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Falls are common for people living with Parkinson’s Disease (PD), but they are not unavoidable. While balance problems are often blamed for falls, many other factors can contribute — some of which are less obvious.
In our Parkinson’s Disease & Movement Disorders (PDMD) Program at Shirley Ryan AbilityLab, we regularly work with patients to improve their balance and reduce their risk of falling. Below, we explore common fall risk factors in PD and provide practical strategies to improve safety, confidence and independence with everyday movement.
Risk Factor: Balance & Walking Changes
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Balance challenges are what most people associate with falls, and, indeed, changes in balance and walking patterns can increase fall risk during daily activities such as standing, turning or walking.
People with PD are at particular risk as changes in balance, freezing of gait, retropulsion (losing balance backward), festination (forward momentum with very short steps) and slowed reaction time can contribute to falls during standing and walking.
Prevention Strategies
- Use the most appropriate assistive device, such as a cane, a rolling walker or rollator (a four-wheeled walker with handlebars, brakes and a built-in seat)
- Practice balance and walking strategies in therapy
- Ensure the right level of assistance during mobility tasks, such as supervision for proper cuing or physical assistance, to prevent or stop a fall
Who Can Help Me?
- A physical therapist (PT) for balance and walking strategies
- An occupational therapist (OT) for safety during daily activities
- Your medical team to optimize medications that affect movement
Risk Factor: Drops in Blood Pressure (Orthostatic Hypotension)
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Have you ever felt lightheaded or dizzy when getting up from a bed or chair? Drops in blood pressure when changing positions can cause dizziness or fainting and, in some cases, falls.
For people living with PD, changes in how blood pressure is regulated — along with certain medications and reduced activity — can cause blood pressure to drop when modifying positions. This can increase fall risk due to unsteadiness or even lead to a brief loss of consciousness.
Prevention Strategies
- Stay well hydrated
- Use compression socks or wear an abdominal binder around the waist (with medical clearance) to help manage blood pressure
- Change positions slowly and deliberately
- Exercise regularly to support circulation
Who Can Help Me?
- Your medical team to adjust medications and approve compression garments
- A PT for safe exercise and position-change strategies
Risk Factor: Visual Changes
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People with PD may experience changes in their vision. This can affect their depth perception and balance and create difficulty with judging distances. As a result, the risk of tripping on obstacles, stairs or uneven surfaces increases. Typical, aging-related vision changes can further reduce clarity.
Prevention Strategies
- Improve lighting at home; reduce glare through the use of blinds, curtains, lamp shades, and/or warm or soft white light bulbs; and limit reflective surfaces in your home
- Avoid busy or patterned flooring
- Add contrast strips to stairs or thresholds
- Use appropriate corrective lenses and limit bifocals during walking and while going up and down stairs
Who Can Help Me?
- An OT for visual and home safety adaptations
- An ophthalmologist for regular eye exams
- A PT to improve balance system integration, which is how your brain learns to better combine information from your eyes, inner ear and body to help you stay steady, confident and safe during everyday activities.
Risk Factor: Incontinence & Constipation
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Difficulty making it to the bathroom in time can lead to rushing, which increases fall risk. Constipation and straining can also cause changes in blood pressure that may lead to dizziness or fainting when standing. Both urgency and straining can increase fall risk, especially at nighttime.
Prevention Strategies
- Use a bedside commode or urinal at night
- Follow a regular bathroom schedule to reduce urgency
- Stay hydrated and eat a fiber-rich and well-balanced diet
Who Can Help Me?
- A PT or OT with pelvic floor training experience
- Medical team to adjust medications or bowel and bladder routines
Risk Factor: Cognitive Changes
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As PD progresses, it can impact attention, multitasking, decision-making and sequencing of movements. These changes in cognition can affect safety during movement — and can increase fall risk, especially in busy or distracting environments.
Prevention Strategies
- Limit multitasking during walking
- Use supervision and verbal cues as needed
- Incorporate memory aids, such as cues from family or signs for reminders to use equipment, and ensure safe home setups
Who Can Help Me?
- A speech-language pathologist for cognitive screening and patient/caregiver education
- A PT or OT for caregiver training and safety strategies
- Medical team for medication management
Risk Factor: Fatigue
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Finally, fatigue is very common in PD and may be related to medications, stiffness, muscle fatigue, poor sleep, reduced activity or mood changes like depression. Fatigue can slow reaction time and reduce balance, which can increase fall risk.
Prevention Strategies
- Plan activities to conserve energy
- Take rest breaks as needed
- Exercise regularly to build endurance
Who Can Help Me?
- A PT or OT for exercise guidance and energy conservation strategies
- Medical team for medication review
General Tips for Fall Prevention
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If you are experiencing falls, let your medical and therapy teams know. Even one fall is worth discussing. Your teams can help identify why falls are happening and develop strategies to prevent them in the future.
Physical and occupational therapists can also assist with:
- Safe home set-up (clear walkways, sturdy furniture, reduced clutter, etc.)
- Equipment recommendations (walkers, raised toilet seats, shower chairs, grab bars, etc.)
- Training on how to safely get up from the floor if a fall occurs
Join Us!
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Register for “How to Prevent & Recover From Falls in Parkinson’s” on May 21. During this free, in-person event, learn practical tips on how to prevent and recover from falls.
Meet the Expert
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Caitlyn Seuschek, PT, DPT, NCS, is a senior physical therapist at Shirley Ryan AbilityLab. She specializes in helping people with PD move more safely and confidently in daily life.
She earned her doctorate in physical therapy from Central Michigan University in 2018 and completed a neurologic physical therapy residency at Marquette University and the Clement J Zablocki Veterans’ Administration Medical Center. Caitlyn became a board-certified neurologic clinical specialist in 2020. She also is PWR!Moves-certified and completed the Parkinson’s Foundation Team Training, an intensive curriculum to strengthen patient-centered care of people with PD.
Caitlyn has worked across all levels of care at Shirley Ryan AbilityLab, and currently practices at the Burr Ridge Outpatient & DayRehab Center. She is a PDMD Champion and has been involved in many initiatives to improve care of people with PD across the organization. She co-developed the Parkinson’s disease boot camp in 2024, which is offered at all Shirley Ryan AbilityLab DayRehab locations.
