“Better Balance and Fall Prevention” – Webinar notes

“Better Balance and Fall Prevention” – Webinar notes

In early June, the Neuro Challenge Foundation for Parkinson’s hosted a webinar on balance and fall prevention. The speaker, Ellen Schaller, discussed how to create a safe home environment by adding grab bars, removing rugs, installing nightlights, and removing cords. She also stressed the importance of exercise, especially exercises with aerobic activity, strength training, balance, agility and multitasking, and stretching. 

Research shows that people with PD who exercise regularly often see an improvement in balance and managing daily activity.  Some strategies the speaker mentioned for maintaining balance include rising from a chair slowly, consciously lifting your feet when walking, standing with a wider stance, and utilizing a cane or walker.  

Ellen finished the webinar with a few example exercises for posture, ankle strength, and balance. These exercises can be done seated, standing, or while walking and can be done anywhere. 

For more information on fall prevention, please see the Stanford Parkinson Community Outreach webpage here.

And, note that a lot of these PD exercise videos include exercises for balance and fall prevention:

See below for notes on the June 4th webinar.

Regards, 

– Joëlle Kuehn


“Better Balance and Fall Prevention” – Webinar notes

Speaker: Ellen Schaller, Neuro Challenge Foundation for Parkinson’s, Sarasota, Florida

Webinar Host: Neuro Challenge Foundation for Parkinson’s (neurochallenge.org), Sarasota, Florida

Webinar Date:  June 4, 2021

Summary by Joëlle Kuehn, Stanford Parkinson’s Community Outreach

Parkinson’s Disease and Movement:

  • Disorder of the brain that leads to shaking (tremors) and difficulty with movement and coordination
  • Nerve cells in the brain that make dopamine (controls movement) are slowly destroyed
  • Without dopamine, the brain cannot properly send messages to the muscles, leading to loss of muscle control

How does it affect you?

  • Tremors, change in muscle tone, problems walking, unsteady posture and balance
  • Difficulty starting or finishing voluntary movements
  • Jerky, stiff movements
  • Muscle atrophy

Fall prevention and balance:

  • Creating a safe home environment can lead to increased confidence and reduce chances of falls.  If someone feels safe in their home environment, they are in much better shape going forward.
  • Research shows that people with PD who exercise regularly often see an improvement in balance and managing daily activity.  New exercise guidelines:
    • 150 minutes of moderate or vigorous exercise per week across 4 domains
    • Aerobic activity
      • 3 days per week, at least 30 minutes per session of continuous or intermittent aerobic exercise at moderate or vigorous intensity
      • Fast walking, running, cycling, swimming, aerobics class
    • Strength training 
      • 2-3 non consecutive day per week, for at least 30 minutes per session recommended 
      • 10 – 15 repetitions focusing on major muscle groups, resistance, speed, power
      • Use weight machines, resistance bands, handheld weights or body weight to exercise the extremities is suggested
    • Balance, agility, multi-tasking
      • 2-3 days per week, multi-directional stepping, weight shifting, balance activities, large movements, and activities such as yoga, tai chi, dancing, or boxing     
    • Stretching
      • 2-3 days per week of sustained stretching with deep breathing or stretching before exercise
  • Effects of exercise last for hours
  • Practice balance movements wherever you go
  • Improved posture decreases rate of falls          

Our balance system:

  • Cooperation between brain, nervous system, muscles, and bones
  • Visual cues:  Eyes detect and brain processes environmental information
  •  Inner ear:  Semicircular canals orient us on head positioning
  • Inner spatial orientation:  Helps us detect where arms and legs are positioned in space from inner feedback (proprioception)

Challenges that decrease balance and stability:

  • Decreased vision
  • Lack of strength in hips, abdominal muscles, legs, and ankles.  Ankle strength and flexibility are very important to balance.
  • Poor posture
  • Inability to properly lift our feet
  • Slower reaction times
  • Medications that can increase feelings of dizziness
  • Low blood pressure that may lead to light-headedness
  • Neuropathy
  • Alcohol
  • Vertigo
  • Improper shoes
  • Other health conditions

Strategies for maintaining balance:

  • Attempt to swing both arms from front to back while walking – helps to maintain balance and posture and reduce fatigue
  • Consciously lift your feet off the ground when walking
  • Rise from a chair or bed slowly- give your body time to adjust to the change of position before standing  
  • When trying to navigate a turn while walking, use a “u” technique of facing forward and making a wide turn rather than pivoting sharply
  • When standing, keep feet shoulder length apart.  When feet are too close together for any length of time, you increase your risk of losing your balance and falling
  • Move slowly when changing positions – use deliberate and concentrated movements
  • Utilize a cane, walker, or walking stick to aid balance and maintain safety
  • Do only one thing at a time
    • Don’t try to walk and accomplish a talk like reading, talking on the phone, looking around at the same time
    • The less distracted you are while moving, the greater your ability to maintain balance will be

Creating a safe home environment:

  • Place everyday (things you deal with regularly) household items at eye level
  • Remove rugs
  • Place non slip mats in front of sinks and tubs
  • Attach safety grips in the bathtub or shower stall.  Grab bars are helpful when things are wet so you have something to stabilize yourself with.
  • Purchase furniture with rounded corners rather than sharp edged.  Make a safer situation for when you fall
  • Carry a cell phone or emergency call button on you at all times
  • Evaluate lighting throughout living space

Tips for fall prevention in your home:

  • Floors: 
    • Remove all cords, loose wires and throw rugs.  Try to go without rugs if you can
    • Minimize clutter
  • Bathroom 
    • Utilize grab bars and non-skid tape in the tub or shower
    • Utilize non-skid bath mats on the floor or install wall-to-wall carpeting
    • Non-skid tape in a shower will start coming off over time
    • Never use towels on the floor as a bath mat or rug
  • Lighting:
    • Make hallways, stairways and entrances well-lit
    • Install night light in bathroom
    • Keep lamps or light switches within reach of the bed if you get up during the night
    • Make sure there is a light switch at the top and bottom of a staircase
  • Kitchen:
    • Utilize non-skid rubber mats near the sink and stove
    • Clean spills immediately
  • Stairs: 
    • Make sure treads, rails, and rugs are very secure
    • Always hold onto handrails
    • If stairs are a challenge – try to use them as infrequently as possible
  • Pets:
    • Watch out for those pets underfoot

Posture exercises:

  • In sitting or standing:
    • Chin tucks
    • Shoulders back and down
    • Sit or stand up straight
  • In standing: 
    • Use wall and try to touch head, shoulders, knees and ankles to the wall

Training your feet:

  • Train your ankles to sense weight shifts, and they help to create weight shifts in the body
  • If your ankles are strong, you get better posture and better balance
  • Exercises for strengthening ankle musculature:
    • Heel raises, toe raises
    • Place 2 chairs or fixed objects in front and behind you, place your feet apart but within your shoulders, lean forward and feel the weight shift in your feet, then lean back

Balance exercises:

  • Seated:
    • Air planes – arms parallel to floor, move down and up.  Move your arms, keep yourself still 
    • One leg air planes
    • Alternating leg extension (bend one, straighten, down, then bend the second, straighten, and bring it down)
    • Bending forward and backwards diagonally.  Try to keep your arms folded
    • Try the above exercises standing up
  • Sit to stand
    • Start out, move to the edge of the chair, if you need to hold on to your hand. 
    • Lean forward, and then stand up
  • Standing:
    • One leg balance
    • One leg balance with eyes closed
    • Balance on unstable surface – try to balance, have something you can hold on to 
  • Dynamic
    • Heel to toe – tandem walking.  Put your heel in front of your foot and walk 
    • Try doing it backwards

Where can I do these exercises?

  • Anywhere
  • Home
  • Park
  • Movies
  • Grocery store
  • If you don’t have stairs, try going up and down the curb

Question & Answer:

Question: How do you transition from tile floors to carpeting?

Answer: If you have to have rugs of any type, especially smaller rugs that move, make sure that you secure them to the floor somehow. When you approach the carpet, take a big step and pick up your feet. 

Question: What can we do for weak ankles other than to roll them in circles or go up and down, or is that enough?

Answer: Like any muscle, it needs stretching and strengthening. Rolling your ankle is for stretching. Strengthening comes from heel or toe raises, or shifting your weight. 


Tips from the audience:

  • When you have PD you have dystonias, and if you have toe curling you can put a tennis ball under your foot and massage the bottom of your foot to help with the curling of your toes
  • I had problems getting in and out of the car because I couldn’t grip anything, so I purchased a car cane that attaches to the inside of the door. When you’re inside the car you grab the car cane, push up and get out of the car. They’re not expensive, they’re around $10. 
  • Don’t be afraid to talk to a second doctor
  • During the sit to stand, for me it is difficult to initiate the sit to stand. What’s easier for me is to do a stand to sit, and go down enough to touch the chair and then go back up.
  • The height of your chair can determine how hard your sit to stand is. If you’re struggling, put your chair higher and little by little decrease the seat height