A hypothetical question about fall risk and Parkinsons
February 26, 2014 3:31 PM   Subscribe

Does activity level during the day elevate the risk of a fall later in the day for a Parkinsons patient?

Daisy has Parkinsons. She is described by her doctor as an extremely high risk for falls. She is old.

Her devoted caretaker John says that Parkinsons patients are prone to fall in the course of certain actions-- bending or reaching, for example. A friend of theirs-- Jenny-- started a fall log. It reflects what John said.

Jenny noticed something else about the falls. Four of the last five late in the day, on days that Daisy had done a lot of activities (visits to the doctor or the mall and/or in-house physical therapy).

Jenny thinks the pattern of activity + falls is something that John should discuss with Daisy's doctor. She was disappointed that the physical therapist was a bit combative about and dismissive of the pattern. John and the physical therapist told Jenny that the nature of action alone is causes the fall. (Jenny privately wonders whether the therapist explaining to Daisy to importance of being safe is enough at this point.)

But, for all Jenny knows, they are right. Jenny is no expert and she can't do anything about Daisy's situation anyway.

Jenny just wants to know what you all think about the question of falls and Parkinsons? Is the physical therapist right to dismiss this pattern? Is heightened fall risk just one of those things that comes with the territory of a progressive disease and not something you'd bring up with the doctor?

Daisy is very well cared for by many health professionals, and Jenny has a great relationship with Daisy and John and doesn't need help there. This question is about the fall angle only-- what the doctor would want to know, what John and the physical therapist are saying, and Jenny's view.
posted by vincele to Health & Fitness (7 answers total) 2 users marked this as a favorite
Couldn't a day out and about make Daisy tired and more likely to fall?
posted by thatone at 3:38 PM on February 26 [1 favorite]

Fatigue could definitely be a contributing factor to falls- folks I've worked with as a PT have reported that their balance can be worse at the end of the day. With Parkinsons I would also wonder about medication timing- if the meds are trending off at the end of the day it could make movement more difficult and increase fall risk. If the falls are happening more often it may be worth a visit to the doctor to help figure out what's going on.
posted by bookrach at 4:11 PM on February 26 [1 favorite]

I've had Parkinson's for 19 years, though it's been well controlled on Sinemet most of the time. In the last few years I've been dealing with what's called the "On/Off" phenomenon of Parkinson's: the levodopa works for a time and then rather suddenly drops off, leaving me very stiff, somewhat off balance, with increased tremor and kind of agitated. I take another pill and that usually perks me up, but not always - in the evenings, I don't "perk up" very well at all. It's the switch on and off, though, that's the real drag and it could most definitely affect this lady's balance/strength/coordination, making it riskier for her to bend over, etc.

I don't bend over unless there's absolutely no choice. I have a "grabber" and I use it. If the item is too big and heavy for the grabber, I can probably pick it up (the small stuff is the hardest) or I'll go find a neighbor or my son and ask him to pick it up for me. Usually it's no problem, though, because I don't let things get put on the floor that I can't get with my grabber.

One wonderful new thing has happened for me that might very well be the answer for this lady. My doctor started me on a patch called Neu-Pro in addition to my other Parkinson's meds. This patch is good for 24 hours and what it does is smooth the on-off edges so there's not so much swing between the good moments and the impossible ones. The patch comes in five or six different strengths and I'm on the lightest one and it's working beautifully. No more sluggish down time (it feels like you're walking in deep mud or against a strong wind) and not so much better-get-it-done-right-now-while-I-can time, either.

Falls are frightening as heck and she definitely should bring this up with her neurologist before she has a bad one.
posted by aryma at 4:25 PM on February 26 [7 favorites]

aryma, thanks especially to you for taking the time to answer. May I ask what brand of grabber you use?
posted by vincele at 4:41 PM on February 26

My Mother has Parkinson's. The disease can manifest in a wide range of ways, so each person's experiences can vary wildly.

I think there is great validity in maintaining a day book which records activities and issues. Over time patterns do appear which are very helpful. The medical professionals don't know everything and a day book can give them a nudge to research an unfamiliar aspect of a disease.

Heightened fall risk is definitely something valid to ask the Dr. about. The PT may not be the best person for the job...if the PT has had a bit of Parkinson's experience than s/he would be aware that this is not a one-size-fits-all situation.

Age is an issue too. Medications can affect the elderly in different ways than someone younger. An older individual often has age related issues (Sundowners for example) which makes it harder to figure things out.

Keep observing and don't be afraid to follow your instincts.
posted by cat_link at 7:30 PM on February 26 [2 favorites]

I agree the falls are likely related to medication wearing off and basic later-in-the day fatigue (but obviously that doesn't rule out being even more weary after an active day).

My dad takes Sinemet and what he describes is quite similar to what aryma says.

I wonder if the PT is dismissing the pattern for of fear of discouraging activity. I'd flat-out ask the PT if that's the reason for the pushback, and I'd also bring it up with the doctor.
posted by whoiam at 7:38 PM on February 26 [2 favorites]

I'm sorry, vincele, my grabber doesn't have a brand name on it, so I don't know. It has a long, straight metal tube (sort of a slot) with a piece of hard foam rubber at the far end and a big plastic "Cap'n Hook" type end that's what grabs things - that hook end makes contact with the rubber and that's what holds the item. It's put into grab mode by another plastic hook-shaped trigger type thing at the top by the handle. That trigger is attached to the big hook at the bottom by a white cord that runs the length of the thing inside the slot.

I imagine none of that makes any sense unless you're looking right at it. I'm sorry.

I want to make one more point that I should have thought of about falling and Parkinson's.

The normal body is made to move by a synchronized action between the legs and the arms - both move back and forth as a person strides along - while his body remains straight, head up. Parkinson's causes a dramatically different situation. P people don't swing their arms! Or possibly they'll slightly swing one arm, but the normal motion is gone and most of the time one arm just hangs there - or is held close to the body, elbow bent, to help control the tremor. Because the arm swing is gone, the feet don't step out there like they should - they tend to move in small, baby steps, sometimes hardly leaviing the floor - the Parkinson's Shuffle. Then, because the body wants to move on, the head reaches out like it's trying to pull the body forward, while the body trudges along in the mud and can't move as fast as the head wants to go. (I know this sounds ridiculous) What the person ends up doing is shuffling along, sliding his feet more than stepping with them, head out in front of his feet, arms dangling or hugging his body. And BTW, the effort to walk is exhausting; in fact, the effort to do anything involving movement is very tiring, since you're fighting what feels like something moving against you to make any progress at all.

This position is obviously off balance and nothing but a fall waiting to happen. It's usually the feet that get tangled up or caught on a small rug or something, or, probably even more common, it's the person trying for all they're worth to hurry up when they just simply can't.

All this is what the medication works on, so a person being treated appropriately med-wise usually has only a shadow of this trouble or deals with it in "on-off" periods. Unless, of course, the disease has progressed to the point where the meds just don't cut it anymore (remember the patch - I think that's going to help keep us moving a bit longer).

I don't know what the physical therapist has in his head, but honestly it doesn't seem like he's very aware of the different quirks of Parkinson's people and I'd seriously think about finding a therapist who specializes in "movement disorders." That's the term for an appropriate neurologist also - a specialist in movement disorders.

Good wishes to Daisy. Sorry to be so long-winded.
posted by aryma at 8:54 PM on February 26 [2 favorites]

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