Who Benefits from Balance Matters® and Step & Connect Services

People with Parkinson's Disease

How We Improve Balance for People with Parkinson's Disease


  • Educate:  There are typical changes to walking and balance when you have Parkinson’s disease.  We will educate you on what you can expect and provide you with the strategies to improve your gait and balance. 
  • Involve:  We will show how to engage all your senses to learn how to take bigger and faster steps to improve your mobility.  By retraining the appropriate components of your balance systems and using the strategies we teach you, your gait can be optimal for you.
  • Empower: Knowledge empowers you. Understand your balance and the rationale for your individualized exercise prescription to start making changes today!

Gait abnormalities, postural instability, and bradykinesia can lead to falls and decreased quality of life for individuals with Parkinson’s disease (PD)1-4.  Difficulty with ambulation is a clinical ‘‘red flag’’ that is an early indicator of emerging disability5.

  • 68% of people with PD sustain at least 1 fall per year which is 2x more than the fall rate in healthy older adults.
  • 50.5% of fallers with PD report recurrent falls (at least 2) over a 1-year period6-7.

Typical Gait Changes in People with Parkinson’s Disease

  • Temporal Parameters
    • Gait speed and symmetry are reduced by the impairments of longer double limb support time8-10 and poor interlimb timing (one leg moves faster than the other leg during swing phase of gait)
  • Spatial parameters
    • Decreased step and stride length
    • Decreased foot clearance during swing
    • Narrower base of support (BOS)12-15 
    • Decreased arm swing
    • Decreased maximal hip extension in terminal stance16 reduces force generation by the gastrocnemius in pre-swing¹⁷ which negatively affects gait speed
  • Gait variability
    • Common in people with PD and is evident by variability in stride time, step length asymmetry, and interlimb coordination18-21.
    • Closely associated with risk of falls in the elderly, particularly in step length and double-support phase22,23.
    • Supported by a meta-analysis by Königa which determined 2.4% of stride time variability distinguishes healthy walking from pathological walking23-24.
  • People with PD are unstable with 90° turns when asked to walk and turn faster than their preferred speed 11.

Typical Balance Changes

  • Reactions are slower. If a foot catches or an individual is bumped, equilibrium strategies are slower.
  • Anticipatory postural adjustments (APAs) that precede and stabilize balance are also hypometric (reduced amplitude) and bradykinetic (delayed onset timing)25. In preparation for stepping, people with PD have:
    • Smaller than normal APAs with insufficient adjustments in the mediolateral direction
    • Longer duration of unloading phase 26
    • Inability to modify the amplitude of APAs when required with wider stance stepping 25-27.
  • Sensory problems negatively impact motor function 28-32.
  • Excessive reliance on vision for postural orientation and walking 30,33.
  • Inability to rapidly change sensory weighting for different balance situations (e.g. switching sensory processing of information from vision to the vestibular when standing on moving or tilted surfaces in poorly lit areas 34.  Re-weighting (the ability to rapidly choose the correct sensory input to determine balance reactions) and sensory processing are both critical for balance.
  • Impaired proprioception results in additional problems with sensory orientation which is required for balance.  Proprioception provides limb and body position information, which is basic information necessary for the kinesthetic body mapping and is essentials to executing accurate movement 31,35.

Good News!

  • Meta-analyses show that Physical Therapy is effective in decreasing fall risk and improving gait and balance 37-46,14
  • Several recent programs such as  Parkinson’s disease Boot Camp44 have focused on restoration with encouraging results.  Therapists improved neuroplasticity using challenging tasks, attentional strategies, increased intensity of practice, and augmented feedback to enhance learning.   
  • Due to the progressive neural degeneration of PD, several researchers 37, 39 emphasize the need for long-term treatment programs in PD patients.
  • The recent shift in rehabilitative training to focus on enhancing sensorial input is promising. Programs such as PD SAFEx™ (a sensory and attention focused rehabilitation program) and Blindfolded Balance Training in Patients with Parkinson's Disease emphasize sensory training and both report positive results in both motor deficits and balance control 47-48.

Reduce the Risk of Falling


  1. Improve the safety of your home and environment (see resources).
  2. Have your vision and medications checked.
  3. Have your balance and gait assessed by a specialized balance expert. 
  4. Educate yourself on balance (Learn How You Balance) and how it affects everyday activities.
  5. Learn tips to overcome freezing.
  6. Exercise! Stay active! Understand which specific exercises are best for you!

Step and Connect wants to be a resource for medical professionals and clients offering the most updated education, appropriate programs in your community, and balance specialists that can optimally decrease fall risk and improve people’s balance.  We developed Balance Matters® as an additional tool to help clinicians and clients to improve their balance programs in the clinic or home.

Balance Matters® was designed to offer a wide variety of training options.  It allows specific sensory training of one or more impaired systems, encourages anticipatory postural adjustments, improves gait mechanics, improves spatial and temporal parameters, enhances kinesthetic awareness, varies equilibrium retraining, and offers cognitive reconditioning.  It is easy to set up in the clinic and or home environment. Clients can obtain their Balance Matters® system to replicate the multisensory, real-time feedback that skilled health care professionals provide in the clinic.  This will facilitate progress achieved while actively receiving therapy and also preserve progress after therapy has been completed.

Resources

Balance, Gait and Freezing Worksheet

Davis Phinney Foundation

Parkinson’s Association of the Rockies

Michael J. Fox Foundation for Parkinson's Research

American Parkinson’s Association

National Parkinson’s Association

Parkinson's Creative Collective