I Love Neuro

202: How To Prevent Falls From Retropulsion in PD


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In this week's episode we address a listener's question about retropulsion in people with Parkinson's. In the show we define retropulsion then provide a plethora of ideas for you to try with your clients to help them restore their ability to move backwards without falling!

  • Sit to Stand (STS) and Standing Postural Issues:

    • Biggest issue: inadequate weight shift forward

    • Factors contributing: "off" medications, low medication with increased bradykinesia, dyskinesia "on" medication

    • Postural changes are a cornerstone of Parkinson's Disease (PD)

    • Perceptual and visual changes, smaller base of support can impact retropulsion

  • Medication Discussion:

    • Importance of discussing medications with neurologists

    • Hard to out-exercise being undermedicated

  • Treatment Ideas:

    • Weighted Vest:

      • Balance Based Torso Weighting

      • Exaggerate feeling by adding more weight behind or in front

    • Aerobic Exercise:

      • Intense, engaged, elevated heart rate

      • Preferable on treadmill, multi-directional movement

    • STS Treatment:

      • Provide a target in front

      • Encourage body awareness

      • Challenge on different surfaces to augment error

      • Use Blazepod for external cues and motivation

    • Resistance Band Exercises:

      • At the hips, pulling backward

      • Secure attachment, various directions

      • Include targets and external cues

      • Repetition, variety, dual tasks, eyes closed

    • Reactive Balance Training:

      • Backward steps in various positions

      • Posterior activation in quadruped, walking, tall kneeling, prone

    • Clock Yourself App:

      • Use front or back half of the clock for different movements

    • Compensatory Strategies:

      • Staggered stance, wider stance

  • Conclusion:

    • Encourage problem-solving and empowerment

    • Highlight the importance of repetition, variety, and external cues

Let us know if you have more questions by sending us a DM @neurocollaborative or posting inside the NeuroCollaborative Professionals Facebook group!

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I Love NeuroBy Erin Gallardo and Claire McLean

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