Easy Retropulsion Treatment Idea for PD

Mandy Chamberlain MOTR/L

Retropulsion has been a teensy-weensy thorn in my side.

As in, “I am not exactly sure how to train or what types of treatment ideas” are there for my patients with parkinsons disease (PD) pushing back or losing their balance backwards when I am specifically working on functional transfers.

It is a big factor in falls with my patients that have Parkinson’s Disease and limits transfer performance. Utilizing techniques from LSVT Big has been helpful, but I set out to figure out some new techniques for postural instability in PD (check out the video of a technique I came up with at the bottom of this article!).

So I did some research… Google searches… Pinterest… AOTA…

How do I make them more safe?

Besides adaptive equipment, can I even work on this effectively?

How can I instruct them to compensate for their limited ability to shift weight forward or maximize their strengths to accomplish this?

Besides verbal cuing of “nose over toes” with perfect body positioning, is there anything else I could try?

The only thing I could come up with and have tried is using a large ball to cue forward weight shift for sit to stands. Click here to see an article explaining the technique.

This technique does work great, but I have found that working in long term care, most of my patients are too advanced in their disease to be able to try this technique without the use of armrests or a stable surface to hold on to for safety.

But let’s start with the basics so you understand why this technique will be helpful for your patients with Parkinson’s disease.

What is Retropulsion?

Retropulsion is a characteristic symptom of Parkinson’s disease. It is a complex symptom that includes any of several motor symptoms that occur during the course of walking and gait.

It can be described as “the feeling that the feet are stuck to the floor” or “feeling like one is walking in glue.” It can also be described in terms of its effect on gait, “the feet feel heavy and may not respond to voluntary attempts to lift them;” this is referred to as “grip phenomenon”.

The feet do not move forward during normal walking but instead remain planted on the floor, causing the person to fall backwards; this is referred to as “freezing”.

This is common in people with Parkinson’s disease but it can also occur in other conditions such as multiple sclerosis, stroke and traumatic brain injury.

Try This Technique for Patients Who Fall Backwards When Transferring:

Video Transcript for the Retropulsion Intervention Idea

Mandy: Hi this is Mandy Chamberlain the occupational therapist with OT Flourish. I’m just going to show you a quick little technique that you can use with your patients that have Parkinson’s that perform retropulsion treatment during functional transfers.

So what that means is basically instead of the patient shifting forward with their weight in order to perform a safe and functional transfer, they are pushing backwards, aka retropulsion. They call them “pushers,” so one some of the pieces of equipment that I use for this technique is red thera band tubing, but you can use any kind of string or rope or anything you have in the clinic.

Then you need something to weigh down each of the ends and I have some fancy hand sanitizer and a chip clip so basically anything you can come up with you can use for this activity. Some of you have maybe seen the technique where you have a pillow or a ball like a therapy ball or balloon and then you have the patient already set up in the position you want, and have them lean forward so they touch the pillow to the floor.

I will use this theraband and I have them put it around their neck. Of course we’re going to have to do this with me while we’re doing training vs on their own. First have the patient get in position for transferring.

Then I’m going to be using this as a visual cue. Basically, I’m going to have them scooch onto the edge of the chair. I would normally get their legs in good position and let this hang so that when they are leaning forward they can still hold on to the stable surface and they can look down and/or feel the pull of the band toward the floor.

The weight should be touching the floor. This also means they have shifted their weight enough that they can stand up safely.

This is just one of my techniques that I’ve been using for some of my patients that have Parkinsons and it’s been working really well. I think it’s a really practical technique using something that they can actually feel because if they can’t feel it in their own body while they’re doing that functional transfer, they then have something they can see and they can feel while they’re doing the transfer.

It creates safer transitional movements and weight shift forward so that they’re not falling backwards, but transferring their weight forward.

End of transcript.

What techniques or exercise for retropulsion have you used to help treat your patients that have difficulty with functional transfers?

Are you looking for more information on treating patients with Parkinson’s Disease? We have a ton of resources in the OT Accelerator and here is a really good course from OccupationalTherapy.com called “A Practical Approach to Treating Individuals with Parkinson’s Disease.” Definitely worth a look.

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