How to Teach a Pd Patient to Walk Consciously
Please note that this and all other articles are written by me, John Pepper, as a person with Parkinson’s disease (Pd). I understand what having Pd is like and what we can and can’t do. I am not a trained medical person. The way I describe things is maybe not the same way they would, but you, as Parkinson’s patients, will understand what I am saying.
When people without Parkinson’s disease walk, they do not have to think about their movements. Many Parkinson’s patients are no longer able to walk properly, because Pd affects their movements. Movements like walking; writing; bringing food to their mouth etc. Because Pd can affect all of these movements, they now have to take back the ‘conscious’ control of all those movements again, as they once did when they were very small.
*When I say “his, him or he”, I mean both sexes.
I have now made 3 videos, which I was unable to do until Dr Doidge's documentary movie was released on the 27th October 2016, when it was shown on Canadian TV on the channel, “The Nature of Things”.
I have continued to successfully help people do this by giving talks all over the English-speaking world and by email.
So let's try this out with you. This is written for somebody else to teach you, the patient, but if you are the patient then you will understand what to do:
Link the patient’s left arm in the helper’s right arm, loosely holding his wrist with your thumb and forefinger. The reason for holding him in this way is to take away his fear of falling, so that he can concentrate on his walking.
You must first carry out four simple tests to make him ‘consciously aware’ of all the movements he is still capable of performing.
Ask him to put his whole weight on his left leg. If he is doing this properly, he should be able to swing his right leg, without losing his balance. Then ask him, “How far can he stick his right leg out in front of him, with his knee held straight? If he is able to do this, as almost everybody is, then tell him to put his whole weight on his right leg and show you how far he can stick his left leg out in front of him, with the knee held straight. Just to reinforce what he has just done, ask him to put all his weight onto his left leg again and loosely swing his right leg backwards and forwards, as high as he can. Then do the same while standing on his right leg, and loosely swinging his left leg. In this way he will become more relaxed.
Then ask him to ‘consciously’ show you both how high he is able to stand up on his toes.
If the patient is able to stand on his own, without falling, then let him do this next test unaided. If he must be held all the time then stand behind him, holding his waist with both your hands. Then ask him to swing his arms as high as possible.
This last test is to ask him to put his whole weight on his left leg again and ask him, “Are you able to move your right leg forward and land on your heel, with your toes pointing upwards, at roughly thirty degrees to the ground?” Then ask him to put his whole weight onto his right leg and ask him, “Are you able to move your left leg forward and land on your heel, with your toes pointing upwards at roughly thirty degrees to the ground?”
If he does all these tests successfully then tell him that he was able to do these things because he was ‘concentrating’ on the actual movements! Up until now, he has been trying to will himself to walk, but now he knows, if he concentrates on each movement he is still able to walk ‘normally’!
There is no a catch in what he has been doing. It is merely pointing out the reality that he is still capable of ‘consciously moving his limbs’, but he is no longer able to do so without concentrating on them anymore.
All he now needs to do is consciously move his legs and arms and walk like that for the rest of his life.
Is that a great hardship?
So, with your right arm holding onto his left arm, you ask him to:
- Place the full weight onto his left foot
- Lift his right foot off the ground and move his right leg forward about eighteen inches (375mm), or even further, and land on the heel of the foot, with his right toes pointing up in the air.
- Keep moving forward, while lifting the left foot off the ground and bringing it as far forward as possible and landing on the heel of the left foot, with his left toes pointing up in the air.
- Keep walking as fast as he can.
Don’t stop walking until you feel that the patient is scraping his feet on the ground, which normally shows when he loses his concentration and starts to walk badly. Don’t feel bad about this, because it is very tiring to begin with. The more he practices the further he will be able to walk.
When you have both come to grips with the simple reality that he is now able to concentrate on his actual movements and start walking normally, then you are both on your way to ‘reversing his Pd!
As soon as he is able to do it more confidently, with you still holding his arm, as indicated above, then he should be able to walk every second day, as fast as he can, and start to reverse his Pd. When he no longer needs you holding his arm then let him walk unaided.
How fast is fast?
If he cannot speak, when he is walking, then he is walking too fast. If he can speak ‘normally’, then he is walking too slowly. When he is walking at the correct speed for him, then he should only be able say, “One, Two”, between breaths. If he can still say, “One, two, three”, he is still walking too slowly. He should breathe as deeply as possible all the time he is walking. Try not to talk to each other, when you are doing the walking as he will need to concentrate very hard on the walking and you may cause him to fall or lose his rhythm. This is very important.
After fast walking for a month –
He should start paying attention to pushing up on the toes of the back feet, before the heels of the front feet touch the ground!
Because this is all happening quite fast, he should be consciously aware that he is pushing forward on the toes of his back feet. He can’t look down to see if he is doing this, but he will feel that he is walking much smoother and he will be aware that the weight of his body is being carried on the toes of the back feet.
Oh! And if he is not standing upright, then tell him to stand erect, with his shoulders back and his head upright, with his chin level with the ground! There is nothing stopping him from doing so, it is just a bad habit he has developed over the years. If he can lay flat on his back in bed then he can stand up straight. He may need some exercises to help strengthen his back muscles.
How far must he walk?
To begin with, he should walk for no more than ten minutes! Then, after every two weeks, he can add an additional five minutes to his time. That means, for the first two weeks he walks for ten minutes each walk. On the third and fourth week he walks for fifteen minutes each walk. On the fifth and sixth week he walks for twenty minutes each walk. And every second week he will add an additional five minutes per walk.
When he reaches one hour he no longer continues to add an additional five minutes per walk. He stays at one hour per walk and concentrates on walking faster and faster!
He must keep a written record of each walk, showing the time walked and the distance travelled. He can then divide the time by the distance and work out how many minutes it took him to walk one kilometre. Seeing his speed improving will give him an incredible boost. Put all these records in a log book for future reference.
How often must he walk?
He must only walk every second day! If he walks every day, he will not give his muscles a chance to recover. That will result in muscle injuries and his muscles will start to eat themselves up, in order to get the energy they need to do what he is calling upon them to do.
He can walk seven times in a two week period, or have a day off each week and only walk three times a week.
What must his pulse rate be in beats per minute (BPM)?
As we are all different, we all have different pulse rates. Mine might get up to 100 BPM while his might get up to 125 BPM. It matters not if he is walking as fast as he can!
Why is Fast Walking better than jogging?
I don’t know for certain the answer to this question. All I do know is that in the controlled studies done By Dr Beth Fisher in 2006, she found that the best exercise was, “High Intensity Walking”. By that I can only think it means “Fast Walking”. She tested jogging and running, although I don’t know how she got Parkinson’s patients to run or jog.
This is an excerpt from The Spring Times article on that 1st World Parkinson’s Congress held in Washington DC in 2006:
For exercise-testing of patients, use was made of a treadmill with an overhead bodyweight-support suspension harness to allow high-intensity exercise without any danger of falling or injury. Patients were divided into three groups: a high-intensity exercise group with MET 3.5 and above, a low-intensity group with MET below 3.0 and a no-exercise control group (1 MET=1kcal/kg, h). Testing was carried out in 24 sessions, each of 60 minutes duration, over a period of 8 weeks.
The outcomes of the exercise were measured in terms of changes in disease severity, functional performance (stair climbing, stand/sit movements) and brain function testing. This latter test, carried out using Trans-cranial Magnetic Stimulation (TMS) techniques, provided the most significant indications of the benefits of exercise. At various levels of stimulation, TMS was used to provide a Motor Evoked Potential (MEP) response, with peak-to-peak maximum amplitude and cortical-spinal rest time (Silent Period Duration, SPD) being measured independently in both brain hemispheres. This enabled a comparison to be made between the more the less affected sides in Pd patients and between Pd patients and healthy controls. SPD tends to be shortened and MEP shows higher peak-to-peak rest values (hyper excitability) in Pd.
Comparison between pre- and post-exercise readings showed that exercise led to a convergence to normal values in Pd patients, with the higher intensity exercises having the greatest effect.
The findings suggest the dose-dependent benefits of exercise and that high-intensity exercise can normalize corticomotor excitability in early PD.
Is walking on the road better than on a treadmill?
Yes! Parkinson’s disease affects our brain. It does nothing to our body. However, because the brain controls all movements and if, as a result of having Pd, we don’t use certain muscles in our body then those muscles will atrophy. So, Pd affects the body indirectly. If we start using those atrophied muscles again, they will start to grow again and get stronger.
Walking on a road requires a lot more brain activity. It has to deal with uneven surfaces and if we walk on uneven surfaces the brain has a lot more work to do. So, the result is that when we walk on a treadmill, we can actually watch TV or even read a book. That means that we use the brain a great deal less walking on a treadmill.
I would strongly recommend that you walk on grass, because if you have a fall you will not hurt yourself as badly as you would on the road.
Remember! There is always a risk of falling. I have fallen quite often, at the beginning, but never broke any bones, because of the exercise I have always been doing. That is why I recommend having someone hold the patient’s arm for the initial period, when he is getting used to using his conscious brain to control his walking.
Please tell me how it goes.
Here are all my videos:
San Francisco Talk:
Interview with Dr Norman Doidge
Dr Doidge’s Video: The Brain’s Way of Healing:
Here is the Dr Norman Doidge Video which you MUST NOT GIVE TO ANYBODY ELSE!
The password is 90para90
If you pass this on to anybody else we will be sued by the company that made the video.
Clovelly Surf Club Talk
Barry Geffen Video