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Quedas na doença de parkinson

fall prevention

AParkinson's diseasecan lead tofallsat any time of the disease, depending on the aspect of the disease, the treatment given, age and associated comorbidities.

Motor symptoms are often the cause, but there are many factors that contribute to a patient's falls. Understanding all associated factors is the first step to avoid falling!

What Contributes to Falls in Parkinson's Disease?

Motor symptoms of Parkinson's disease
The motor symptoms, which are bradykinesia (slow movement), a rigidity and tremors, added to the change in posture, contribute tothe risk of falls.

The very stiffness and slowness of leg movements can lead to difficulty walking and difficulty maintaining balance and favoring falls. HThere is still stiffness of the trunk, which we call axial stiffness. 
Aaxial stiffness, leads to a decrease in the flexibility of movements related to posture, generating apostural instability (loss of balance),  increasing the chances that the person will fall.
Aposture change, often associated with axial stiffness, it leads to a shift in your body's center of gravity.
What does that mean? 
> Thegravity center  (or center of mass) represents the vertical point of balance of the body in relation to the surface.
Depending on the momentary posture (forwards, backwards or to the side), the body has to adapt to   return to balance, otherwise the person falls. 
 > Patients with Parkinson's and other similar diseases tend to have a "curved" body, in which they project their trunk forward (or often to the side), as if they were falling. In a spontaneous and unconscious attempt not to fall, the person tends to hurry the steps (running or increasing the number of steps), giving an appearance ofsmall step gait, also calledfestive march.As said, this is an attempt not to lose balance. However, due to the slowness and stiffness characteristic of the disease, this attempt can be frustrated, resulting in falls.

Sintomas de quedas e motores da dença de parkinsonelas
Non-motor symptoms of Parkinson's disease

In the patient with Parkinson's, there are symptoms not related to movements, which we callnon-motor symptoms.


All symptoms present and characteristic of Parkinson's disease that are not directly associated with voluntary movement.​arms, legs and trunk, we group them as 'non-motor symptoms'.

The non-motor symptoms involved with falls in Parkinson's are:

  • Orthostatic hypotension: which is an inadequate blood pressure response to a change in posture. That is, there is an exacerbated decrease in pressure when the patient stands up from a previous lying or sitting position. It can lead to symptoms of dizziness, visual dimming, palpitations  and falls. 

  • Fatigue: Feeling of tiredness, physical or mental exhaustion, can make it more difficult for the patient to walk or perform movements, leading to a greater risk of falls.

  • Alteration of cognitive function:They can occur mainly in patients with Parkinson's in more advanced stages. There isddifficulty in planning or executing tasks, leading to impaired ability to select, inhibit, organize and sequence information. This can lead to distraction, difficulty in recognizing dangers in the surrounding environment and limitation in natural reactions to a situation, leading to an increased risk of falls. there may still be, difficulty in performing simple actions that were previously done automatically, such as walking. The patient "unlearns" to walk, which we call gait apraxia.Usually present in much more advanced stages.

  • Anxiety: Mood disorders are common in Parkinson's Disease and can increase the risk of falls, as the patient becomes  nervous, anxious, or rushed when trying to make movements and realizing the difficulty._cc781905-5cde-3194 -bb3b-136bad5cf58d_

Sintomas não motores da dença de parkinson
How to prevent falls related to Parkinson's disease?

Since the greatest risk involves the characteristic symptoms of the disease itself, the most effective way to prevent falls is toeffectively treat Parkinson's Disease! 

This means that treatment should always be optimized and adjusted as new symptoms appear. Periodic medical follow-up is essential, so that the neurologist can try to identify any symptoms that are not yet noticeable to the patient or family members.

As Parkinson's Disease is a progressive disease (we've talked about this before), new symptoms are expected over time and symptoms almost always evolve subtly. 

In addition, we can decrease the chance of falls by performing:

  • Physiotherapy: That in the patient with Parkinson's it should be periodic and be started as early as possible (and not expect to have any difficulties). 

  • Physical activity: Regular aerobic activity, such as walking, cycling, for at least 40 minutes a day, for at least 3 times a week). It can be slow and must be supervised depending on the stage of the disease.

  • Other activities are also highly indicated, but should be added to physiotherapy and not substituted for it. Are they:Pilates, Yoga, Water aerobics, among many others.

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