Gait and Balance Webinar Notes (5-28-09)

Did anyone attend this webinar on gait and balance webinar on May 28, 2009 and take notes (especially during the Q&A and when some photos were shown) that you can share?  It was at 2am in the timezone where I was that day, so I was unable to call in.

Though CurePSP was the organizer of this webinar, it applied to all the disorders in our group.

Today, as a registered attendee of the webinar, I received a copy of the slides.  I don’t think these have been posted yet to the CurePSP website (

It seems from the slides that it was a very good webinar.  I’ve copied below the text from some of the slides shown during the webinar.

Here are some highlights from my perspective:

  • Assistive Device Golden Rule:  If you find yourself reaching out to touch walls, furniture, friends or care partners (or they are reaching to you) while walking–you are in need of an assistive device.
  • If falls continue no matter what we do, then safety gear may be the answer:  helmets; HipSaver®; chair or bed alarm; wheelchair; geriatric recliner chair.
  • How can PT and OT help?  Assess & treat functional mobility and ADL abilities.  Perform home safety assessments.  Develop new and safer ways to perform activities.  Train care-partners to safely assist.  Recommend appropriate adaptive equipment for the home.  Recommend appropriate mobility devices.




Gait & Balance Questions Answered
by Heather Cianci, PT, MS, GCS, Penn Neurological Institute
5-28-09 CurePSP Webinar

Causes of Gait Changes & Falls
..Rigid/Stiff Muscles and Joints
..Shuffling steps
..Narrow base of support (feet too close)
..Slowed or absent balance reactions
..Slowness of Movement
..Visual Changes
–Difficulty with scanning your surroundings
–Double vision
..Loss of Coordination
..Blurred vision
..Orthostatic hypotension –sudden blood pressure drop
..“Alien limb”
..Myoclonus–quick, jerky movements
..Sensation changes
..Impaired safety judgment

Common Places Falls Occur
..On Stairs or Curbs
..While Reaching
–In & out of bed
–In & out of the shower/bath tub
–In & out of the car
–Up & down from a chair or the toilet

Tips for Walking Safely
..Slow down & concentrate
–You must now “tell”your body what to do
–If you are unable to do this, it is important to have a care partner remind you
..To avoid shuffling
–Focus on landing with the heel hitting down first, not the toes
..Do one thing at a time
–Do not reach for the refrigerator door while walking toward it
..Keep your hands free
..Be aware of changes in the floor surface
–Tilt your head down to look at the floor
–Stop before the surface change and step over the threshold

Assistive Device Golden Rule
If you find yourself reaching out to touch walls, furniture, friends or care partners (or they are reaching to you) while walking–you are in need of an assistive device.

Getting Out of Bed
..Bend up knees
..Roll completely on your side
..Grab rail
..Allow your legs to drop off of the side of the bed…
..While you push yourself up sideways into sitting
..If help is needed, care partner can lift under shoulder & push down at outer thigh

Getting In & Out of the Car
To Safely Transfer
–Slide seat back
–Back into car & then slide legs in, reverse to get out
–Plastic bag on seat can make moving on fabric seats easier
–Place cushion on low seats to help with standing

Handy Bar (for gettign in and out of the car)
Allows for a safe place to hold, 888-738-0611

Sit to Stand Transfer
..Scoot to front of chair
..Open legs wide
..Pull feet back under the knees
..Lean forward –“Nose over Toes”
..Push forward until butt lifts off of chair
..Then push up to stand

Protection Products/Devices
If falls continue no matter what we do, then safety gear may be the answer…
• Consumer Safety Product Commission brochure)
•Local sporting goods store
HipSaver®(shorts with hip and tailbone pads)
• or 800-225-2610
Chair or Bed Alarm
•Posey Sitter II®Alarm Unit
•www.posey.comor 800-447-6739
•Features different alarms or voice recording when person moves from chair or bed
Wheelchair or Geriatric Recliner Chair
•Contact local PT/OT or Rehabilitation Center to find a “Seating Clinic”or Wheelchair specialist

Rehabilitation Strategies
Current Research is Supporting
..Balance exercises
..Balance exercises along with eye movement training
..Treadmill and weight-supported treadmill training
..Group exercise programs
Exercise needs to be ongoing throughout the course of the disease. Delays in the need for wheelchairs, less falls, improvements in gait & balance, and reduced gait changes are possible.

How Can I Get More Help with Finding Assistive Devices?
RESNA (Rehabilitation Engineering & Assistive Technology Society of North America)
..“Statewide AT Program”
..“State AT Program”or “Device Loan”
NATTAP (National Assistive Technology Technical Assistance Partnership)
..Locate programs available in each state

How Can I Find Someone to do Home Modifications?
Certified Aging-In-Place Specialist (CAPS)
..Certified specialist through The National Association of Home Builders
..Remodelers, Contractors, Interior Designers, Therapists
–Resources –Online Directories –Find a CAPS

How Can PT and OT Help?
..Assess & treat functional mobility & ADL abilities
..Perform home safety assessments
..Develop new & safer ways to perform activities
..Train care-partners to safely assist
..Recommend appropriate adaptive equipment for the home
..Recommend appropriate mobility devices

Locating a PT or OT
..American PT Association
–“Find a Certified Specialist (Neurologic or Geriatric)”
..American OT Association
–“Find a Clinician”
..Call Local Outpatient Rehab Centers
–Generally those associated with Hospitals (Regular & Rehabilitation), & non-sports oriented centers
–Ask if they have therapists who have worked with PSP or those who deal with neurological & balance problems
..We Move
–“Find a Doctor”–Physical Medicine & Rehab
..National Parkinson Foundation
–Allied Team Training (ATTP)
–List of Graduates