Parkinson's disease. Strategies for everyday living
Avoid falls. Remove any obstacles
Remove any obstacles! Clear any obvious obstacles such as loose carpets. One study showed that this simple measure alone could prevent two thirds of all falls. Nevertheless if you want to keep carpets, pay attention to at least two things: Lay a special underlay under the carpet or fix it with a tack strip, so that it can't slip. And stick the corners down with a tack strip or an adhesive strip in such a way that you can't get caught on it. You can find the necessary materials in any hardware store. If possible avoid using carpets you "sink" into (such as Persian carpets or similar). The less height the carpet has the less the danger of tripping. The right shoes. It is best to wear shoes with smooth leather soles (no rubber and with little profile). This reduces the danger of getting caught on objects. At home wear shoes which fit firmly or at least well-fitting slippers with heel straps. Soft slippers without heel straps means more work for your brain because you have to keep on making sure they stay on your feet. At the same time it is good to keep checking that you can lift your feet high enough off the ground and keep your balance at the right time.
Avoid falls. Do not try and do everything at once
Think about whether you stumble or fall more often when you are talking to somebody else as you walk along or get distracted in other ways (e.g. because the phone rings and you want to quickly get there, or because the radio or television presenter is talking or because you are carrying something at the same time). Should you observe this commonly occurring phenomenon in relation to yourself, avoid such situations:
- Avoid talking while you are walking, explain to the person you are talking with why you would rather not do this.
- If the phone rings, take a deep breath first and then walk slowly over to it and concentrate as you go.
- Buy a trolley instead of always having to carry your full dinner service from the kitchen into the living room.
Avoid falls. Improve lighting conditions.
Improving lighting conditions. The darker it is or the more light blinds you the more you have to concentrate on where you are walking. This means you have less concentration remaining for the act of walking itself and have to make a lot of effort. Therefore check the lighting conditions in your home. Ensure that the places where you have to walk are lit well enough and that the light isn't too bright for you.
Avoid falls. Start a fall diary.
If you have started falling more often, start keeping a diary: Write down when and where it happened and why you fell.
Avoid falls. Go to physiotherapy and ergotherapy
If you have fallen more than two to three times in the last year, let your doctor prescribe something for you.
- The physiotherapist will analyse what exactly your difficulties with falling are in terms of muscle strength, posture or balance. The physiotherapist will show you exercises to improve these functions. Studies have already successfully investigated special weight and balance training in which the therapist keeps repositioning you while you make the greatest possible lunging actions (of course so that you can still just about keep a hold or can be held onto).
- The ergotherapist will ask you more precisely about the situations where you fall (e.g. using a "Fall Diary'). From this the ergotherapist can work out suggestions for the behaviour patterns or external factors you could change to minimise the risk of falling. Where did you fall?
How to avoid or overcome problems with walking ("freezing")
The typical Parkinson's gait disorder, "freezing" (scurrying all at once then being glued to the spot) is particularly common in the following situations:
- In narrow places, e.g. when having to get to a seat on a bus, in the theatre or cinema,
- At doors or in a lift or in front of it;
- In unfamiliar places and in crowded places (e.g. the underground);
- If the flooring suddenly changes e.g. walking from cobblestones onto a tarred road.
If "freezing" does not respond to dopamine substitutes, training with a physiotherapist for other strategies is an option in order to overcome the situations where freezing occurs or &- best of all &- not allow it to happen at all. Using a laser pointer project a point onto the ground in front of you and step towards this point.:
- Use the pattern of the pavement or the flooring for step direction;
- Walk to the rhythm of some music,
- Give yourself instructions either verbally or in thought or let another person give them (e.g. say "let's go", one, two, three &...; imagine there is a shoe box in front of you which you have to climb over) etc.
In addition you can use the following ruses
- At doorways never stand still but walk on the spot until the door opens.
- Watch other people start walking and imitate them.
- Instead of immediately setting off, shift your weight onto one leg so that the other leg is free making it easier to set off.
- If you go around corners don't think about an abrupt change of direction ("corner"), but imagine going around a curve. This curve should be a wide as possible.
- To turn around on the spot try using the 'clock strategy':
- Imagine you are standing on number 12 of an analogue clock. Take your next steps &- for turning around &- onto other numbers of the clock face for example the next step onto number two, the following to four and the third to six.
- At home 'freezing' danger spots can be prevent by putting adhesive strips on the floor you can use to direct where you walk. Also if possible you should clear objects out of the way which could increase the danger of injury from falling or pad them out, e.g. chairs or a washbasin the corners of which could cause a head injury. Also if possible you should clear objects out of the way which could increase the danger of injury from falling or pad them out, e.g. chairs or a washbasin the corners of which could cause a head injury.
How and why you should avoid dual tasking.
Studies have shown that with Parkinson's, walking speed drops if you try to do something else at the same time for example carry something or you are thinking about other things. Doing two things at once ("dual tasking") also increases the danger of falling! You can derive a basic principle for your everyday life from this: Try and do everything in succession. Concentrate fully and completely on what you are doing at the time. Here are some examples where you can put this into practice in your everyday routine:
- If you are sometimes distracted because you are thinking about what you have to do later, make a habit of jotting it down straight away. Then you don't forget what you were thinking about but also don't get distracted from what you are doing at the time.
- Avoid carrying things in your hands. If possible use a rucksack or a shoulder bag.
- When hoovering either move yourself OR the hoover. OR stand firm and likewise the hoover and concentrate completely and utterly on the suction action. Only use hoovers which are easy to pull along. For smaller areas you can also work with a small hand-held hoover.
What you can do about swallowing problems
- Check your weight and liquid intake on a regular basis in order to prevent deficiencies;
- adjust food (consistency, number of meals, calorie intake) to the individual circumstances and how you are feeling on the day;
- pay attention to the instructions for swallowing saliva normally when taking medication and eating meals;
- pay attention to having a clear voice;
- if you choke make sure you cough up well. Health is more important than "etiquette"
How to deal with sleep disorders
If you are having trouble sleeping well, you should discuss this in any case with your doctor to see what can be done about it.
If you have problems staying asleep because of difficulties moving during the night (so that you wake up because you are no longer able to automatically turn over), try the following coping strategies:
- Use lightweight bedspreads/duvets that can easily be straightened and bed clothes made from silk or satin (glide more easily);
- Also wear pyjamas or nighties made from silk or satin,
- Put a cardboard box or thin wooden board at the end of the bed. Spread your sheets over this and cover the end of the bed with the bedspread/duvet. This slightly raises the height of the bedspread/duvet making it easier for you to turn over because you don't have to turn the whole bed bedspread/duvet as well;
- Put a rope, latticed rope or a bed gallow that you can clasp hold of at the top of the bed, at the side or across the bed,
- Have a small light on during the night if it doesn't disturb anyone. In this way you can make use of visual references for turning over (you see the direction you have to turn towards)