From someone who freezes:
 Carline is not leaning forward because she wants to.  It's because her brain is
telling her to step forward but the connection isn't made to the muscles that
operate her legs.  Her feet are actually stuck to the floor - she can't pick
them up, so she falls.  It's not a question of her forgetting to move her feet,
it's impossible to always know when you're going to freeze.  She really doesn't
have much control over it.

I use a walker with wheels and brakes.   The brakes are extremely helpful in
avoiding falls because it gives you something steady to stop you.

I have also included an article I wrote for our support groups newsletter.
Maybe some of these tricks will be helpful as well.
=========
I'M FREEZING…AND IT'S NOT EVEN COLD!

            Nina Brown

PD is generally considered a movement disorder creating symptoms that affect
your gait, balance and can cause slowness of movement and tremors.  But as one
who suffers from Parkinson's, I can tell you that those symptoms are only the
"tip of the iceberg."

To the uninitiated, freezing might refer to the temperature, but if you have
Parkinson's, "freezing," a temporary, involuntary inability to move, is a
symptom where your feet feel as if they are stuck to the ground.  Freezing seems
to be directly related to how long you've had PD, and whether your primary
symptoms began with the absence of tremor and gait problems.  It is sometimes
referred to as "start hesitation" or "gait initiation failure" and can occur
when you begin walking, while walking, when turning, in doorways, upon entering
a confined space, or even as a result of anxiety or panic.  This condition can
last anywhere from a few seconds to many minutes.  What activates these brain
reflexes is still unknown, although low dopamine levels seem to be related.
"Freezing" is a difficult symptom to treat but your neurologist may be able to
alter your medications using Deprenyl; possibly adding a dopaminergic agonist
such as Permax, Parlodel, Mirapex or Requip and/or adjusting your medication
schedule to help control this problem.

Walking in general is more problematic for a person with Parkinson's because of
the slowness, the diminished arm swing and the shuffle that comes from not
raising your feet or toes high enough off the floor.  The stooped posture
affects your balance as your center of gravity shifts forward with the upper
part of your body preceding the lower part as you walk.  In order to catch up
with your center of gravity and regain balance, the tendency to take
increasingly faster, shorter and more frequent steps, known as "festination"
occurs.  "Propulsion" occurs when you try to run forward to catch up to avoid
falling.  "Retropulsion" takes place when you feel pulled or forced to run
backwards to recover your balance.  As you might imagine, falling becomes the
biggest concern when your body continues moving and your feet stop.

Older bones tend to break easier, so it's important to keep them strong with
weight bearing exercises and the proper diet. Stretching and range of motion
exercises can also help combat muscular rigidity and keep your joints from
becoming immobile.

Falls are not only dangerous to your physical health but your mental health as
well.  Fearful of falling again, many people stay close to home, abandoning
exercise routines and social pursuits, but withdrawal from activities is the
worst way to prevent another fall.  (And anxiety also increases the tendency to
freeze.)  A fall to the floor doesn't need to be a fall into isolation or
depression.  If you've been hurt from a fall, it's important to get out even if
you need to use a cane or a walker.  Just pay careful attention to the threat of
"freezing" or being off balance and don't make any reckless movements.

You need to think about every step you take.  Walking is no longer an automatic
function.  Actions that were once routine become a challenge because your
muscles aren't getting instructions from your brain to move and therefore don't
respond to your need to move.  It can be very frustrating when familiar tasks
must be constantly relearned and given such disproportionate amounts of
concentration; but attitude and exercise are vital to your well-being, so
approach this challenge with spirit and determination and fight to keep as much
mobility as you possibly can.  Don't become discouraged.  Some days it's just
easier to move than other days.  Resolve to maintain a "can do" regarding
attitude and a "will do" regarding exercise.  If you do fall down, at least it
proves you were on your feet and moving.

 EXERCISES

Abracadabra…or a few tricks for better balance and some techniques to overcome
freezing when your head won't tell your feet to take that first step.

 For better balance:  practice the ancient martial art of Tai Chi (pronounced
tie-chee).  Tai chi consists of more than 100 flowing, dance-like movements of
"postures" or "forms" that resemble ballet in slow motion, performed while you
concentrate single-mindedly on your movements and your breathing.  The
concentration required has been likened to "meditation with motion."  Taken
together, the forms are designed to work all of your limbs and muscles.  Since
it's a no-impact form of exercise, it's much better for bones and joints that
can't withstand the jarring from high-impact activities.  The continuous,
smooth, gentle movements have been said to strengthen the motor skills impacted
by PD.  It is also particularly helpful in decreasing tremor because Tai Chi
reduces stress and the muscles relax.

Dr. Timothy C. Hain, a neurologist and associate professor at Northwestern
University Medical School, conducted a study examining the potential benefits of
tai chi on some patients with Parkinson's.  His results were overwhelmingly
positive.  Hain said, "We think it is possible that tai chi can not only restore
balance but eventually make it better than normal." In addition to preventing
falls, other benefits included increased strength (especially in the thighs,
buttocks and calves) and flexibility (working a full range of motion without
straining the joints or connective tissues) as well as better posture.

More suggestions for better balance:
Ø Stand with your hands on your hips, feet spread apart:
Ø Practice marching in place
Ø Practice raising your leg straight out behind you.
Ø Practice raising your leg out to the side.
Ø Practice drawing a circle with your leg.
Ø Stand with your hands at your side, feet spread apart:
Ø Lean forward and backwards.
Ø Lean to both sides.
Ø Lean in a circular motion and reverse the motion.

To help alleviate freezing:
Ø Start by maintaining an upright, tall stance, moving your body's center of
gravity backward so it runs straight up and down through the spine, legs and
ankles.

Ø Use your imagination.  Dr. Dwight C. McGoon, a Mayo Clinic surgeon, pretends
he has a rocking chair leg attached to each of his legs, and that a proper step
requires that the back end of the rocker touch the floor on the forward step and
the front end of the rocker touch the floor before the step is completed.

Ø Exaggerate your step.  Imagine a point on the floor about two feet ahead.
Make that first step as long a stride as possible because subsequent steps tend
to shorten.

Ø Rock from side to side to initiate a marching in place step.

Ø March like a soldier with a stiff-legged, long-striding military gait.

Ø Swing your arms up above your head, then bring them down sharply to your side
2 or 3 times.
Ø Walk sideways
Ø Take a quick step backwards.
Ø Watch other people walk.
Ø If you hesitate walking through doors, focus on an object past the doorframe.
Ø Step over an imaginary object on the ground, or use a cane or another person's
foot, tile or carpet patterns. Make a path at night with white socks on carpet
or white tape on a hard floor.
Ø Alternate the distribution of your body weight.
Ø Have someone rhythmically pull or push or raise your knee.
Ø Stamp your feet
Ø A sudden sound such as a clap may break a freeze.
Ø Walk to music to increase speed of motion and improve rhythm.
Ø Make wider turns to decrease the chance of getting your feet entangled and
falling.
Ø It helps to count each step.  You're less likely to freeze if you know how
many steps it takes to get from the bedroom to the bathroom.
Ø Avoid clutter.  Keep floor areas free of shoes and other objects to reduce the
risk of a fall.
Ø If you need a walker for balance, using one with wheels (with automatic
locking mechanisms) will allow for a more normal walking pattern than standard
ones.  [Hint: if tremors make the walker unsteady, try weighting the lower bars
by tying on socks filled with pennies.]
==========





KF Etzold wrote:

> I have been struggling to understand the phenomenon of falling in a PWP.
> Carline has taken many spills and I have tried to teach her ways to avoid
> them. The net is that I am unsuccessful and that somehow she cannot change
> her ways to prevent most falls.
>
> My observation is that the principal cause is the bradykinesia or freezing
> which is ultimately responsible. I have also observed that because of her
> difficulty walking she tends to lean forward to somehow initiate a step. Of
> course this does not work but I have not found a way to stop her from
> leaning forward. Anybody have any thoughts on preventing falls? She often
> uses a walker, but even with it, yesterday she took a spill trying to turn,
> where again she tends to try to avoid the foot movement and turns the body
> instead which is conceptually just like leaning forward.
> I think I understand that it is difficult for her to walk but the
> consequences of not moving the feet and then falling are worse.
>
> I also thought the pain of various bruises would cause her to walk very
> cautiously but somehow she seems to forget and try to initiate a step but
> without moving her feet.
>
> Thanks for any comments,
>
> K-F Etzold cg Carline
>
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