park in sons affects gait balance

8/9/2019 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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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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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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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?

park in sons affects gait balance

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