What might cause me to fall if I have Parkinson's?
Loss of balance and falling affects many people with Parkinson’s and the problem tends to increase over time. But everyone’s experience of Parkinson’s is different, so you may not have these difficulties. If you have Parkinson’s, you might fall because of:
- poor balance
- taking steps that are too small or that vary in size
- your arms not swinging when you walk
- involuntary movements (dyskinesia), which are a side effect of some Parkinson’s medication.
Other reasons you might fall include:
Some people with Parkinson’s fall because they have problems starting to move or they ‘freeze’ while they are moving. Freezing is when you stop suddenly, and it can last for a few seconds or minutes.
If this happens, you may feel as though your feet are stuck to the floor or you’re unable to move easily, which can make you feel unsteady. This can increase your risk of falling. If you have difficulty with your medication wearing off before your next dose is due, you may find freezing becomes worse. Speak to your specialist or Parkinson's nurse as they may be able to adjust your medication.
As Parkinson’s progresses, your posture can change. You might become more stooped and your muscles may become more rigid. Having muscles that are less flexible can increase your risk of falling, as it’s more difficult for your body to move and for you to protect yourself if you do lose your balance.
General muscle weakness
You may be much less active than you used to be if you have Parkinson's. This can cause muscles to become weaker and increase your risk of falling. Staying active can help muscles and joints from getting stiff and rigid.
Problems with blood pressure
Problems with blood pressure can affect people generally as they get older, but some Parkinson’s medication can cause side effects, including problems with blood pressure. This can lead to dizziness and falls. If you’ve felt dizzy, or fallen because of dizziness, ask your GP or practice nurse to check your blood pressure both when you’re sitting and standing, to see if it’s too low.
Drugs used to treat other medical conditions, such as high blood pressure, can potentially make dizziness worse, especially if you are losing weight or not eating and drinking as well as you used to.
Postural hypotension is a sudden drop in blood pressure when changing position, for example getting up out of a chair. It can make you feel very light-headed, which will affect your balance. You may experience postural hypotension as a symptom of Parkinson’s. But it can also be caused by the drugs used to treat Parkinson’s.
You can avoid some dizzy spells by taking your time. For example, before you get out of bed, sit with your feet touching the floor for a few minutes to get your blood flowing. Then stand up slowly, but try not to walk away immediately – stand for a while until you feel steady.
Some people with Parkinson’s experience problems with their eyes. Difficulty moving your eyes and side effects of some Parkinson’s drugs (including anticholinergics) can cause blurred vision. If you're unable to see hazards clearly, this may make you more likely to fall.
You may also have difficulty judging the space around you or not be able to accurately assess the distance between objects. This means you might experience problems finding your way when walking past objects or through a narrow space. Bifocal glasses may also affect how well you judge distance.
It's important to get help and advice about how to avoid falls. Even if you've never fallen before, anxiety or fear of falling can increase the chance of it happening.
Your GP, specialist or Parkinson’s nurse can also give you advice on how to avoid future accidents, or refer you to a physiotherapist or occupational therapist.
Get into a rhythm when you walk
Try counting each step, marching on the spot, stepping over patterns on the floor, humming or singing to yourself. You could repeat a word or phrase such as ‘walk tall’ or ‘stride out’ to help you stay focused when walking.
Move to the beat
Walking to the tick of a metronome can help you maintain a rhythm, or help you restart walking if you freeze. A metronome is a device that produces a regular tick or beat that musicians use to keep to a rhythm. They are available from musical instrument shops or online.
Focus on taking longer strides and swinging your arms
Taking bigger steps will help to increase your arm swing. Gently swinging both arms will help you keep your balance when you walk.
Shift your weight
Move your weight from one foot to the other or try to step backwards before moving forwards. If you freeze, you may be able to re-start moving by rocking gently from side to side.
Ask a friend for help
If you’re out with a friend and you freeze, they can help you by holding your arm and supporting your balance while you concentrate on moving again.
Try to concentrate and keep distractions to a minimum – avoid walking and talking at the same time. If you want to have a conversation, pause and touch something solid, such as a lamp post, when you want to talk. If you cross a busy area plan your route in short stages so that you're not having to concentrate on too much in one go.
Slow down turns
If you need to change direction, try not to turn too quickly or pivot on the spot. It's better to slow down and take a few extra steps to walk around in a half circle. Try to imagine your feet are following the numbers on the face of a clock. Take your time.
How well your symptoms respond to medication can affect your risk of falling. For example, you may freeze suddenly or unpredictably when your medication starts to wear ‘off’ (when your medication not working so well) and this can cause falls. So any changes your specialist or Parkinson’s nurse makes to your medication to reduce freezing may also help to reduce falls.
Sometimes, Parkinson's may cause people to walk very fast, as if they are running. This can also cause them to fall.
If your drugs don't seem to work as well as they used to, or you think you're falling due to side effects of the drugs you're taking, speak to your specialist or Parkinson’s nurse about making changes to your medication.
If you experience dizzy spells, which may make you more likely to fall, make sure you’re taking your medication as prescribed.
There are many things in the home that could make you more likely to fall, including slippery floors, loose carpets and general clutter. Here are some tips on how to reduce hazards in the home:
- Try to clear away as much clutter as you can and arrange your furniture so that moving around is as easy as possible.
- Hand or grab rails can be useful in tight spaces, such as in toilets, bathrooms or by the stairs. Putting non-slip mats in the bathroom will also help.
- Make sure your house is well lit.
- Apply strips of coloured tape to the edge of steps to make them more visible and help prompt you to lift your feet.
- Floor coverings can sometimes be a hazard. For example, carpet patterns can be visually confusing. Speak to an occupational therapist or physiotherapist about applying strips of tape or plastic footsteps on the carpet. These can guide you in places you might be more likely to fall, such as a tricky turn on stairs, or in doorways.
- Keep commonly used items close to hand or stored in a cupboard within easy reach, so you don't need to bend down or stretch too far to get them.
- Make sure you have contact numbers nearby in case of an emergency. Keep a mobile phone with you, or change your landline telephone to a cordless model so that you can carry it with you, in case you fall and need to call for help.
- Try not to rush, even if the phone’s ringing or there’s someone at the door.
- If you’re prone to falls, you might find a community alarm system really helpful. This involves wearing a small device that has a button to alert an emergency response centre, who will send someone to help you. Your local social services, social work department or health and social care trust can give you details of local schemes. There is usually a small cost for this service.
The more fit and active you are, the better your body is able to respond to the demands placed on it, making you less likely to fall and injure yourself. In some areas of the UK, you can be referred for a fitness review through the Exercise Scheme. After the review, a fitness instructor can tailor a programme to your individual needs. Your GP may be able to tell you about schemes available in your area and refer you.
The Inclusive Fitness Initiative (IFI) supports leisure centres to provide an accessible environment for everyone, including providing adapted equipment for disabled people. Find your nearest IFI centre.
Equipment and walking aids
You might find that equipment can help you to walk, such as a walking stick or a rollator (a frame with wheels).
Before you start using a walking aid, it's very important to get advice from a physiotherapist. Some walking aids aren't recommended for people with Parkinson’s as they can affect your walking pattern and make you more likely to fall. But, the correct walking aid can increase your confidence and help you to lift your feet better.
You might find shoes with low heels or flat soles are easier to walk in. Try to avoid unsupportive shoes, such as floppy slippers. An occupational therapist or physiotherapist can give you advice about what shoes to wear and ways of making the places where you walk easier and safer to manage.
If you're experiencing falls, make an appointment with your GP, specialist or Parkinson’s nurse to talk about what can be done to improve your safety and balance. The following professionals can also help:
A physiotherapist can help you improve your confidence and reduce any fear of falling. They can also teach you techniques to help you get down safely on to the floor, and up again if you fall. Often, a physiotherapist will work with an occupational therapist to help you remove any tripping hazards from your home.
Ask your GP, specialist or Parkinson’s nurse about a referral for physiotherapy as soon as possible after your diagnosis. In some areas, you can refer yourself at the local hospital or a community health centre, depending on the type of service available.
You can also self-refer to a private physiotherapist, which you will need to pay for. The Chartered Society of Physiotherapy can help you find a private physiotherapist.
Some Parkinson’s UK local groups have sessions led by a physiotherapist – check with your local group for details. Find your local group on our website or call our helpline on 0808 800 0303.
An occupational therapist can suggest strategies to help you reduce the risk of falls. They might ask you to keep a falls diary to identify when, where and how you fall. They can also recommend equipment that can help reduce the risk of falling, or help you get up if you do fall.
You can usually contact an occupational therapist through your GP, your social services or social work department, or health and social care trust. You can also ask your GP, specialist or Parkinson’s nurse to refer you to a rehabilitation unit if you need to see other professionals too, such as a physiotherapist or speech and language therapist.
You can also pay for private occupational therapy. The Royal College of Occupational Therapists can help you to find a private occupational therapist in your area.
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