How can I help my dad correct his bad Parkinson's posture to avoid falling over?

A fellow caregiver asked...

My father, who has Parkinson's disease, has a hunched posture, and he's been falling down when he tries to turn. My mother and I constantly remind him to stand up straight and to avoid falling by turning more slowly, but he doesn't listen. How do we get him to fix these bad habits and correct his bad Parkinson's posture?

Expert Answer

Joseph H. Friedman is director of the Parkinson's Disease and Movement Disorders Center at NeuroHealth in Warwick, Rhode Island. He wrote Making the Connection between Brain and Behavior: Coping with Parkinson's Disease .

Parkinson's disease patients lose the "automatic pilot" programs in the brain that normally let you do many complex tasks without thinking about them. Spouses and family often try to help by telling a patient to straighten up or to make sure to swing both arms when he walks. But the patient can only do those things while he thinks about it, and no one can think about posture all day. So telling your dad to stand up straight doesn't help. It's nagging.

In general, nagging doesn't accomplish anything, and often I find that both the family and the patient feel relieved when the nagging stops. Most people don't like to nag; they feel they must do it because it's part of their job as a caregiver. The only thing you should nag your dad about is staying physically active and getting exercise -- that, I think, is a good thing.

Now, falling is a very difficult problem. It's terribly frustrating, and I don't have a perfect solution for it. But not long ago I had an epiphany: If a patient hasn't learned from falling down to take precautions, is it even possible to teach him to be more careful? Normally, how can a person not learn from falling down? If a fall doesn't teach your father that falling is dangerous, nagging him is not going to do anything. You can't keep him from turning. But at the very least, I'd recommend that your father see a physical therapist, if he hasn't done so already. The therapist will show him how to use a safety device such as a cane or walker and encourage him to do so. She can also prescribe exercises to improve balance. Exercise is generally the most important aid for someone with Parkinson's, but it has to be done safely: Activities such as tai chi may be helpful, for example.