Managing Postural Instability in Parkinson's Disease

In this week’s episode we address a listener’s question about retropulsion in people with Parkinson’s. In the show we define retropulsion then provide a plethora of ideas for you to try with your clients to help them restore their ability to move backwards without falling!

• Sit to Stand (STS) and Standing Postural Issues:

• Biggest issue: inadequate weight shift forward

• Factors contributing: “off” medications, low medication with increased bradykinesia, dyskinesia “on” medication

• Postural changes are a cornerstone of Parkinson’s Disease (PD)

• Perceptual and visual changes, smaller base of support can impact retropulsion

• Medication Discussion:

• Importance of discussing medications with neurologists

• Hard to out-exercise being undermedicated

• Treatment Ideas:

• Weighted Vest:

• Balance Based Torso Weighting

• Exaggerate feeling by adding more weight behind or in front

• Aerobic Exercise:

• Intense, engaged, elevated heart rate

• Preferable on treadmill, multi-directional movement

• STS Treatment:

• Provide a target in front

• Encourage body awareness

• Challenge on different surfaces to augment error

• Use Blazepod for external cues and motivation

• Resistance Band Exercises:

• At the hips, pulling backward

• Secure attachment, various directions

• Include targets and external cues

• Repetition, variety, dual tasks, eyes closed

• Reactive Balance Training:

• Backward steps in various positions

• Posterior activation in quadruped, walking, tall kneeling, prone

• Clock Yourself App:

• Use front or back half of the clock for different movements

• Compensatory Strategies:

• Staggered stance, wider stance

• Conclusion:

• Encourage problem-solving and empowerment

• Highlight the importance of repetition, variety, and external cues

Let us know if you have more questions by sending us a DM @neurocollaborative or posting inside the NeuroCollaborative Professionals Facebook group!