Part 2: How to Trick the Disease by adapting your walker

Make a simple adaptation to your walker and walk better!

Welcome to Part 2 of my series on exercise and well-being strategies for Parkinson’s: How to Trick the Disease. This week I’ll be showing you how to make a simple adaptation to a walker to improve your gait. Before you attempt this, be sure to check with your doctor to make sure it’s an appropriate strategy for you.

Early on in my pursuit to find exercise strategies and methods to address the symptoms that can occur for people living with Parkinson’s disease, I discovered that by adding visual cues was an extremely effective way in getting my clients to move in larger, smoother and in more consistently coordinated movement patterns. I did some research and found out very quickly that there are numerous studies that validate the phenomena I noticed.

Research has shown that by intruding auditory and visual cues, larger amplitude of movement can be immediately achieved. From the International Encyclopedia of Rehabilitation:

“External visual and auditory rhythmic cues are important features in the treatment of PD, although not widely used in clinical practice. Studies have shown improvement in electromyographic and spatio-temporal parameters of gait in Parkinson’s patients undergoing gait training with auditory, visual and tactile cues.”

Fátima Rodrigues-de-Paula, PTPh.D.
Department of Physical Therapy, Universidade Federal de Minas Gerais

Many trainers and physical therapists that are acquainted with current Parkinson’s exercise strategies employ these techniques to make the sessions more effective. If you’re currently working with a physical therapist or a trainer who understands PD, you will have likely performed drills that include auditory and visual cues.

Working with individuals on a regular basis who use walkers and many of whom are fall risks, I’ve always searched for ways that safely and effectively improve movement, stride length and reduce freezing. Training to avoid falls is always first on the list when working with this population.

I discovered the technique I’m about to demonstrate over 10 years ago with my first Parkinson’s client, Joe. Joe had an atypical form of Parkinson’s called vascular Parkinson’s and he was an extremely tough customer. He also suffered from Lewy body disease and to top it off, was an extremely stubborn and head strong individual.

During our sessions together, we would spend quite a bit of time trying to get Joe to walk. Although it was extremely important for him, he hated doing it. Walking is a great way to get the entire skeletal and muscle system weight bearing and involved. Joe disliked doing it. For me, it was like trying to push a boulder up a hill.

Whether we were performing upper body, or lower body exercises, I soon discovered that by swinging a ball to Joe or giving him a target to reach for, the success we had at getting him to participate and getting him to move as instructed was greatly enhanced. It also added a component of fun or play to the session which engaged Joe and allowed me sneak in some meaningful exercises.

One day I decided to experiment with applying visual cues to his walker. I attached a piece of brightly colored exercise tubing to the back legs of the walker about shin high, and instructed Joe to attempt to touch the tubing with his shin as we walked. Joe’s gait changed immediately.

It eliminated nearly all of his freezing, increased his amplitude of stride and significantly increased the speed of his walk. Because his movement was so improved, Joe ran out of breath quickly so we’d rest a lot, but it was obvious that we were on to something important.

This experience with Joe was the inspiration for an accessory I’ve invented for a walker that is currently undergoing validation studies and design refinement. Although the accessory works better because it combines lighted visual cues and auditory cues, you will see that the simple application of tubing to the legs of the walker is extremely effective all by itself.
Here’s a short video demonstrating the accessory. This is a client of mine, Julie attempting to walk using her walker. Julie has significant gait deficits and has a problem with freezing.

Now, notice what happens when I put the accessory on the walker.

The difference is immediate and significant.
How to do it

Simply attaching a short length of elastic exercise tubing to the back legs of your walker may improve your ambulation in many ways.

Take a 3′-4’ length of tubing, tie a loop in each end, and slide it up each of the back legs of the walker so it rests about 10” above the ground and crosses perpendicular to your body. You’ll want it high enough so it doesn’t interfere with your feet and rests at a height a few inches below the knees, mid shin.

Once the tubing is attached and positioned, get ready to walk. You should have someone with you that is capable of steadying you if you lose your balance. Stand up straight, glance down at the tubing so that you have a visual target, then stride forward so that your lower leg pushes into the tubing.

The feeling of the shin pressing into the tubing may help you as well by providing tactile feedback. Continue striding forward, keeping close to the walker at a consistent distance.

With Parkinson’s, there can also be a tendency to let the walker get too far ahead. You may have seen an individual with PD following a walker which is way out in front of them. They walk following the walker, their body bent over at the waist and their arms stretching forward.

This is neither proper nor safe and can be an extremely dangerous positioning. I have found that for many of these individuals, the tubing also helps cue them to stay in the proper position behind the walker.

As with all strategies, individuals are either responders or non-responders, this technique may not be suitable for everyone. Before you attempt it, check with your medical team or physical therapist to make sure it’s appropriate for you.

Also, if you are a fall risk, you should not attempt this strategy without having your doctor, physical therapist or trainer present. You might find that reaching for the tubing will prompt you to walk with a quicker pace and larger stride than which you’re accustomed to.

Whether this strategy works for you or not, please send me an email or post a comment so that I can share your experience. I hope this video encourages you to become proactive in the management of your disease and gives you hope that there are things you can do to make your life better.

As I like to say, I’ve seen small changes make differences. This is one of the most pronounced validations of this statement that I’ve experienced.

Stay positive, keep moving, and I’ll see you at the gym!


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