Dr. John Nutt 00:00:05
The way to prevent falls is to begin well before you start having falls. The thing that we think is important there is exercise. Exercise that emphasizes balance and emphasizes agility.
Once falls start to happen, exercise remains important, but there are other things that need to be done. First, one needs to think about what the causes of falls are. I generally think of three main causes of falls in Parkinson's disease. The most common are falls that occur when changing the position of the body. A person gets out of a chair or tries to turn, and these can be falls to the side, forward, or backwards.
A second common type of fall is one that occurs when the feet stick to the floor, or freezing. The person's body is going forward, but their feet don't move forward, and people fall forward onto their knees and onto their outstretched arms. The third type of fall is one that occurs when the blood pressure is low. This fall may actually be a faint, where people are losing consciousness very briefly. Obviously, these three types of falls have different ways in which you try to manage them.
The easiest is probably the falls that occur with the blood pressure being low. Oftentimes, what the clinician needs to do is look through the medicines that the person is on. There are medicines that will alter blood pressure, and altering those is often enough. But there are other things that can be done as well. The falls that occur with freezing are very difficult to treat.
Dr. John Nutt 00:01:59
One thing is to help people not be injured by them. Some patients find that putting on knee pads will protect their legs and, for that matter, their pants if they fall forward on their knees.
Better control of Parkinson's disease may reduce freezing and reduce falls as well. The other type of falls, and probably the most common ones, happen with turning and with getting out of a chair. These are things that the physical therapist can work with the patient to find safe ways of doing those and prevent falls. Walkers may also be very helpful for that.
The other thing that can be done is to look at the home. Are there loose rugs around? Can furniture be placed in a way that it can actually help people walk, such that they can put their hands on the back of a sofa? Grab bars put into the bathroom are often very helpful.
Oftentimes, we'll have occupational therapists go out to the home, look at it for safety and make recommendations. Occupational therapy can be very beneficial in trying to prevent falls.
In Parkinson's disease, as the disease progresses, walking becomes more difficult. One of the consequences of that is that people have to pay more attention to walking and where they're going. Anything that is distracting from walking will be a problem. Sometimes if you're walking with friends or family and they're asking you questions and trying to talk to you, you have to tell them that this is not a good time to discuss things because that distraction will often lead people to fall.
Finally, nobody likes to talk about a wheelchair because that seems to be defeat. A lightweight folding wheelchair often gets people back out into the community. They go to movies. They go out to restaurants and so forth. I think the use of a wheelchair to get out into the community is often very helpful for somebody that has poor balance and cannot walk any distance safely.