Postural instability is a syndrome in which difficulties arise in maintaining balance in certain poses or when changing them. Quite often, this kind of instability is observed in patients with Parkinson's disease. But the development of postural instability as an independent pathology is not ruled out. The syndrome can develop as a result of impaired functions in the brain, while the basal ganglia and frontal lobes can be affected. Parkinson's postural instability is characterized by a shaky gait, a tendency to fall. In severe cases, patients cannot even stand or sit on their own.
A detailed description of this pathology
In Parkinson's disease, such a phenomenon as postural instability is one of the main signs of the development of this disease. The occurrence of this disease is directly related to neural degeneration and impaired functioning of the basal ganglia, responsible for the direct walking and gait of a person.
Violations of the gait are accompanied by changes in body position, when the center of gravity can move, and the person at the same time leans forward. With the development of postural instability, people are forced, as it were, to follow their own body, which can tilt in different directions, which leads to the threat of falling forward, backward or even sideways. It becomes difficult for patients to start moving and stop. Gaining pace, it is extremely difficult to repay the inertia of movement, which sometimes leads to a fall.
Progressive degeneration of brain regions
Progressive degeneration of brain regions that are responsible for the postural mechanism and reflexes (we are talking about direct walking, coordination of movements and maintaining the balance of the body), over time, the body inclines forward. At first, this contributes to impaired gait and loss of balance, and in the future it can deprive people of the ability to independently move and sit. As a result, the person remains confined to his wheelchair.
The first signs of postural instability
People become unstable during the rotation of the body, at the beginning of any movement, against the background of rising and, if necessary, stop. This can be felt as follows:
- In the form of uncertainty when walking.
- In the form of a sense of rotation of the body during movements.
- You can also observe forced walking behind your own torso, which, as it were, is trying to tip over all the time, especially when turning the body and changing the pose.
Agoraphobia as a common symptom of Parkinson's disease
Agoraphobia is a fear of open space, and at the same time, crowds. This symptom of Parkinson's disease can occur as a result of the development of this phobia in humans. With this mental disorder, people have such fears:
- Fear of a large number of people.
- Fear of unusual situations in public.
- Fear of passing along a large street or square.
- Fear of visiting public places that cannot be left unnoticed (we are talking about theaters, restaurants, public transport).
Agoraphobia is usually associated with the fear of public disgrace in case of an attack. Since seizures usually occur spontaneously, being constantly awaiting for his appearance will further aggravate the situation. People are afraid to leave the comfort zone, avoid situations that can cause a feeling of fear. With panic attacks and the presence of Parkinson's disease in patients, postural instability can form. Her characteristics in this case will be:
- The absence of an objective reason for the imbalance.
- Dizziness can develop during an attack of fear, while people lose touch with reality, experiencing a brief wiggle.
- Attacks of postural instability occur in certain cases. Usually they are associated with a phobia.
In people with Parkinson's disease and agoraphobia, the number of situations leading to postural instability is gradually increasing. As a result, the desire to exclude such situations may increase, resulting in complete isolation with detachment. Such people may not leave their homes for weeks or even years. Postural instability may be associated with emotional disturbance in addition to physical brain disorders.
The causes of this pathology
A symptom of Parkinson's disease can occur with damage to the subcortical structures called the extrapyramidal system. There are many of them. For example, we are talking about black substance, blue spot, red nucleus, cerebellum, basal bodies and more. They are located in the hemisphere and brain stem under its cortex. The main objective of this system is to regulate muscle tone so that a person can stand stably in any position. These parts of the brain also control the postures and movements of a person.
The main cause of postural instability is, as a rule, Parkinson's disease. In this case, the neurons that make up the structure of a given system may begin to break down. When eighty percent of their total die, dopamine, which is necessary for proper functioning, becomes insufficient. Against this background, an excitatory mediator called acetylcholine begins to be produced by the basal ganglia , and this process activates the cerebral cortex. Normal teams that provide muscle tone along with their willingness to move according to the will of consciousness can be interrupted. So there is postural instability in Parkinson's disease.
Other diseases in which the described ailment may occur
Violation of muscle tone during a change of pose or during movements is observed in patients not only with Parkinson's disease. This symptomatology is also characteristic of all those pathologies when nerve cells die in the extrapyramidal system. These are pathologies in the presence of which cerebral blood supply is disrupted or cells die, which provide neurons with nutrition:
- With encephalitis and dementia with Levi bodies.
- Amid brain injuries.
- In the case of a stroke, if neurons die in the region of the substantia nigra or in a structure called the "shell".
- Against the background of progressive paralysis.
- With basal degeneration, brain tumors and Drager’s syndrome.
- Against the background of atherosclerosis of arteries that carry blood to the substantia nigra and other extrapyramidal structures.
- In the case of spinocerebellar ataxia.
Pathology diagnostics
To diagnose postural instability in Parkinson's disease, you need to visit, first of all, a neurologist. The specialist will determine the primary diagnosis, that is, Parkinsonism. He will also prescribe to the patient all the required examinations that will establish the causes of postural instability. As part of the examination of patients, the following procedures are prescribed:
- Positron and emission tomography.
- Performing dopplerography of the neck vessels.
- Clarification of the level of copper in the bloodstream.
- Conducting computed tomography of the brain and cervical spine.
- Performing electroencephalography.
- Sampling with the introduction of the drug "Levodopa".
What are the main methods of treating an ailment
Treatment for postural instability depends on its causes. In Parkinson's disease, appropriate treatment is carried out, for example, in the form of taking Levodopa or Carbidopa preparations. In the event that an elderly person has no contraindications, one of the following operations may be performed:
- The procedure of implanting an electrode into the brain that stimulates brain activity.
- Conducting local destruction of a site called a pale body (i.e. pallidotomy).
Perhaps, among other things, stem cell therapy is also needed, which, getting into the bloodstream, can turn into neurons. When postural instability occurs as a result of taking certain medications, they are canceled and replaced with another category of drugs. And when it comes to a symptom of atherosclerotic lesions of the cerebral arteries, then drugs that affect lipid metabolism are prescribed.
But it is worth noting that, regardless of the causes of postural instability in Parkinson's disease, drugs will not be enough. It is necessary to create conditions against which a powerful impulse will go to the brain from muscles with impaired tone. In this situation, there is a chance that the pathology will cease to progress, and directly between the neurons that survived, new connections will appear. Such influences include massage and gymnastics. You must also follow the correct diet.
Parkinsonism gymnastics
Gymnastics in Parkinsonism helps people to prolong their physical activity for many years and, with due diligence, stops movement disorders in the future. Before proceeding with classes in Parkinson's disease, the patient needs to consult a doctor, make up an individual complex. The main requirement for exercises is the implementation of all types of loads, from stretching to aerobic and strength training.
Gymnastics with postural instability can be very effective.
Sitting exercises
Here are the gymnastic exercises for the muscles of the face:
- It is necessary to portray different emotions (joy along with anger and surprise).
- Carrying out the movement, raising, lowering eyebrows.
- Perform lip compression.
- Performing movements with his tongue sticking out in different directions.
Now consider the exercises for the muscles of the shoulder girdle and neck:
- It is necessary to make a slow turn of the head to the right and left.
- You should tilt your head in different directions in the direction of the shoulders.
- Raise and lower the shoulders.
- Performing circular movements in the shoulder joints. To do this, touch the shoulders with your fingers, hold your hands in this position, then carry out a circular motion with bent hands.
- The shoulders are spread: they bend their arms at the elbows and pull them back, bring the shoulder blades together, holding for several seconds, then relax and repeat the exercise.
What else will help with difficulties in maintaining balance?
Standing exercises
In this position, you must perform the following movements:
- They extend their arms in front of them, turn their palms towards each other, then slowly spread their arms in different directions and back.
- Performing half-squats: leaning on the back of a chair, slowly bending your knees, keeping your back straight.
- Rises on the toes: rest on the back of the chair, rise on toes, tear off the feet from the floor.
- Stretching: lean on the back of the chair, stretch the leg straight back, crouch, bend the second at the knee, then return to the starting position and repeat the exercise, stretch the other leg.
Finally
Thus, in the event that a person does not lose clarity of reason, this does not mean at all that he will be able to command his body. In the brain there are ancient systems that we inherited from the lower vertebrates. These structures command that the human body itself can take a stable posture during body turns, so that the muscles that are on different sides of the limb work alternately. As soon as the work of these structures is disrupted, a syndrome of postural instability occurs, which is often observed in Parkinson's disease. In addition to the main therapy, it is worth fighting this ailment with the help of regular gymnastic exercises.