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Topic freezing on the stairs Go to previous topic Go to next topic Go to higher level

By Mary556 On 2013.08.28 22:28
I'm wanting to understand more about the PD symptom of "freezing".
A few weeks ago my PWP Mom froze on the stairs. (We have a 1/2 flight of five steps going from our kitchen to the main level of the house. I stand behind my mother to "spot" her since she started to be more wobbly.)

During the particular episode, Mom got half-way up the stairs and then just stopped. I asked if she was OK and she did not respond. Her pause seemed to last a minute or two. I did not know how to assist her or get her back onto solid ground. I am not strong enough to bear my mother's full weight.

Questions:
- Is freezing more-or-less a fluke that rarely happens, or is it very common for some people?
- When a PWP freezes do they usually come out of it within a short time? (Should I just be patient and wait it out?)
- When my PWP's steps are frozen, is there any chance that her legs will buckle under her?
- What could I do to help in a situation like that?

A few times in the last month or two my mother has lost her balance and fallen backwards (not on the stairs, fortunately... it has always been a soft landing back into her easy chair).
I'm just beginning to read a book written by a physical therapist who specializes in PD. She mentions a "gait belt" and I'm wondering if we should get that.

I just want to be more prepared if there is a next time.
Thanks for any advice /suggestion that anyone may be able to offer.

By jcoff012 On 2013.08.28 22:40
i cannot speak through my experiences with my husband, but observations and comments made at the assisted living where I worked...and experiences with my MIL..First, we were told to not touch the two people with PD at the AL...they would move when ready, just make sure they appear ok, keep an eye out, but not to try to MAKE them move. Next, my MIL froze quiet often, sometimes she realized it, sometimes she was noncommunicative. We let her alone and eventually she would start up again. My FIL used to walk in front of her on the stairs...in fact, he would walk backwards...

I hope others respond with better information.

Not a fan of gait belts, but that is strictly a personal thing...I never used "leashes" on my kids, either. However, if you are a slight woman, I can honestly see how a gait belt would be of great help in helping your Mom go from one place to another...it gives you great control over the situation and leverage when you need it...just not for me...that may change if and when it is needed. Hugs, good questions. Jane

By Mary556 On 2013.08.29 12:53
Thanks much for responding, Jane. Your experience and insights are very helpful to me.

By dans316 On 2013.08.29 14:41
Mary,
My wife's first episode of freezing caught me unaware. She had fallen and broken her hip about 3 months before, so I thought maybe the hip was the problem, never realized at the time it might be Parkinsons. In the next few months, she had several more episodes so we finally got her a Rollator Chair that could be used as a walker or wheel chair. When she had freezing episodes, I would get her into the seat and usually after a few minutes she was ok.

I never did know what caused the episodes, but sometimes it seemed to be a problem if the room was dark, or if the floor surface changed as in tile to rug.

Doorways could also be a problem and even now she hesitates when going through a doorway using the walker.

One thing I've seen recommended is when an episode occurs, just stop and then shift your weight from one foot to the other. It takes some practice and you should shift the weight to one foot and raise the other foot off the ground. Also always do it the same way as in shift the weight to the left foot while raising the right foot off the ground. Sadly I could never get June to do this, she said it was easier to just sit down and she would be alright:)
The few times that she does use stairs I always help her by lifting on one side while she holds onto the railing on the other.
Dan

By VioletV On 2013.08.29 15:46
We've started using a gait belt for the times when my husband is "off." His balance is (IMHO) better than he thinks it is -- especially since he started with LSVT-Big exercises. But when he feels shaky there's no question that wearing the gait belt gives him added confidence that we can safely get him to the floor without injuring either of us. I like the fact that I can be confident that I can keep him safe without risking my own back.

Editing to add--we have never had to actually GO to the floor. He hasn't fallen in 4 years (knocking wood, spitting three times) but he still worries, and walks much more confidently when he knows I have the belt, just in case.

By jcoff012 On 2013.08.29 15:54
Violet, we have the chance to be in a BIG class...does it stay with your husband long after the classes?

By VioletV On 2013.08.29 16:06
About LSVT Big

To really benefit long-term from LSVT-Big, I think the person has to treat the exercises as a way of life. They don't take long (10 or 15 minutes once he/she has learned them).

After 3 or so months my husband is more flexible, has better range of motion and better balance. He hasn't carried over the tasks as much as I envisioned, but I definitely think it has, overall, improved his quality of life and his safety. He gets into and out of the car more easily, can move his arms under the blankets whereas before he was completely still once he settled in to bed. His posture has definitely improved, and he only has that hanging-head PWP look at the very end of the day when he's quite tired. We have better skills for getting him up from chairs. He now climbs stairs in one "go" rather than painstakingly taking each step as a single task. It used to take several minutes for him to get upstairs when he was "off" at the end of the day. (Ask me what we were thinking when, less than 2 years ago, we bought a house with TWO sets of stairs and 3 stories!) Now he stands at the foot of the stairs, I remind him (tho he tells me I don't need to) to plan to go to the top and to continue in a steady, but not rapid, pace. Instead of tottering with tiny shuffling steps, a single reminder to "walk big" gets him taking more rhythmic normal-seeming steps, so that it takes much less time to move across the floor, and (to my eyes) less effort.

It's important to note that in my experience, the caregiver is being trained to give the cues as much as the PWP is in knowing how to respond to cues for "amplitude" "big steps" "reach big" in different situations.

We were lucky-- the OT came to our house 4 times a week for 4 weeks so that we had one on one with her. Now getting monthly (self-paid, Medicare only goes so far) boosters, in part just because my husband really likes the OT (after firing her PT partner--a long story).

I'd also say that earlier in the course of PD would give bigger gains.

So, in a word--yes!

By jcoff012 On 2013.08.29 16:16
Thank you for responding...you quickly answered our question...we wanted to know if *I* needed to go to classes, too...thank you for the insights..why this board is invaluable..

Like I said in another post, we all need the constant validation of what works and what doesn't work...and this board does an excellent job of that...answers from those who face PD challenges everyday, especially problems not found any other way. Again, thank you. Jane

By LOHENGR1N On 2013.08.29 16:20
Mary, Dan's observation about doorways and changes in the flooring is right. To break a freeze shifting weight from one foot to the other while lifting the foot a bit is good too. Also they suggest trying to "march in place" Sometimes a gentle touch or a voice will break the freeze. They train Walker/Balance dogs like my dog Tess to step on top of our foot when we stop walking to break the freeze if we're having one. They sell canes with those laser pointers to shine down in front of Us so if we freeze we can "step" on the dot. Outside stimulation will break the freeze most times. Freezing is quite common in many with Parkinson's Disease. Some people put down a ruler to be stepped over to break the freeze others pick a line on the floor, something to concentrate on maneuvering on or over. On the stairs if going up I'd try a hand on the shoulder or elbow and "Okay Mom, lift your foot and move it forward" kind of prompting. Going down you've got to really be careful! I wouldn't recommend waiting it out if someone is frozen on the stairs as it is inviting more to go wrong the longer they are there.

Freezing is a strange thing, As Dan said, doorways, darker hallways and floor changes can bring on freezes. Stairs, sidewalks and curbs, many things. What I think is happening is our environment changes, We know our nervous system and muscle control is effected. It is harder for us to multi task or do two things at once, Our autonomic nervous system is effected (it is in charge of running the systems we just take for granted like heart rate, breathing etc, etc.) When we learn to walk we learn if coming to a curb or stair we have to lift our foot up while going forward, it becomes automatic. With Parkinson's we sense the change we know the foot goes up but it isn't always automatic now. The doorway closes in on our sides, we sense it but hesitate and now we freeze. The automatic everything's fine step forward doesn't work. We have to take our time and sometimes be reminded to lift your foot or step up now at the curb or stair or we fall because it didn't automatically do it. In some respects it's like a toddler learning to walk and having to be reminded to step up, lift your foot. Not because we forgot but because the system is faulty and doesn't work right any more. Kind of like the side to side shifting of weight We get into a rhythm and our brain says oh I got it hey look a stair or a doorway step through it!. But We freeze, it is our body refusing to move because it doesn't know what to do. Many time we stumble or trip over something because our foot didn't move high enough or not at all, we know we have to step up or over but the message doesn't go to our foot in time or not at all. We can lay there and answer the what happened? With an I don't know and really many don't know. Hope this helps you out with your Mom and with the what's going on and why. Take care, best of luck and hang in there

By daisy On 2013.08.29 17:06
Just wondering if anyone else has come across this. When off, my DH has to be wheeled to the top of the stairs, can manage the stairs well enough (both up and down) but then needs the wheelchair again at the bottom. He cannot move at all on the level, but can go up and down quite easily. Someone told me that it's a different brain process, but it does seem bizarre. Has been this way for several years.

By Mary556 On 2013.08.30 09:56
Thank you, everyone. You all are most helpful.
Yes, to navigate those five stairs my Mom has to go through two doorways, from smooth floor to rug, from bright light in the kitchen to dim light in a hallway. Now that I understand the triggers, we will turn on every overhead light in that area. If she ever freezes on those steps again, I will shine a spot in front of her foot with my pocket flashlight and ask her to step on it. We will keep a gait belt and white ruler within reach on a little landing there; I'm not sure how Mom would feel about wearing the belt more often, but we will cross that bridge later.

It is good to feel more prepared. Thank you so much for your help!
I'm hoping to have a home care physical therapist visit so that we can learn safest ways for my mother to move around her own environment and best ways for us to assist her.

Earlier this year a PT taught my Mom how to go up stairs tapping her first foot on each riser (a la Shirley Temple and Mr Bojangles), then bringing her second foot up to the same level. The last week or two her feet seem confused, moving the wrong way and then starting over. I've been giving her more prompts, hoping I am not getting on her nerves. Thank you, Lohengr1n for explaining that process. When automatic movements that most of us take for granted are not automatic anymore, it must be hard work to get through a day. I am in awe of my Mom's determination and all PwP's. God bless you.

By dans316 On 2013.08.30 10:21
Mary,
Just curious do the stairs she use have railings and is it wide enough for you to walk beside her? June goes to her hairdresser every week and she has 4 steps to go up and down. The steps are wide enough that I can hold her arm while she holds the railing with the other. She also cannot walk on level ground, but so far has not had a problem with steps.

By parkinit On 2013.08.30 10:33
Physical cues do help. My husband often goes into festination before he may freeze. If I can catch it in time, I jump in front of him, grab both his hands and say "let's dance!" I sway back and forth shifting from one foot to another until he matches my movement and then we can take small steps. Me walking backwards facing him. I think this and verbal cuing such as "step on the circle on that tile," help immensely to work out of a freeze when in the middle of walking or taking stairs as in your case.

The laser lights in walkers and canes just irritated my husband. Lol

By phoenix On 2013.08.30 22:54
Daisy, my husband has also been doing this for years, to the amazement of many. He can also ride a bicycle, even when he is barely able to walk,

As for freezing, I stand in front of my husband(both facing the same direction) and I call out the rhythm (left right, left right, ) . It never fails to unfreeze him and he can walk with me, perhaps because he was in police college and had to learn to march. When he was in hospital a few months ago, the nurses and PT were amazed because it took two of them to move him and I could always get him walking by myself. Try it - works for us

By LOHENGR1N On 2013.08.31 00:04
Daisy, Yes I have a friend (a co-worker from long ago) who before he was confined to a wheelchair could handle walking up and down stairs, even up and down hills. Put him on a level floor or flat land and he'd fall within taking 3 steps! Every time he tried to walk on level. phoenix, my friend too would hop on a bike and peddle off,,,,however he didn't handle that as well as the stairs and had to stop after many spills and the police picking him up and delivering him home, P.D. tis a very strange disease the longer it goes the curiouser it gets!

By Mary556 On 2013.09.03 22:27
After reading about all the PWP's who are able to handle stairs (and bicycles) with no problem, I'm beginning to wonder if my Mom's episode that day was true freezing. She has never frozen when walking on level ground. It does not seem to make sense that my mother's mechanics would be the opposite of everyone else. Maybe she was very tired and stopped on that middle step to rest. Maybe there was some other reason why she didn't answer me when I asked if she was OK.

Please let me ask you this: when someone with PD does not respond to a question that is asked more than once, when it seems like words are not being absorbed by them, is that a form of freezing?

Dan, thanks again for another helpful suggestion. Unfortunately our small stairway between the two levels has railing only on one side. I am not very strong and tend to be clumsy as well. I've been staying behind my mother with one hand gripping the railing and one hand near her back to steady her if she starts to falter. When she takes a step, I take a step so I am right behind her. I'm hoping to get a home aide PT or OT over here to advise us, hopefully soon.

Thank you, everyone. I'm very grateful for all your help.

By LOHENGR1N On 2013.09.03 23:48
Mary, Just because your Mom freezes on the stairs not on level ground doesn't mean she doesn't freeze. My friend I was referring to could do stairs and hills without falling but fell on level ground and floors. He could do a bike which was amazing since he couldn't walk four feet without falling! As they say we're all different!

Several years ago I was talking with my Neurologist during an appointment, He asked if anything new was going on? I told Him yes that sometimes while sitting watching TV I noticed I couldn't move my feet, it was like they were glued to the carpet. I'd just be sitting there and kind of zone out then back and I couldn't move my feet for a minute or so. He said that it was a form of freezing. Who'd a thunk you can freeze just sitting in front of the tube? So to your question of not responding to question asked I'd say it could be. I'd say by the second time you ask try putting your hand on Her shoulder or arm and ask again the extra stimulation of touch should break it if it is a freeze (then again others have had loved ones not respond for hours to anything).

Glad you asked this question I and probably other Parkies need to be reminded as we were in youth by our wise Mom's........stop making those faces! You want your's to freeze like that? I won't be so funny then will it mister!?!

Doc Holliday: What did you ever want?
Wyatt Earp: Just to live a normal life.
Doc Holliday: There's no normal life, Wyatt, it's just life. Get on with it.

By Mary556 On 2013.09.04 04:11
Lohengr!n, your memory of your mother's words made me smile.
(on a day when I often felt like crying...)
Thank you for lighting candles in other people's dark spots.
I will remember to touch my mother's arm next time.


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