Introduction
This is a short information booklet on how your walking may be affected by Parkinson’s, and what you can do to help improve it.
Why is my walking becoming difficult?
The basal ganglia is a part of the brain affected in Parkinson’s.
It is responsible for automatic movements (the ones we don’t usually think about). This means it is responsible for guiding our walking and other complex movements such as getting in and out of a chair or bed.
Due to loss of cells in the Basal Ganglia, a key chemical messenger called dopamine (responsible for automatic movement) is depleted.
How might my walking be affected?
- The length of steps becomes smaller
- The rhythm of walking is affected
- Stooped posture
- Starting and maintaining the walking pattern is a problem
- Concentrating on other things while walking is difficult
- Falling is more frequent
- Change in muscle tone (rigidity) can cause stiffness
- Changes in balance can cause feelings of unsteadiness
- Involuntary movements (dyskinesia) can cause reduced balance
- Reduced arm swing and movement can cause reduce balance
How can I help my walking get better?
Cues
Cues are prompts that give information on when and how an action should be carried out. In relation to walking, this information can be about the timing of movement or the size of movements.
Types of cues:
- Attention – thinking about your movement
- Auditory – a beat from a metronome or music
- Visual – a marker e.g. on the floor or wall
Top tip
In the hospital, you will often hear therapists counting “1-2-1-2…” to assist the patient in the speed and fluidity of walking. This is something that can be repeated at home!
Why can cues help?
Cues make movement less dependent on the automatic pilot, which is situated in the part of the brain affected by Parkinson’s. Cues use a different route through the brain to activate and maintain movement.
My walking is slow
When might this happen most?
- When you are tired
- When your medication does not work well
- When you are distracted
- When you have not been very active or you have been unwell
What can I do about it?
You can increase your speed of walking by using a faster rhythm than you normally use. You can increase your rhythm by:
- Counting in your head or by using a metronome beat
- Think about taking bigger steps, making them long and even
- Use stripes in floor patterns, or on paving stones, as visual cues for this purpose
- Swinging your arms rhythmically by your sides when walking
I tend to freeze and get stuck
When might this happen most?
- When you are approaching doorways, chairs or obstacles
- When you are taking turns or changing direction
- When you are distracted by another task and stop focusing on your walking
- In places that are crowded or cluttered
- When your medication does not work well
E.g. – this is why stepping & turning from your bed to chair in a small space can be difficult.
What can I do about it?
If you feel yourself freezing and getting stuck, stop and think about the 3 S’s:
- Stand tall with your feet apart
- Shift your weight from side to side
- Step out in front of you, making your first step bigger than usual
Continue this pattern for the first few steps until you feel you’ve got going.
If there are areas where you stick often, you might want to use cues.
Top tip
Placing a stripe on the floor in the doorway to step over can help. Or you can try stepping in time to a metronome beat – start to count or use the beat as you approach where you often freeze.
I tend to shuffle my steps
When might this happen most?
- When you have been walking for a while and feel tired
- When you are distracted by another task such as carrying something or talking
- If you have been inactive and are stiff, e.g. first thing in the morning
- When your medication does not work well
E.g. – this is why stepping & turning from your bed to chair in a small space can be difficult.
What can I do about it?
Try to concentrate on keeping your steps long and even. You may have to reduce your normal number of steps to make them longer. It is better to take fewer, longer steps than lots of fast, shuffling ones.
Top tip
This is why you may hear therapists in the hospital counting or instructing their patient ‘heel – toe’ when walking.
You can use this prompt at home too!
I can’t get up from the chair
What can I do about it?
Rehearse the movement in your head. Have a set of simple commands for each part of the movement.
- Front of chair
- Hands on chair arms
- Feet flat on floor
- Nose over toes (feel your weight move on to your feet)
- Head up
- Stand tall
Top tip
If you are sitting far back in a soft chair, rock from side to side to move to the front of the chair. Counting may help this sideways movement.
Once at the front of the chair, you can count whilst rocking gently forwards and backwards to give yourself some momentum to push up.
Top tip
In the hospital, you may see the therapist helping the patient gently rock whilst giving the instructions “ready, steady, stand…” You can do this at home too!
You can use a visual target on the wall opposite to help you straighten as you stand.
Please speak to your Physiotherapist / Occupational Therapist about the type of chair you have – we may be able to advise you on the type of chair best suited to you, or how to adapt the one you have to make it more appropriate.
I feel like I am stooping / bending over
When might this happen most?
- If you have been in one position for a long time, e.g. sitting watching television
- When you are tired
- When you have to concentrate particularly hard on another activity
- When your medication is not working well
What can I do about it?
Try to be aware of your posture in sitting, standing and walking.
Have a checklist for good posture:
- In sitting; Am I sitting at the back of the seat? Am I sitting centrally, not leaning over to one side?
- In standing: Use a visual target to help lift your gaze from the floor to aid good alignment, e.g. a clock on the wall. If you live with someone, ask them to regularly check your posture.
Top tip
Establish a prompt to revisit your checklist regularly, e.g. checking your posture each time the advertisements are shown on the television.
Top tip
If you use a walking aid, make sure to ask your Physiotherapist / Occupational Therapist whether it is the right height for you!
I feel like I am going to fall
When might this happen most?
- In crowded or cluttered places
- On uneven or unpredictable terrain
- When distracted
- If you reach too far or too quickly, e.g. for a door
- When you are wearing inappropriate footwear
What can I do about it?
If you feel you are going to fall, try to stop with your feet apart and stand tall. To avoid feeling unsteady, concentrate on making sure your heel hits the ground first, which will help your feet clear the floor. You could use stripes on the floor or paving stones to help your stepping.
When going round a corner or making a turn, take wide turns rather than sharp turns. Stand close to anything you want to reach for and avoid stretching too far.
Have a well-rehearsed strategy to help you get going when you stick and tend to fall. Identify areas where you often feel unsteady so you are more aware of where you are at risk.
Top tip
Your Physiotherapist or Occupational Therapist in hospital will assess whether a walking aid is appropriate and which would be most helpful for you. If you are at home and feel like you need more help, please contact your GP.
I feel stiffness in my body
Where might I feel most stiff? Why?
- The joints of your spine and shoulders are particularly prone to stiffness
- Your legs will feel stiff if you are less mobile
- You may have stiffness in your hands and arms if coordination is difficult
- When your medication is not working well, especially early in the morning
What can I do about it?
Moving well will allow you to be more active and will reduce your level of stiffness. Working on the quality of your walking and your posture will be beneficial. Regularly moving all the major joints in your body through their full range of movement will prevent stiffness.
Top tip
Using a rhythm or music will help you to make the movements bigger. Why not try a seated exercise program that emphasises movement? Ask your Physiotherapist or Occupational Therapist for exercises appropriate for you!
How can my loved ones and carers help me?
What can I do when the person I am caring for…?
- Walks slowly or with shuffling steps
Walk beside them at a steady pace and encourage them to match their footsteps to yours. Count in a steady rhythm to encourage regular longer steps. - Has difficulty with freezing when walking
Encourage the person to stand tall with feet wide. A steady count to sway to can help to unlock. Give them prior warning of something that can cause freezing e.g. leading up to a doorway. Use a strategy such as counting out loud to enable stepping to continue. - Has difficulty turning
Give as much room as possible, do not stand too close to someone. Ensure you turn together in an arc, not sharply. If possible, rearrange furniture to allow for this. - Gets stuck in the chair
Give short, clear commands for each stage of the movement. - Has a stooped posture
Give feedback about how straight they are sitting or standing
Provide a target ahead to focus on to encourage straightening. - Has a tendency to feel unsteady
Avoid distracting with too much talking whilst walking as they may need to concentrate on their steps. Encourage larger steps by example or by counting. Encourage them to walk tall rather than leaning on you.
Further information
Please feel free to discuss any of the above or ask any questions with the Physiotherapist and Occupational Therapist in the hospital. We are happy to help and want to encourage you to be as independent as possible!
It’s important that you don’t feel alone. There are lots of helpful websites, sources of information and support groups out there. Contact your GP or liaise with your Parkinson’s Specialist Nurse if you would like to be signposted.
Feedback
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