Preventing and Minimizing Falls — March 6 Meeting Notes

We welcomed Physical Therapist Yuliya Jackson to our March 6 Zoom meeting to speak to us about preventing and minimizing falls. As a Board-Certified Clinical Specialist in Neurologic Physical Therapy and a Vestibular-Certified Specialist who is LSVT-BIG certified, she is well-versed on the topic.

According to Yuliya, falls are a big problem! About 60% of people with Parkinson’s experience a fall annually, which is about 5 times more than people in the same age range without neurologic issues. Falls can be Parkinson’s or non-Parkinson’s related (such as a pet pulling you on its leash). Yuliya highly recommends a PT evaluation after a fall to determine the cause, of which there are many possibilities. 

Risk factors for falls with Parkinson’s include freezing of gate, cognitive impairment, poor leaning balance, lower limb weakness, slow gait speed, low blood pressure, decreased amplitude, dyskinesia, festination, previous falls, and fear of falling. Falling, even just once, can make you more fearful of falling again and lead to avoiding activities outside your home. Fatigue is a huge risk factor for falling as all Parkinson’s symptoms get worse with fatigue. 

Festinating gait is characterized by taking quick steps forward. Festination is an inappropriate stepping response to the forward weight shift as you walk and made worse by fatigue, posture, and medication off-time. 

Amplitude is everything! Not lifting your foot high enough and taking big enough steps when you walk is a hypokinetic problem and occurs during medication off-times, but not exclusively. It also can occur during on-time if you are fatigued, or when there are multiple environmental issues demanding your attention, such as walking into a crowded room or having to dual task. The LSVT-BIG program focuses on increasing amplitude. When you fix this, everything improves, including festination, and appropriate balance reactions are restored.

Dyskinesia, a side effect of medication, can contribute to falls. Most common at peak dose, dyskinesia can affect the feet, trunk, neck, and arms. Physical therapists work on strengthening your core to help prevent falls when you are dyskinetic. A strong core makes your body more stable. Yuliya suggests also talking to your doctor about medications that can help with dyskinesia.

Gait speed, measured in meters-per-second, is considered the 6th vital sign and the best predictor of functional decline and disability. (Pulse rate, respiration rate, blood pressure, body temperature, and blood oxygen level/saturation are 5 other vital signs.) You are more likely to be independent with activities of daily living and less likely to be hospitalized if you can walk at a gait speed of 2 miles-per-hour or more. 

Leg strength is also important. Recurrent fallers have decreased quad strength, which is associated with gait speed. If you don’t use it, you lose it! For adults in their 60s and 70s, leg strength can decrease as much as 227% and as much as 274% for adults in their 90s. According to Yuliya, it doesn’t matter how old you are—if you use your muscles, they will stay strong and get stronger. She advises that everyone, not only people with Parkinson’s, work on strength and balance on a daily basis: strength training is recommended 2-3 times a week; aerobic 3-5 times a week. You should aim for 150 minutes a week minimum of exercise.

Resistance (strength) and balance training prevent falls. Yuliya advises everyone with Parkinson’s have a follow-up physical therapy assessment every 6-12 months to check on their progression. PT is prescribed for exercises specific to an individual’s needs, just like your doctor prescribes medication specific to your needs. Physical therapists overtrain you, pushing and challenging you to work beyond what you normally do as a part of your daily life (while you are on your Parkinson’s medications), so that when you are fatigued, it is easier to overcome your symptoms and they won’t seem as bad. 

Dual and multitasking activities put a strain on our attention, placing physical movement in the background. A physical therapist’s goal is to make our movement more automatic while challenging our cognitive function. Because of the way our brain operates, people with a more left-sided presentation of Parkinson’s have more attention issues and need to work more on dual and multi-tasking. People multitask all the time. A few examples Yuliya cited are talking with someone while walking together and walking into a supermarket while consulting a shopping list. 

Speed and amplitude training improve balance reactions. There are also environmental compensations we can make at home. Be aware that when we sit down, we twist and turn, movements which can throw our balance off. Doorways present small areas to walk through and cause some people to freeze. Yuliya suggests setting up good visual targets beyond the doorway to focus on while moving forward. Regularity of geometric rug patterns as opposed to floral ones help with balance. Area rugs should be removed as they create tripping hazards for a toe to catch on.

Talk to your doctor and pharmacist about your medication if you frequently feel drowsy or dizzy or if you take more than four medications. One cause of dizziness in Parkinson’s is orthostatic hypotension, which is a more light-headed feeling than vertigo. Orthostatic hypotension causes your blood pressure to drop with prolonged standing activities and to increase when lying down. It’s important to consult your doctor to manage this condition as drowsiness and dizziness may result in falls!

Vestibular Agnosia, loss of vertigo perception, is a neurodegenerative condition which may be caused by Parkinson’s. Vestibular problems are a major contributor to falls. You can have vertigo but not be aware of it due to a loss of vertigo perception. 

New and fun things at the clinic: Biodex Treadmill with music helps people with Parkinson’s take bigger and quicker steps. NxStep Unweighing System holds people up so they don’t fall while walking on the treadmill. Yuliya has been putting everyone on it to work on changing speed, changing direction, and distracting themselves without fear. The Slip Trainer, a reactive step trainer, can help those worried about slipping and losing their balance.  Using a harness for safety, you work on taking bigger and bigger steps and catching yourself before you fall. 

Yuliya concluded by reminding us of the brain’s neuroplasticity, its ability to change and adapt, forming new neural networks throughout your life. By working on gait speed and amplitude, strength and resistance training, and dual and multitasking, you will react quicker and with better balance control. 

The Inova Fair Oaks Rehabilitation Department where Yuliya works recently moved to a newer and larger location at 3620 Joseph Siewick Drive, Suite 106, Fairfax, VA. She can be reached at 703-391-3642. Feel free to email any questions to

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