Fall prevention care for patients with Parkinson’s disease

Fall prevention care for patients with Parkinson’s disease. Falls are one of the biggest headaches for Parkinson’s patients and their families. Falling can not only cause physical injury to the patient, but also may cause the patient to fear walking.

April 11, 2020 is the 24th World Parkinson’s Day.

Parkinson’s disease is a degenerative disease of the nervous system that is common in middle-aged and elderly people. There is currently no cure and requires life-long treatment. It is the “third killer” of middle-aged and elderly people after tumors and cardiovascular and cerebrovascular diseases.

Falls are one of the biggest headaches for Parkinson’s patients and their families. Falling can not only cause physical injury to the patient, but also may cause the patient to fear walking. To reduce going out during the epidemic, how should we prevent patients from falling at home? Now let us correctly understand and prevent falls as much as possible, and learn the most effective way to deal with a fall.

What are the reasons that cause Parkinson’s patients to fall?

1. Abnormal posture:

As Parkinson’s disease progresses, the patient will assume a walking posture of bending forward, which makes it easy to fall.

2. Balance disorders:

Parkinson’s easily affects the brain areas (basal ganglia and brainstem) that control walking and maintain balance, making it difficult for patients to complete normal postural adjustment reflexes. For example: Parkinson’s patients have reduced walking accompanying movements, so it is difficult to reach out their arms to maintain balance when walking on uneven ground or standing unstable; when they are tripped, it is also difficult to re-establish balance by moving small steps (physical examination) The “back-pull test” at the time is to detect this).

The above two are the most common causes of falls.

3. Decreased muscle strength:

Muscle weakness can cause the patient to bend forward more severely, thus indirectly increasing the risk of falling. In normal life, we must insist on exercising as much as we can to avoid muscle atrophy and weakness, and further avoid joint stiffness and contracture.

4. Freeze gait:

The so-called “freezing” refers to a sudden stop when walking, unable to move, or difficulty starting to walk when starting to walk. The patient will feel as if his feet are stuck to the ground. This phenomenon can last for several seconds or minutes, and it will also cause The patient feels unstable and increases the risk of falling.

5. Orthostatic hypotension:

When we change our position from lying or sitting to standing, blood vessels can be adjusted automatically by the autonomic nervous system to maintain blood pressure stability. However, under certain conditions, this adjustment function will fail, such as dehydration, disease, or drug side effects. In this case, the blood supply to the head is reduced when standing, and the patient may feel dizzy, and may even cause fainting or falling.

Therefore, you must take your time when changing your position, and don’t suddenly stand up and start walking. Blood pressure problems can be the manifestations of PD itself, or the side effects of certain treatment drugs. In addition, other drugs, such as antihypertensive drugs, can also cause similar symptoms, and they need to be carefully distinguished. Once the aforementioned manifestations occur, be sure to inform the doctor, clarify the reasons together, and adjust the use of drugs if necessary.

6. Visual impairment:

Some Parkinson’s patients may have vision problems, such as blurred vision or difficulty distinguishing distance. This will increase the risk of the patient when crossing obstacles or passing through small spaces. If you have vision-related problems, you must tell your doctor, because it may be a side effect of some Parkinson’s treatment drugs, which can be resolved by adjusting the drugs. Of course, regular vision checks are also very important.

7. Dangers encountered at home and work: through careful planning and arrangement, many falls can be avoided. A physical medicine therapist can help you achieve this. Many falls occur when patients rush to the toilet, especially at night, which is particularly noteworthy.

How can Parkinson’s patients reduce the occurrence of falls?

√ Vision problems:

1) If the patient has vision problems, he should first go to the ophthalmology clinic.

2) If there is a distance problem, you can use a walking stick. It can help you judge the height of the stairs when you go up and down. In addition, the stair railing can also play an important role in maintaining balance.

√When walking and turning, especially when two feet are stumbling on each other, it is most likely to fall. You can break down the movement when turning, first turn the feet, and then turn the body to adapt to the position of the feet, slowly turning around in small steps.

√ Carrying things while walking will increase the difficulty of maintaining balance, so you should:

1) Try to put things in your clothes pocket or use a diagonal bag (the kind that crosses over from the shoulder and puts on the opposite side).

2) In a flat area, you can use a trolley to place items and maintain balance. However, this method varies from person to person. The trolley can increase the walking speed, so it increases the risk factor for some patients.

√Completing the movement while standing has higher requirements for maintaining balance (for example, standing in front of the sink to wash your face). At this time, try to use a high stool or seat, and the risk of falling while sitting is lower.

√When looking up and looking up, due to poor posture, it will often lead to backwards and easy to fall. If you must look up or look for high objects at this time, you should step back with one leg first, and place your weight on this leg as much as possible Ensure a stable center of gravity.

√Poor recognition of the object’s position, for example, it is easy to fall when going to reach or lift an object. Therefore, when you pick up, you should be as close to the object as possible, and use your other hand to support the surrounding fixed objects (such as a solid table, wall, etc.) to avoid falling.

√Sudden noise when walking, talking with others or other interference may affect balance and fall. Therefore, PD patients must be attentive and fully focused when walking!

√ “Freezing” is more likely to occur when passing through small spaces and crowded places. Physical rehabilitation is very useful at this time. For example, when the “freezing” phenomenon occurs, use sound or music rhythm, visual or tactile rhythm stimulation, restart walking motion, etc., please consult a physical medicine rehabilitation doctor for details.

Practicing to start correctly can effectively avoid falling

1. When walking, first determine the target you want to go to, stabilize your emotions, and concentrate.

2. Look ahead, step forward, the first step can be slightly elevated.

3. When walking, first touch the ground with your heels, then touch the ground with your toes, and move your weight to one foot before taking the next step. At the same time, swing your arms as much as possible.

4. Wait until there are fewer people before walking. When encountering obstacles, you need to change direction in advance to avoid falling when approaching.

5. When a “freezing gait” occurs, don’t let the body instinctively lean forward, but stand still and wait until the mood is relaxed before walking.

6. When there is a “freezing gait”, you can imagine that there is a horizontal line on the ground in front, step the foot over the line, or use the L-shaped crutches to assist in walking.

7. At home, you can draw a grid or line on the ground according to the daily step length to train the start and step.

8. When walking, you can listen to rhythmic music or shout passwords, and walk with the rhythm of the music or passwords, which can give yourself encouragement and confidence, and overcome tension.

9. Patients with unstable gait can use crutches or walking aids to assist in walking to avoid falls and ensure safety.

During gait exercise, the patient is required to look straight ahead, keep the body upright, and the upper body must not lean forward. When starting, the feet should be raised as high as possible, and the steps should be as slow and large as possible. The order of the feet on the ground is the heels and then the toes, and the arms swing back and forth naturally when walking. The key is to “raise your legs high and step hard.” It is best to have someone present during the practice, who can remind and correct the abnormal posture at any time.

What should I do when I fall?

First check if you are injured!

If you are injured, you should:

1) Ask for help: Use a whistle, home personal alarm system or phone to call for help, vigorously tap the floor or wall to attract others’ attention, and if there is a call, call the emergency number as soon as possible.

2) If the injury is severe, do not move easily.

3) Keep warm with blankets, coats or all clothing within reach.

4) If you have to lie on the ground for a period of time, if possible, move your hands and feet properly and roll gently to the sides to avoid long-term pressure on one limb or one body. If you fall on a hard ground, try to climb to a carpet or other softer place if possible.

If you are not injured, you should:

1) Once you recover a bit, roll over and lie on the ground, touch the ground with your hands and knees, and climb to the side of sturdy furniture such as sofas and beds.

2) Facing the supporting furniture, kneel on the ground with your hands, move the stronger leg forward, lift the leg and bend the knee, and let the foot touch the ground.

3) Lean forward, move the center of gravity forward to the front leg, pull to support the object, and let the other leg stand up.

4) Turn around and sit on the sofa or bed.

5) Sit and rest for a while and then stand up.

(source:internet, reference only)

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