BALANCE AND MOBILITY

Balance and mobility are interlinked, especially when we have symptoms of Parkinson’s disease. Nerve damage caused by the progress of the aetiological pathways that have caused these symptoms tend to create challenges in standing upright, walking with good posture and certainty, maintaining balance while dressing, showering or preparing food, and during other everyday tasks we used to be able to do without thinking.

We face a critical cycle here. Poor balance discourages us from moving about energetically for fear of falling, so we become more sedentary. This reduces our body’s ability to “learn balance” through movement and carrying out tasks. So poor balance reduces mobility and lack of mobility exacerbates poor balance.

We need to break this cycle with determination and dedication. We have to “practice before we can”. We must undertake activities that will teach our body balance again so we can undertake the activities that will teach our body balance.

Does that make sense? Possibly not, so let me give some examples.

Kevin (67 years old, diagnosed with Parkinson’s disease 3 years earlier) had lost the ability to ride his bicycle, walk to the shops (10 minutes) and mow the grass; all activities he had enjoyed in the past.

We commenced daily exercises with support to keep him safe. Kevin stood with his back firmly in a corner of the room, with a walking frame in front for support as necessary. He then “marched” on the spot, lifting his knees to at least waist height. He then practised on a balance board** with support for three minutes twice daily then, using his walking frame for balance, but standing upright and looking straight ahead, he walked a circuit around the house ten times.

Over several weeks, Kevin became more confident and was able to march on the spot with just a wall behind him (rather than a corner) and no frame in front. He reduced his reliance on support with balance board practice and rested only his finger tips on the walking frame when walking his house circuit.

Kevin cautiously reduced the amount of support for each activity until he was able to safely walk and balance without assistance. This too about three months with persistence.

His first venture outside was to walk to the shops for s newspaper. He rested outside the newsagents to read for a few minutes, then walked home. A few days later, he retrieved his lawn mower from the shed and cut the grass.

It was another month before he tried cycling, and then only 100 meters or so. But this rapidly increased until he could confidently ride 5km (3 miles); he extended his rides until, after about six months, he was riding 20km (12 miles) for relaxation.

Kevin persisted and practised until his balance allowed him to be more independently mobile, and his extra activity improved his balance.

Personal effort and practise are really the only ways to improve balance and mobility. Medication may mask symptoms and make it seem that these skills have improved, but that improvement will wear off over quite a short time, and you will need ever-increasing amounts of medication until it no longer works.

If you are able to work with a skilled Occupational Therapist, Neuro Physiotherapist, or Pilates teacher, I am sure they will provide you will exercises/activities to improve balance and mobility.

However, these home-based activities will help you if done daily with persistence. There is no quick fix. You must practice and persist until you see improvement.

Do what Kevin did:

Simple Exercises

High Knee Marches – back into a corner so you are supported on two sides. Have a chair or walker in front in case you need to hold something for safety. Initially it is a good idea to have someone with you until you are confident you won’t fall. March on the spot, lifting each knee at least waist high. This will work best if you play rhythmic music while you march. Take deep, steady breaths while you march.

Use a balance board or balance disc (“wobble disc”) – with solid support, practice balancing on the board/disc so that your feet are level, you are standing upright and looking straight ahead. As you become more proficient (and this might take some weeks or even months), reduce your dependence on support. Make sure the support is still there, but gradually stop holding on. Breath deeply and steadily while practicing – don’t hold your breath!

Practice, practice, practice. Using this equipment will help build strength in the muscles that hold us upright and adjust the various sensory inputs that grant us balance. To remain well balanced, we need high functioning visual and vestibular systems, plus sensory input from feet, ankles, knees, hips and pelvis. Everything must work in harmony to keep us upright and confident.

The ultimate aim with this equipment is to reach a level of confidence that will allow you, while balancing without support, to sing, read a book/magazine or hold a conversation while perfectly balanced.

Practice walking – if you need support (human or equipment) to walk safely, do not try to walk alone until you are confident of not falling. But practice walking twice daily (at least) in a safe environment. ALWAYS play rhythmic music while walking as this will significantly improve your gait and balance.

Remember that walking and music are great companions. Use music as often as you can.

Crawling – now Kevin did not do this, but it can really help. It is best to find a space with a long straight uncluttered area and with carpet if possible. Otherwise, get some good quality knee pads. Make sure you have someone with you to begin this exercise so you can be confident you won’t “get stuck” on the floor. As you practice, you will gain strength and confidence and be able to crawl on your own.

Crawl forward (again, with music) as far as possible, then turn around and crawl back. Repeat this until you begin to tire, but do not become exhausted.

Once you are confident in crawling forward, practice crawling forward one way and backwards to your starting point. This is difficult, so take your time and keep on practicing.

When you are confident crawling forwards and backwards, crawl sideways – both ways.

All the time you are practicing crawl, check your ability to stand upright and balance each day, but make sure you have support while checking this.

SAFETY FIRST!!! If you are uncertain of your balance and stability always have someone with you while retraining your balance systems and/or use mechanical aids like walking frames, solid chairs, etc. While it is critical to continue developing our balance and mobility skills, we must stay safe.

To be mobile, we must be mobile !

Some of the peripheral symptoms associated with Parkinson’s disease include fatigue, lassitude, unwillingness to participate in physical activity, lack of will to actively get well and low spirits.

If we allow these symptoms to dominate, we move less and less and, as time goes on, we lose the ability to move freely. Yes, the imbalance of neurotransmitters tends to make movement more difficult but, if we give in and move less, we reduce our ability to move, so we move less, so reduce our ability to move. See what I am saying.

If we want to be able to move, we must move.

In class 8, we explored exercise in many forms. Are you exercising every day? Do you have a set exercise regimen that you diligently follow day in and day out? Do you participate in group exercise at least once each week?

If you answer to any of these questions is no, you have been wasting time for 13 weeks! Get moving!

From today, your regimen should include:

1. High-knee marches with support;
2. Time on a balance board or wobble disc;
3. Walking with or without support as needed;
4. Daily aerobic exercises;
5. Stretches;
6. Resistance or weight exercises;
7. Dancing;
8. If your balance is severely compromised, you need to be crawling.

In the next class, we will be looking at techniques for repairing neural pathways to help you become even more balanced and mobile.

References

• COLEMAN John ND; “Stop Parkin’ and Start Livin’”; Michelle Anderson Publishing, Melbourne, Australia, 2005.