Ask the expert

Neera Garga, B.Sc., PT is a consultant physiotherapist with Parkinson Society of Southern Alberta
Neera Garga, B.Sc., PT is a consultant physiotherapist with Parkinson's Society of Southern Alberta

Balance and mobility in Parkinson’s
Neera Garga, B.Sc., P.T.
Consultant Physiotherapist, Parkinson’s  Society of Southern Alberta

Why does balance become more of a problem with age?

As we get older, we stop exploring our environments the way we did as kids. For instance, we don’t do headstands or ride on swings. But those are activities that force the brain to integrate various kinds of information; so, when kids stumble, it’s easy for them to regain their balance. However, when an adult trips, the influx of information can overload the brain and the adult loses balance.

Does this mean the difficulty of recovering from a stumble isn’t necessarily a mechanical problem?

It isn’t. It happens because the brain hasn’t incorporated information fast enough to respond appropriately.

How can physiotherapy help improve balance and mobility in Parkinson’s?

People with Parkinson’s and other neurological conditions causing weakness or postural changes are often forced to move in limited ways. Once that happens, it becomes hard for them to explore other types of movements and, if left on their own, many never will. A physiotherapist can recommend exercises that force the body and brain to experience different scenarios that people would never put themselves into. The physiotherapist can also help people retrain their brains to respond more quickly when their balance is disturbed.

How does this balance retraining work?

Balance is a beautiful relationship between
• the visual system, which takes in information through the eyes;
• the proprioceptive system, which takes information from the receptors in your joints and tells your brain if you’re in alignment or out of alignment; and
• the vestibular system, which is located in the inner ear and takes into account head and eye position.

Because vision usually takes precedence, most people have underused one or both of the other systems. However, if you can improve the use of the idle systems, you can achieve some good results.

Try this simple exercise. Stand in front of a counter, rest your hands lightly on the counter and close your eyes. How do you stay on your feet and not wobble? Well, your proprioceptive system kicks in. If you’re out of alignment, it signals the brain which then alerts the muscles to pull you back into alignment. Your vision isn’t doing its usual bossy job, so these other systems have to pick up the slack.

When people with Parkinson’s do this type of exercise regularly, then, the next time they encounter a slight disturbance in their balance or get nudged or trip on the curb, their proprioceptor-brain-muscle pathways are likely to respond sooner because people have had practice integrating the different strands of information.

How does physiotherapy help with posture?

Over time, many people with Parkinson’s develop a stooped posture where their centre of gravity falls in front of the body rather than over the feet. A good physiotherapy routine will include both exercises to strengthen the muscles along the back and counterbalance the tendency to be pulled forward, and exercises to stretch the muscles along the front of the body which tend to contract when a person becomes stooped.

How much exercise is enough?

Set realistic goals. A consistent 20 minutes of exercise a day is worth more than an occasional 45-minute spurt. In fact, exercise should be seen as a Parkinson’s disease management strategy. It can make a big improvement to quality of life, balance and walking; but if you don’t keep it up, you lose all the benefits. Some of my clients say that exercise empowers them with some sense of control over their disease.

What should a person with Parkinson’s look for in a physiotherapist?

If looking for a physiotherapist, ask the clinic how skilled or experienced the physiotherapist is with Parkinson’s disease.

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Taking a trip

Careful planning can make travel away from home easier. Try the following suggestions to minimize problems and enhance the quality of your time away.

• Never leave the house without a day’s supply of medication
• Keep a few extra tablets in a labeled container in the glove compartment of the car.
• Use a small shoulder bag or fanny pack and keep it stocked at all times with crackers or cookies and a mini-juice carton so you can take your medication. Take this bag with you even if you think you may be out for only a short time.
• Carry a card in your wallet listing the medications you are taking.
• If you are driving, plan frequent stops for exercise and rest.

<strong>When traveling by plane</strong>

• Take advantage of early boarding privileges.
• Check in early and request an aisle seat close to the washrooms if mobility is a problem.
• Even if you don’t normally require assistance to walk, you may want to consider using a wheelchair or an electric cart in the airport. It may be easier for your escort to push you rather than carry hand luggage and help you to walk at the same time.
• During flights where a time change is involved, take medications, as needed, keeping to the same number of hours between doses.
• If necessary, adjust medications to ensure mobility at the beginning and end of the flight.
• Take all your medication for your entire trip in your hand baggage. Checked baggage lost enroute or flight delays may leave you without enough medication.
• Wear comfortable clothing and shoes.
• Use a small soft neck pillow to increase your comfort on a long trip.
• Try to rest both the day before you leave and the day after you arrive.
• Drink extra fluids the day before and after you travel. This will allow you to drink less on the travel day and reduce visits to the washroom.
• When travelling for extended periods of time ask your physician if he/she can recommend a neurologist in the place you are visiting, in case you need to see a doctor quickly.
• When travelling out of the country, make sure you have enough medical insurance coverage.

*An excerpt taken from <em>A Manual for People Living with Parkinson’s Disease, Parkinson Society Canada, 2003</em>. To request a copy (free of charge), contact <a href=”mailto:general.info@parkinson.ca”>general.info@parkinson.ca</a>.

<strong>This site also offers useful information and travel tips:</strong>

<a href=”http://www.cta-otc.gc.ca/themes.php?aid=2〈=eng” target=”_blank”>• Persons with Disabilities – Canadian Transportation Agency</a>

<a href=”http://www.viarail.ca/planificateur/en_plan_beso_acco.html” target=”_blank”></a>

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Research Committee news

We would like to extend a thank you to outgoing committee chairs, Dr. Anne-Louise Lafontaine who served as Chair of the Research Policy Committee and to Dr. Jon Stoessl, who served as Chair of the Scientific Advisory Board. Their dedication and commitment to the Parkinson’s community has been invaluable.

We welcome Dr. Edward Fon as new Chair of the Scientific Advisory Board and Dr. Pierre Blanchet, as Chair of the Research Policy Committee.

Dr. Edward Fon, incoming Chair Scientific, PSC Scientific Advisory Board
Dr. Edward Fon, incoming Chair Scientific, PSC Scientific Advisory Board

Dr. Fon is a neurologist-scientist and director of the McGill University Parkinson Program. His research, based at the Montreal Neurological Institute, focuses on the function and dysfunction of Parkinson’s disease.

Pierre Blanchet, incoming PSC Research Policy Committee
Dr. Pierre Blanchet, incoming PSC Research Policy Committee

Dr. Blanchet is an associate professor in the Department of Stomatology of the Faculty of Dentistry at the Université de Montréal. He directs the experimental Neuropsychopharmacology Laboratory at the university’s Movement Disorders Clinic.

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