park in sons affects gait balance
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How Does Parkinsons Affect
Gait and Balance
By Ann Zylstra PT
11-18-06
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Why does someone with Parkinson's get
referred to PT?
#1 referral: Gait and Balance
Walking Not falling
(difficulty walking) (imbalance / potential to fall)
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DifficultyWalking
How would you
describe this
difficulty walking?
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DifficultyWalking
Slow
Small steps
Shuffling
Freezing: Sticky feet (cant start)
Cant stop (Scurry and splat)
Cant turn
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DifficultyWalking
Why?
What is happening that is changing the way a
person walks?
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DifficultyWalking
POSTURE!
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Normal Walking Posture
Head over shoulders (over
hips over feet)
Hips are extended (notbent)
Knees are fairly straight
Normal stride is 2.0-2.5 ft
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Parkinsons Posture
Original sketch for James Parkinsonthe Shaking palsy
1817
Google Parkinson's posture2006
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Parkinsons posture
Head forward
Hips and knees bent
Walking on the front of feet
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WHY?(does Posture change with Parkinsons)
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Rigidity
What is Rigidity?
Stiffness
Inability to relax muscles
Coordinated movement requires firing and non
firing of a muscle
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The human anatomy
Symmetric side to side
Asymmetric front to back
Designed to climb vines
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The human anatomy
Designed to climb vines
Front of shoulder
muscles bigger than
back of shouldermuscles
Inside of thigh bigger
mm than outside ofthigh
Back of legs bigger mm
then anterior of leg
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The human anatomy
Bigger muscles win over time
Shoulders rotate in
Trunk flexes forward
Weight goes forward on the front of
feet
Tight hip adductors/ weak hip
abductors
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How does this posture effect walking?
Forward weight shift causes firing of themuscles of the feet and ankles This decreases the ability to clear the foot and reduces the
step length
Hips and knees are bent
This increases the amount of energy needed to moveChin comes forward to achieve horizontal
gaze
Stance narrows (scissoring & cross over)
Tight shoulder muscles reduces ability to swing arms
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Loss of balance
Center of gravity (COG) isoutside the base of support
(BOS)
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Base of Support
Normal gait BOS Parkinson's gait BOS Forward posture BOS
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How does Parkinson's affect balance?
Smaller BOS (shorter steps/ narrower stance)COG forward (posture brings the weight forward)
So by the definition of balance weight outside of base= fall risk
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With Parkinsons disease the Center of Mass is
in front of the base
Bigger BOS; Center of massBigger BOS; Center of mass
is central overBOSis central over
BOS
Smaller BOS; COG forward of base
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How to improve Gait and balance?
Stretch the big muscles
Calf stretch
Hamstring stretch
Chest stretch Hip stretches
Stretches should be done
slowly (20-30 second hold)
and repeated 2-3 times(1 minute per muscle)
Stretches should be done
daily
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How to improve Gait and balance?
Strengthen the little muscles Focus on the smaller muscles
Muscles of the posterior shoulder
Muscles outside the hips
Muscles of the back and between the shoulder
blades
Focus on endurance
Increased repetitions / lower weights
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How to improve Gait and balance?
Increase the BOS Bigger steps/ Wider steps
Keep a wider base (feet 10 inches apart even
with turns)
Turn in a U if possible
Use of Assistive walking aids
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How to improve Gait and balance?
Look forward not down
Lift your toes taking longer steps
Try strategies to decrease freezing
Remember going faster does not = safer
Slow builds control
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Questions?