I don't know much about other peoples families who have a member with PD, only my own. I've brought this up before on the "old board" but would like to rehash it because i'm having increasing problems as my family grows older and need the input and advice from others.
My problems all started when a young child would get "uppity" with me; "in my face" so to speak, ya know what I mean? It could be anything really, but just a feeling of loudness, screaming, and not in a playful manner. It used to make me skake terribly and get me really upset, so much so that I would vociferate back (give 'em $hit ). They were actually quite innocent and after a few years wore on, realized that dad could be a bear, if you messed with him. This brought nothing but anguish, for all involved, but we adapted, and for the most part were like nearly any other family.
As I have just past the decade mark in my PD sojourn things are getting increasingly tense if, after a few weeks, someone forgets the "leave dad alone or he'll get in one of his moods rule" . The real trouble is that my falling down is increasing in frequency and the strangest thing is, I could be standing comfortably, or especially walking (with or without cane), And as long as I'm undisturbed, I won't (usually) have any reason to initiate a fall. However something has changed and it's very disturbing. I could be, say, walking along and the mere eye contact with someone else talking loud "at me" will instantaneously make me slump into a fall. The severity of the fall is proportional to the "emotional index" (as I call it) of the "get my attention " event.
Today my daughter drove me to the liquor store and I bought some beer and a bottle of rum . Now the wife has put it in my 11 year old's head that I'm not supposed to drink any alcohol (which in moderation, I have found does absolutely NOT affect my tendancy to fall, although one would think ,naturally, that it would indeed, but it doesn't). I can see my wife's point of view, but alcohol (once again in moderation) helps to soothe the pain of PD, and makes an "on" even more pleasurable, since being on is the high (couldn't resist that one!) part of any day, and on periods are getting shorter and shorter. At any rate, he came barrelling towards me, screaming "dad why did you get booze, you know you're not suppossed to drink alcohol ! Well, my body went limp at this sudden, unexpected barrage and I fell, smashing some bottles, and giving ol'cs another "kill" mark on my left knee. Needless to say, I was angry and completely flustered, but didn't say much as I have learned that any reaction on my part always makes matters worse. Now this is not restricted to the bit that I have shared with you guys. Just about any fast, loud movement towards me for any reason makes me just turn into jelly and fall down. For instance, a ball thrown at me unexpectedly or someone coming unnoticed from behind a door in a confined space, things of that nature. AS long as i'm emotional neutral, I can still walk a short way without falling, but distract me in anything else but a very slow and subdued manner and it's like my brain just "shuts off" momentarily and I just fall down. It's not like passing out, it's a very short period of loss of any ability to keep muscle tonus.
Anybody else experience this? It is a new and very disconcerting symptom of PD, that I haven't found much info about .
Since each fall sets my walking ability back further and further, I am so worried that i'm soon to be in a wheelchair, not to mention the emotional turmoil that I am wreaking on my poor families' emotions, when I sometimes insinuate to them that their actions are the result of my reaction. . cs

Hi CS,
A physiotherapist who specialized in PWP nagged and nagged me not to talk when I walk.
Multitasking....is that a real word?
Well that's what she called it, anyway it's apparently much more difficult for a parky than the average person and the cause of many a fall.
I guess your reaction could come under the word multitasking even if you weren't talking you weren't concentrating on standing or walking.
Hope this helps.
Cheers,
Lee

I've heard of this before. It has to do with the startle reflex. I found these two pieces, although, truthfully, the second one doesn't make much sense to me.

I will look some more and get back with you,
mama

Jumping Frenchmen" is a disorder characterized by an unusually extreme startle reaction. The startle reaction is a natural response to an unexpected noise or sight. This disorder was first identified during the late nineteenth century in Maine and the Canadian province of Quebec. Lumberjacks of French Canadian descent were originally associated with this phenomenon but it has since been observed in other societies in many parts of the world as well. "Jumping Frenchmen" is suspected to be a genetic disorder and/or an extreme conditioned response to a particular situation possibly influenced by cultural factors. Symptoms tend to improve with age.
NORD


Although P50 event-related potential (ERP) suppression and acoustic startle prepulse inhibition are conceptualized as measures of sensory and sensorimotor gating, respectively, the relationship between these measures is unclear. In the present study, P50 and prepulse inhibition trials were interleaved in a single testing session to determine their relationship. Thirty-one healthy participants were presented with startle- and P50-eliciting stimuli across six trial blocks. Lead stimuli (i.e., the prepulse to the acoustic startle and the first click in the dual click ERP paradigm) resulted in significant gating, or amplitude attenuation, of responses to the startle probe and second paired click. There were no meaningful correlations between the P50 and prepulse inhibition variables, indicating that P50 suppression and acoustic startle prepulse inhibition measure distinct neural mechanisms. The implications of these findings for operationally defining the psychological construct of gating with these psychophysiological measures are discussed.

Blackwell Synergy - the source of highly cited peer-reviewed society journals from Blackwell Publishing

dearest CS,
I must tell you thank you!
You always tell it like it is! I appreciate your honesty more than you know, you make me laugh!!!

ALSO -
I also felt that way on cymbalta? dizzy like? I had more falling episodes.
but I call them catching episodes -I try to catch hold of something, or
this is kinda hard to put into words -(but I may run slowly as to get
the feeling of my feet frozen to be free, I am both a freezer, and a shaker?

I get very upset when people speak loudly - I tell them it scares me -please
speak abit softer, cant stand too much loud, I asked my sister to turn down the scream button on the "clicker" to the TV, she said -you can hear the TV,
and I said yep! I have damaged nervous system -the ears are connected to the be quiet response.

I live by my self, but try not to let myself feel lonely - I love & enjoy my sisters coming to visit. Bringing me to the store, and My older sister has MS,
and we both have canes, and she is my sweet 9 year older sister, I told her that PD makes me feel very old. I am 44 going on 90.

I believe I was born with PD, this may sound abit odd, but the high alert, over sensitive too loudness -too many people around me - has always caused an adrenaline rush through my heart,
and actually that hurts! it never felt like butterflies in my stomach,
more like I was going to be sick too my stomach, I shook while sewing,
as hemming clothing made me nervous -

sometimes I do extreme things- but safely -
to try to keep my balance or change my mood, I will dance
and sometimes I will get on my sister's trampoline and jump -if I can
take the heat in the midwest summers, I will have to be by a pool, thankfully my sister has one. I have never been able to swim well, but I splash around
and keep cool...

I have realized that PD has become a series of either good or bad days?
I must take my meds and eat correctly... and think on beautiful moments,
otherwise -the overwhelming thoughts come and steal my day!
sunny days are good, but too many cloudy days are not great for the psyche,
balance is my goal -best found by thinking about heavenly things.

PS. I do know of two Parkies who are in heaven with God, BLU and Jimwrite
they both had a few martinis a day...
They told me someday I would do the same, because they both felt that
this old medicinal called -liquor - helped them relax, and now I will have a glass of wine after diner, and it helps, or maybe a beer. all in moderation?

The more happy chemicals we have -the better the condition of life,
and that would apply with or without illness...

take care my dear brother -

I know what you are talking about. Not that bad yet or at least no falls.

We have to start looking at PD as one of a spectrum of disorders coming from a disrupted stress center. Autism is out at one end. Autistic kids supposedly are overwhelmed by the sheer volume of stimulus pouring in from their environment and withdraw in self defense. I can relate to that. When I am off, walking across a room is like crossing a busy street and each piece of furniture a speeding car to be tracked. And don't even think about talking to me!

It seems to result from our stress system and things like cortisol and adrenaline. We have higher levels of the former even at baseline and that's not good. And we seem to be sensitized to the same chemicals too.

The net result is that we are fragile. We who were once so strong are now blown over by a breeze. So far the only things that I've run across that seem likely to help are the things that relieve stress - exercise, yoga. tai chi. etc. Anything that peaces you out.

cs,
I've been having problems falling for a few years now. Yes, your right in that when someone or thing distracts me while walking, down I go. My MDS had me go through gait training. We found that because of the PD, I don't lift my right foot high enough to clear the ground when taking a step. Therefore I stub my foot and create a fall situation. To help relieve this problem they had me start saying or thinking " lift your foot when you step". Amazingly it works for me. Now when I become distracted I forget to think "lift your foot when you step".
Lee - made it up - mentioned multitasking. With everything going on in the parky body one little miscue can lead to painful results.
As much as I dislike it, a walker has really helped me with the problem. I would suggest you go see a physical therapist for gait training.

GregD

This may not be helpful. I do find it a bit disappointing that these are the ONLY research studies I could find on this topic of "startle" and "falling" in PD.

redline.jpg

Startle responses in Parkinson patients during human gait.

1: Exp Brain Res. 2006 May;171(2):215-24. Epub 2005 Nov 24.Click here to read
http://www.ncbi.nlm.nih.gov/entrez/q...indexed=google

Department of Rehabilitation Medicine, Radboud University of Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.

Falls frequently occur in patients with Parkinson's disease (Bloem et al. 2001). One potential source for such falls during walking might be caused by the reaction to loud noises. In normal subjects startle reactions are well integrated in the locomotor activity (Nieuwenhuijzen et al. 2000), but whether this is also achieved in Parkinson patients is unknown. Therefore, in the present study, the startle response during walking was studied in eight patients with Parkinson's disease and in eight healthy subjects. To examine how startle reactions are incorporated in an ongoing gait pattern of these patients, unexpected auditory stimuli were presented in six phases of the step cycle during walking on a treadmill. For both legs electromyographic activity was recorded from biceps femoris and tibialis anterior. In addition, we measured the stance and swing phases of both legs, along with the knee angles of both legs and the left ankle angle. In all subjects and all muscles, responses were detected. The pattern of the responses, latency, duration, and phase-dependent modulation was similar in both groups. However, the mean response amplitude was larger in patients due to a smaller habituation rate. No correlation was found between the degree of habituation and disease severity. Moreover, a decreased habituation was already observed in mildly affected patients, indicating that habituation of the startle response is a sensitive measure of Parkinson's disease. The results complement the earlier findings of reduced habituation of blink responses in Parkinson's disease. With respect to behavioral changes in healthy subjects we observed that startle stimuli induced a shortening of the step cycle and a decrease in range of motion. In the patient group, less shortening of the subsequent step cycle and no decrease in range of motion of the knee and ankle was seen. It is argued that the observed changes might contribute to the high incidence of falls in patients with Parkinson's disease.

PMID: 16307244 [PubMed - in process]

redline.jpg

The auditory startle response in the Steele-Richardson-Olszewski syndrome and Parkinson's disease.

1: Brain. 1992 Aug;115 ( Pt 4):1181-92.Click here to read
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

MRC Human Movement and Balance Unit, Institute of Neurology, Queen Square, London, UK.

The startle response to an unexpected auditory stimulus was studied in eight patients with a clinical diagnosis of the Steele-Richardson-Olszewski syndrome (SRO), 11 patients with idiopathic Parkinson's disease (PD) and 12 normal subjects. The patients with PD were studied 'on' at the time of maximal effect of their treatment; five of these patients were also studied in their 'off' state without treatment. The auditory startle response was absent in three patients with SRO: in the remaining five the latency to onset of earliest electromyography activity (EMG) of the auditory startle response was delayed and few muscles (orbicularis oculi, sternocleidomastoid and rectus abdominis) were recruited in the response. In PD the auditory startle response was similar to that recorded in normal subjects, both in terms of the pattern of muscles recruited and the amplitude of the EMG responses, but the latency of responses in orbicularis oculi and sternocleidomastoid muscles were significantly delayed. This result was not influenced by treatment with L-dopa. In patients with SRO the finding of an abnormal startle response is consistent with loss of neurons in the lower pontine reticular formation. This region is intimately involved in the startle response in animal studies. In patients with PD the late auditory startle response might be related to withdrawal of facilitatory input to brainstem centres and reticulospinal pathways from basal ganglia. The similarity of the responses in patients when 'on' and 'off' suggests these pathways are not under potent dopaminergic control.

PMID: 1393510 [PubMed - indexed for MEDLINE]

redline.jpg

Falling in Parkinson's disease: the impact on informal caregivers

Authors: Christine Davey a; Rose Wiles b; Ann Ashburn b; Caroline Murphy b
Affiliations: a North Yorkshire Alliance Research and Development Unit Bootham Park York UK.
b School of Health Professions and Rehabilitation Sciences University of Southampton UK.
DOI: 10.1080/09638280400000195
Publication Frequency: 24 issues per year
Published in: journal Disability & Rehabilitation, Volume 26, Issue 23 December 2004 , pages 1360 - 1366
Subject: Rehabilitation;
Formats available: PDF (English)
http://neurotalk.psychcentral.com/forumdisplay.php?f=34

Abstract
Purpose: The aim of this study was to explore the views and experiences of the informal caregivers of repeat fallers with Parkinson's disease. Method: Individuals were invited to participate in this study if they were the informal caregiver of a person with Parkinson's disease (PD) who had experienced more than one fall in the previous 12 months. Participants were interviewed about their experience of managing falls using a semi-structured interview schedule. Interview data were transcribed and analysed using thematic analysis. Results: Fourteen caregivers (11 female) participated in the study. All were marital partners of a repeat faller with Parkinson's disease. The average age of the participants was 69.9 years (44 - 79). Their partners had had PD for an average of 16.7 years. Six major themes emerged from the analysis of the interview data, four directly related to falls management (the falls; consequences of the falls for the person with PD; caregivers' experiences of falls; consequences of falls for the caregiver). The majority of caregivers were frightened about their spouse falling. They used a number of methods of getting their spouse up from the floor but often injured themselves as a consequence. Caregivers highlighted the high level of care they provided and the social and psychological impact of the condition on them. They received limited help in looking after their spouse and little information about falls or about the disease in general. Conclusion: Caregivers in this study felt unprepared for their role and expressed a need for more support and advice, especially about managing falls.

view citations (1)

http://www.fi.edu/brain/stress.htm#how

Actually, this is one of the best sites for understanding the brain that I have found. Very readable.

...I am writing this reply with caution.The last thing I want to do is upset anyone but having read and re-read your post ,I am compelled to say something.What strikes me throughout,are the references,of which there are many,to what I feel,is a severe state of anxiety.There are "falls" and there are "FALLS" if you get my meaning... but to my knowledge these are mainly caused by freezing...or loss of balance owing to the way we walk for example.Short,shuffling steps are a recipe for falls as the body is propelled forwards faster thasn the brain can control the movement.
BUT...what I rightly or wrongly have picked up between the lines,is a huge state of anxiety,and "falls" which occur not by tripping over something,but because your whole body almost collapses in response to extremely clear defined codes of behaviour from others.
These following words,appear to me to be the key to your emotional state,which then acts as a trigger,almost,for the way in which your body reacts.
anguish tense slump limp turn to jelly flustered barrage barrelling The latter two words suggest aggressiveness in the way someone approaches you.Also I picked up on two areas in which you state you don`t fight back in order to "keep the peace" or prevent further angers to arise. In which case it would suggest that you have very little say in how you wish to live your life.
Who has the right to dictate that you shouldn`r take an alcoholic drink once in a while? Shouldn`t you a] be applauded for your desire to find something which helps ease the pain? b] be respected in your ability to make such choices?
Who has the right to take offence at your suggestion that "their actions are the result of my reaction."
and the sentence I found to be the one holding the key...
"I am wreaking havoc on my families emotions"
Excuse me...but you have a seruious illness here.You deserve the respect of all around you...and forgive me for being so brutally honest...What about the havoc,that insensitive actions or responses,are having on YOUR emotions?
It seems from this angle,that your inner response to aggressive,loud and threatening behaviour has been "conditioned" over the years and Parkinsons is simply exaccerbating these responses.
I know because I have reacted pretty much the same over the years.
At one stage I couldn`t bear the phone ringing...I shook uncontrollably. For I was conditioned that a phone call meant a threat .blackmail or just plain verbal insults.Up uintil a couple of weeks ago [before I joined a confidence building and assertiveness course, whenever I was confronted by this one person,.my legs turned to jelly..and as you have described,my body would slump and go limp. Again,this was a condiotioned reflex to behaviour I knew would without a doubt,bring even more misery should I stand up for myself.It was as if my body were shrinking,and disappearing so that I couldn`t be seen.Literally./...my legs would not hold me up.
For what it`s worth,I think you would benefit from much the same type of course.You are keeping quiet in order not to rock the boat.That can only serve to make you more fearful,,,for this is what it reads to me...fear. Fear of aggressive confrontation...fear of what implecationsa there would be should you voice your opinion or retaliate...Fear of upsetting the applecart.
Been there...done it...got the T shirt.
Please try to find a way to build up your confidence to speak out...and take a course which helps you to keep a grip when these "barrages" rain down on you.
Gosh..I so hope I haven`t spoken out of turn but it is so close to the mark that I picked up on these key issues.

Thinking about you.

It was interesting reading all your comments. some I can relate to and some are not in my range of experience. I have yet to take a fall, at least in the literal sense. One of you commented on adrenalin actually hurting when it shot into your system. That is a phenominon I've experienced many times. It actually stings. I''ve never known anyone else who experiences adrenaline like that. Its like some sticking needles in me. The telephone thing that steffi mentioned also rings (excuse the pun) true for me. When the telephone rings my tremor goes into overdrive. I decided that the underlying problem was that in the back of my head I knew, somebody wants something from me....expectations. I hate the idea that anybody expects anything from me. Personally I agree that it is all conditioning and probably started from the prenatal zone while we were overhearing our parents conversations. The trick is to tie the idiosyncratic behavior to the root cause, then we can do something about it. (at east that seems like the rational approach to me) Until we can identify the cause we are victims of our own minds. CS, your noting that your falls are associated with a certain pattern, now what you have to do is figure out what it is about that pattern that elicits the response (bizarre as it is.) In my opinion we all need a good psychiatrist more than we need a neurologist. Did you know that PD patients excell in the area of experiencing the "placebo effect". This tells us that our disease is closley tied to our thinking patterns. (so tell us something we don't know you say....) It has occurred to me that animal trials of new meds on monkeys or fruitflys or whatever, lacks one crucial element... Those species cannot reason (actual correctness of the reasoning is another ball of wax) Therefore, that little warped, jaded, illogical, conditioned ball of muck in our head that we call our brain, may well skew any potion or potential cure that comes our way. "as a man thinketh" So CS, the problem with being very bright is that you are also very complex in your thinking patterns and that is your downfall (another pun...they,re just rolling out like melting snow tonight)...tooo much material to sift through! RE: the telephone -I have recently given up caring about who's phoning and all the stream of hysterical thought that it triggers and I'm feeling much better. I think I need to work on being like the Dali Lama. Peaceful people are so nice to be around. Whats with us that we are so hard pressed to be peaceful in our hearts and minds? I can't figure it out. All I know is that if I stop caring about whatever it is that sends me into space, it loses it's power to send me into space. I just read a book on panic attacks and that's the message. We have to learn to manage our minds. Good Luck! Have you considered having your legs amputated? A bit radical I know, but it is one solution to falling down. Although I guess technically you could still fall over. Maybe I'll have a few more "unique" approaches to your problem in the morning. None of which will be useful, unless of course they make you smile. Apologies for the disconnected ramble....is it a full moon?