lifestyles.
After completing a Master’s degree in physiotherapy, Naomi became focused on neurological rehabilitation, and over time, treating people with Parkinson’s disease (PD) became the focus of her work. Now, she runs NeuroFit BC, where she teaches classes, treats clients, and offers courses for other health professionals to learn about the positive impact of exercise on neuroplasticity for those living with PD. Naomi is also an adjunct professor at the University of British Columbia.
What are some balance issues commonly experienced by people with Parkinson’s?
People with Parkinson’s disease often experience balance issues related to four specific challenges. These include:
- Freezing of gait (e.g. your feet not following when you are trying to turn)
- Retropulsion (the increased risk of falling backwards that comes with PD)
- Postural hypotension (a sudden drop in blood pressure when you stand up)
- Postural and gait issues (e.g. your affected foot catching when you step up a curb, or over an obstacle on the ground)
How is fall risk evaluated?
Fall risk is evaluated based on a thorough assessment that takes into consideration medical history, falls history, neurological assessment, and a gait/postural assessment.
Some of the tasks which we often look at in a balance assessment are someone’s ability or inability to do the following:
- multi-task, especially while walking
- get up and down from the floor
- maintain their balance when nudged in various directions
- turn in a small space
- pick-up objects from the floor
- step backwards safely
What are some strategies for self-managing balance problems? What about helpful assistive devices or exercises?
One of the most important self-management tools people with Parkinson’s can use is to stop and think about when, where, and why they are falling. Are you falling when trying to turn in the kitchen? Are you falling when trying to pick up an object? Are you getting dizzy when standing up, and then falling? Are you falling backwards?
Determining why falls are happening will allow you to problem solve much more effectively to improve balance and reduce fall risk. The second and very effective management strategy is exercise, including functional movement challenges.
Assistive devices can be helpful or harmful depending on their use. A walker set too low can actually increase freezing and fall risk, and canes can worsen a forward leaning posture. However, using assistive devices properly can be extremely beneficial for balance. Walking poles are often a great tool to help improve posture and gait, and are a common assistive device we prescribe and use in the clinic.
How can people with Parkinson’s minimize their risk of falling?
Balance exercises should be completed under the guidance of a healthcare professional. Please do not try the following at home without having had your balance assessed or a professional to guide you as you begin adding new challenges to your routine.
Practice your balance! When it comes to Parkinson’s, it is truly a “use it or lose it” phenomenon. If you practice your balance, it is much more likely to be there for you when you need it. This does not mean standing on one leg and counting to ten; it means including dynamic balance challenges. Some examples you can work on building into your fitness routine include:
- Stepping over and around objects
- Turning in various directions
- Getting up and down off the ground
- Getting up and down from kneeling
- Turning your head slowly while walking
- Practicing tall posture and dynamic arm swings while walking and standing still
How can physiotherapy help people with Parkinson’s who have difficulties with balance, or a high risk of falling?
Every person diagnosed with PD should get a detailed physiotherapy assessment as early as possible. A qualified physiotherapist can assess posture, gait, balance, strength, and coordination. They can also help design a PD-specific exercise and treatment plan which will assist in achieving your goals and improving in areas you may be struggling. It is important to remember that our brains are neuroplastic, and can change. Healthcare professionals are trained to see things through a detailed biomechanical lens, and can help pinpoint what needs to be worked on in order to optimize your function, both now and for the future.
Specific functional exercise is key! Feeling off balance can be scary, but there are things you can do to take action and optimize your function. The time to get moving is now!
This content was published in the Fall 2019 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.