In patients with severe postural instability, wheelchairs can be used to prevent morbidity from falls. Motor fluctuations, including dyskinesias and episodic freezing, may be additive to postural instability and contribute to the tendency to fall. Freezing refers to a patient's feet getting stuck to the ground while walking, with an inability to initiate lower limb movement for a few seconds to minutes. Occasionally, decreasing or. increasing daily levodopa dosage or adding a dopamine agonist may help. When drugs are of no benefit in freezing and festinations, physical therapy may he helpful.
Behavioral therapy is often beneficial in freezing.
Verbal or auditory stimuli that are used include marching like a soldier to commands, walking or dancing to music, sudden clapping of hands and swearing. Hence, parkinsonian patients with dementia have an even higher risk of falls, Patients and their families should be educated about the increased risk of falls, and occasionally these patients may benefit with gait training and physical therapy. Patients with PD can have associated neurologic conditions that may increase their risk of falls. If clinical signs and symptoms suggest any other neurologic condition, a detailed workup should be performed. Physical therapy plays an important role in strengthening weakened muscles and improving stability and gait.