Ask an Expert: Naomi Casiro Discusses Falls Prevention and Training for People with Parkinson’s

Naomi is a physiotherapist and the owner of NeuroFit BC, a Parkinson’s-specific clinic with locations in both Victoria and Vancouver. She was born and raised in Winnipeg, MB and moved to BC to pursue her undergraduate degree in kinesiology, followed by her master’s in physiotherapy. Naomi spent her undergraduate years as a student athlete on the University of Victoria swim team and as a lifestyle bootcamp instructor/swim coach. It was from these experiences that her passion for using physical activity to improve the lives of others grew.

After graduating, Naomi quickly became focused on neuro rehabilitation, working in both the public and private sectors before opening NeuroFit BC, a company she founded to allow her to better serve the Parkinson's population and as a platform on which to educate healthcare professionals. Naomi teaches her course “Changing Parkinson’s: The Fundamentals of Functional Movement” across Canada and is an adjunct professor at the University of British Columbia in the physiotherapy program.

When not in the clinic, Naomi can be found playing with her three young children, in the gym or pool, or baking treats in the kitchen.

What inspired you to focus on falls prevention and training for people with Parkinson’s disease (PD)?

As physiotherapists, we are often taught to help people get up from a fall, but rarely taught how to teach people to fall properly. After many years of treating older adults and neurological populations, I began to realize that there was a gap in both education and treatment that needed to be addressed. I was able to work with some incredible martial arts experts who helped me combine my physiotherapy and kinesiology training with my martial arts training to create a program which would address this missing puzzle piece. After realizing the important impact and improved outcomes this treatment led to, I became passionate about spreading the word to health professionals across the country.

What are some key facts individuals with PD and their loved ones should know about falls?

• Falls happen and are one of the leading causes of mortality in older adults. No matter how much we try to prevent them, many people fall, and many fall more than once.
• Falls are very common in older adults and even more common in those living with Parkinson’s disease.
• We know two important things from the research:
  • 1. How you fall matters when it comes to fractures and injuries.
  • 2. Older adults can be safely taught how to fall properly.
• If you or someone you know has fallen or is at increased risk of falls, you likely need a two-fold approach to treatment. You need falls prevention, and you need to learn how to fall safely.
• Falls with PD can come from a number of different issues, including blood pressure changes, freezing of gait, balance issues, dystonia, and more. Understanding the root cause of your falls is important and helps to guide treatment.

How do you evaluate falls risk for your clients?

In our clinics, clients begin with a one-hour 1:1 assessment with a physiotherapist. This allows us to collect important information, which we use to create a falls portfolio and individualized plan. We include details such as direction and number of falls, environment, and cause, as well as physical examinations of strength, balance, rigidity, gait, blood pressure, etc. to create a clear picture of what each client's risks are, and what treatments we can use to mitigate them.

What are the key techniques you teach to help individuals control their movement and momentum during a fall?

When it comes to falls training, it’s important for everyone to understand that it doesn’t just consist of getting someone to go from standing to falling on the ground. We work with clients to ensure they build up the components necessary to learn to fall properly. We work on falling in multiple directions from various heights and angles on safe shock-absorbent mats, and provide assistance and guidance on learning to protect the head and spine, while continuing momentum instead of arresting it.

We want our clients to avoid fractures if they do fall, and help them be more confident in their ability to carry their momentum all the way down to the ground. We get clients to learn to focus on relaxing and ‘rag dolling’ instead of stiffening up and reaching out. Most importantly, we practice and repeat so that if it happens in the real world, they have the experience behind them to create a different, better outcome.

Are there any specific conditions/situations where falls training might not be advisable or safe?

Falls training should only be done in an environment with a trained professional on safe, protective flooring. Safe falls training, in my opinion, requires an individual assessment to rule out any contraindications and ensure the client is informed. There are individuals for whom this may not be appropriate; for example, those with a current unhealed fracture or untreated heart issues. We also need to remember, however, that often those most at risk of fractures are left out of this training for fear of injury, when in reality, they are the groups who need it the most.

Can you share any success stories or notable improvements you’ve seen in clients who have undergone falls training programs?

The reason I am so passionate about this topic is because I have seen client after client who has been trained to fall properly and has had a subsequent fall without injury. Often these are scenarios where there had been injuries in the past from a similar fall, or where there would likely have been one had they fallen differently.

I believe, and have been told, that this training instills people with the confidence to do more of what is important to them in life, be it hiking, walking, playing with grandkids on the floor, or anything else that involves them living their lives to the fullest.

One notable memory is a client who had significant shuffling and freezing issues. He was participating in our outdoor track class and had been taught falls training in the clinic. While pushing himself in the intervals, he began to shuffle (a common issue that he had been struggling with and was nervous about). He fell forwards, landed, and rolled sideways. He then got up and participated in the rest of the class without issue. Not only was he able to confidently participate and challenge himself because of his training (both important aspects of treating PD through exercise), but he was able to fall safely and return to activity without missing a beat.

Are there any at-home exercises people with PD can do to help their balance and reduce their risk of falling?

There are lots! Exercises will vary depending on an individual's level of function, but in the clinic, we often start by working with each client to practice getting up and down off the floor. If that’s not something that is safe and achievable, we work on the components you need to get there, such as deep knee bending (deep squats), ankle mobility, core strength, and upper and lower body motor patterning and strength.

The first step to improving your balance and deciding which exercises you need to do is figuring out why and where your balance is off. Start by asking yourself some questions like, “which direction do I most often tip? When do I feel most unstable? Can I predict the environments where I tend to be off balance or fall?” The answers will help guide you and your healthcare team to the most effective exercises you can do to treat your challenges.

Anything else you would like to add?

Though the goal may be to not fall at all, the reality is that for many, falls do happen. It is integral to learn to fall properly, because what comes after a fall depends almost entirely on how you land. I would like people to understand that there are things you can do if you are at risk of falls or already falling. Please see a healthcare professional who can help.

Naomi was recently a guest speaker on the I Love Neuro podcast, discussing falls prevention and training in depth. To listen to this episode, please visit https://bit.ly/FallsPodcastPD 

This content was published in the Fall 2024 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.