THE GOOD TIMES NEWSLETTER
               THE PARKINSON SUPPORT GROUP@EMERSON HOSPITAL

 BACK IN JULY I POSTED A MESSAGE TO THE LIST WITH REGARD TO THE ISSUE
OF FALLING. I COLECTED SOME 52 OTHER POSTINGS AND SENT THEM ON TO
KATHY KUNZ WHO, AS SOME OF US ARE AWARE, IS A FINE WRITER AND EDITOR.
I WAS HOPING THAT SHE MIGHT BE ABLE TO DEVELOP A STORY WORTH TELLING.
INDEED SHE DID JUST THAT AND WHAT SHE WROTE MAY SERVE AS A GUIDE ON
THE ART OF FALLING    George J.Lussier   Editor   Kathy [log in to unmask]


                       Fall Safe Strategy
                                By
                            Kathy Kunz
                          Special to the
                       Good Times Newsletter

When Dick van Dyke did it, we laughed, but for PWP, falling is no laughing matter.  Those of us whose muscles are stiff, whose feet drag, who have trouble keeping up with our center of gravity, have all fallen a time or ten.  Our cyberspace support group discussed it at length on line and came up with some conclusions on what makes us fall, what we can do to prevent falls, and failing that, how we can fall more gracefully or a least more safely.  You may find some help here for your own falling problems.


Why do we fall?   The reasons for falling provide vital clues to prevention.

1. Due to rigid muscles and bradekinesia, we don't recover our balance as quickly as necessary; therefore, when we turn too suddenly or tightly, tilt too far to one side (as when carrying uneven loads) or festinate--that quick-step to catch up-- we can't always get our feet far enough under us to maintain our upright position.

2. Our shuffling gait or a dropped foot promotes tripping; even the smallest obstacle (in my case, a half-inch sidewalk bump) can send us down before we realize it.

      3. Orthostatic hypertension, a sudden drop in blood pressure when standing up, can cause fainting and the resultant fall

      4. A fourth reason for falling for PWP, not clearly defined by the meds/neuros, but alluded to by several, is the fact that PD seems to actually interfere w/our normal sense of "righting" ourselves,  in ways that we cannot perceive until the subsequent falling behavior is in evidence.  This tends to make many falls very insidious.***
 .
How can we prevent falls?  Needless to say, the basic preventive actions recommended for everyone apply even more so to us: avoid slick floors, throw rugs, soapy bathtubs;  make sure toys or other snall objects aren't scattered around; light up stairs and walkways; look where we're going.  But our special circumstances call for further measures.

1. Practice being aware of the way you walk: force yourself to swing your arms so that the left arm goes forward with the right foot to counterbalance (although one list member swears by clasping his hands behind his back or putting them in his pockets!); carry yourself as straight as possible; take as long a stride as you can  if prone to festinating; pick up your feet and put them down heel to toe--on uneven surfaces, exaggerate this even if you look like you're tramping a cow pasture or a mine field.

2. At the first sign of festination, stop walking; don't wait until the fall is imminent.  Next, adjust your posture so that your feet are under you properly; start out afresh, slowly and with a longer stride if possible.

3. Do not pivot when turning; instead, walk in a circle as large as necessary to maintain balance.

4. Avoid carrying heavy or uneven loads.  A small sack in each hand is safer than one large sack carried in front that pulls you off balance.  Learn to lift objects properly.

5. When changing directions, glance toward the direction you plan to go before you initiate the turn in order to orient yourself.  This same lack of orienting yourself occurs if you try to walk in the dark--turn on the lights for that toilet trip!

6. Take advantage of balance-enhancing activities such as tai chi, ballroom dancing, and rhythmic exercises such as bike riding.  A complete program of stretching and range of motion exercises done daily will help keep muscles, especially those hamstrings, from shortening and causing backward falls and foot drop.

7. If your balance is so impaired that falling becomes frequent and unavoidable, shop the full range of walkers available.  One of the best is called a U-Step Walking Stabilizer, featuring five swivel wheels on a broad (22 inch), U-shaped base that glides over doorsills, etc. eliminating the need to lift it.

8. If orthostatic hypotension is the problem, always sit on the edge of the bed a few moments before getting up from a reclining position; rise slowly from a chair and hold on to something stable until you know it's safe to attempt walking.

      9. To add to one's PD lexicon the "nose to toes" incantation, rehearsing it ofte so that it clicks in automatically as an orientational strategy when the sense of a backwards fall comes on.***


How do you fall gracefully?  The airborne division teaches paratroopers to fall that last foot of a jump, but few of us have had such training.  Karate, judo and  other martial arts teach falling safely also, but I, for one, don't want to risk a body slam in the process.  The following are some suggestions for coping when a fall is unavoidable.

1. Whenever possible, sit instead of falling--get as low as possible while still in control of your fall.   This will minimize the distance and danger.

2. Curl into a ball and roll as you fall to distribute the impact along the length of you body, tucking your head in line so as not to hit it.

3. Try to relax!   Hard to do, but tense muscles seem to injure more severely; that's why drunks and babies often survive serious falls with little damage.

4. If possible, aim for a bed, soft chair, even a wall that is at least closer than the floor.

5. If falling backwards, try to slap the ground with your hands and keep your head up to prevent it from hitting the ground.

6. Use arms and hands as shock absorbers, not as weapons; let them bend slightly on impact instead of stabbing stiffly, which will invite a fracture.

Falls often happen so fast that we don't know we've fallen until we've already landed.  Once on terra firma with first aid measures administered, however, ask yourself if there was any way to have avoided this tumble.  If not, then I can only wish you "Happy Landings."





The *** denotes that this item was a contribution by John Bachman. The rest of Mr Bachman's contribution follows:
"Examples:  I've taken four horrific falls in recent months, none of which I'd any idea were even occurring until after the landing.   Three I could have avoided, by the obvious but distasteful strategy of not engaging in the activity initially; but the one (falling  off our stone front porch onto the walk, w/significant leg cuts, I could not have predicted nor avoided and had (uncannily) no idea it was occurring until I found myself on the ground.  [The other three involved twice while wading on rocky river bottoms while trout fishing, and once (the worst), two months ago falling backwards to a sitting position while lifting my canoe to car top, with a resultant broken rib that's still plaguing me.]  But it  is the uncanniness of not even recognizing that the imbalance is in progress until after the fact that is so disquieting, because it so limits one's defenses.  Should we try to describe that situation and hint at its cause as well?"