Walk Safely: It’s Exhilarating, Healthful and Stimulating

If walking is still possible, safe and enjoyable for your loved one with Lewy Body Dementia, do it! It can be a lifesaver: physically, emotionally, and spiritually.If the ability to walk is lost, make sure to get outside — or to a window at least — as regularly as possible. Being able to see trees has clear, documented health benefits that include going home one day sooner after a surgery.

For caregivers themselves, walking is likely the best thing you can do for your own mood, health, sleep, weight, energy, and cognition. Nothing else can so effectively provide such a great improvement to your life, which will then help you provide a better life for your loved one as well. You don’t need to do much walking, but you need to do some. The optimal time-to-benefit ratio is to walk about 30 minutes daily.

There are quick tips to safe walking below. You may not have considered all of them. They might just avert a catastrophic fall, or an equally debilitating inability to walk from disuse.

Although it is far from easy, I have helped to keep my parents walking as long as possible. I am convinced that regular walking has kept my mother (diagnosed with Lewy Body Dementia in 2008 at age 79) in much better condition than would’ve been the case otherwise. I am equally confident it has lessened the necessity for many medications. There are countless other factors in every person’s case, but walking — outdoors — has made a world of difference for our family.

Keeping a loved one mobile will also keep them in a better mood, feeling more independent, give them cardio-vascular exercise, and help improve their sleep patterns. In many cases, the ability to walk can continue far longer than you might expect. However, it will likely require a significant commitment from a care partner to maintain, in terms of making it a routine, facilitating it, being vigilant about safety and, frequently, physically supporting the person walking.

Always keep in mind how potential falls need to be actively prevented.

Here’s the points that are covered in detail below:
> Walk Safely: It’s Exhilarating, Healthful and Stimulating
> Vision Is Impaired With Lewy Body Dementia
> Parkinson’s-like “Freezing” Lessens When Underway
> Remember That You Have To Walk ALL The Way Back
> Be Surface Sensitive
> Be Hands On
> The Twisting Path: Your Own Safety
> Canes = Danger. They Give A False Sense of Safety
> Walkers and Rollators Usually Better Than Canes
> Rollators and Walkers: What’s The Difference?
> Choose Clothes for Protection
> Get Outside. Even If Walking Is Impossible

Vision Is Impaired With Lewy Body Dementia

Visual acuity is impacted by Lewy Body Dementia, and can wreak havoc on the ability to walk. If, for example, your loved one has a loss of effective peripheral vision, going on a crowded sidewalk may be impossible: they may collide with people or objects. It can also make crossing a street very dangerous. Depth perception is also commonly impacted, so any change in elevation – such as a curb – may be misinterpreted and lead to falling. Contrasts in brightness, pattern and colour can be seen as something entirely different than reality, misinterpreted by a Lewy-affected perception.

Parkinson’s-like “Freezing” Lessens When Underway

“Freezing”, the temporary inability to move ones legs and feet is a common source of falls. Once walking has started, this freezing usually ceases until they stop temporarily, or something distracts the person, particularly with changes in terrain, ground patterns, contrast, surfaces, etc. Rhythmic talking and coaching, as well as presenting a slight visual barrier which they can see, but does not pose a hazard, can break the cognitive feedback loop that initiates the freezing.

Remember That You Have To Walk ALL The Way Back

It’s easy to get going, excited by the exhilaration of the exercise and vitality the walking provides, and get a fair distance along before you realize you’re getting tired. What works well is to go only a short distance — an overly easy distance — in one direction from your home base, and then walk back: if you still feel energetic, continue walking the other way from home base to keep it interesting. Always keep in mind that you have to have enough energy to walk back. If you can, bring something to sit on, but be extremely cautious that it is safe to sit on, especially if balance and flexibility are not perfect. Look for routes that have places to sit at good intervals, which should allow you to persevere for longer, and get even more benefits from the exercise.

Be Surface Sensitive

Vigilance is a necessity: pay attention to the surface you will be walking on before you get to them. Areas that may initially seem completely smooth may have enough inconsistent texture, rough areas and differences in elevation to make walking risky. Slanting paths and slopes are also challenging, including ramps or even very small hills. Be extra careful if the slant is sideways — that can greatly exacerbate the risks, especially if they already have the “Lewy Lean”. Changes in surface can also induce freezing, so keep an eye out.

Icy and snow-covered areas are extra dangerous. Remember that what poses no problem for you, as a fit person with clear perception and balance, may be highly risky for one with Dementia.

Be Hands On

Directly hold on to anyone who is not absolutely stable. Depending on the mobility, strength, balance and postural stability of your loved one, you may need to physically hold the person, to ensure they stay upright and on the right track. Avoid becoming distracted so you can focus on their walking. Once a person starts to fall, it is almost impossible to stop them, no matter how quickly you react. However, you can often sense impending instability and help them get to a safe place to sit down before that happens if you have a direct connection as they’re underway.

The Twisting Path: Your Own Safety

Helping a person walk can be dangerous to you as well. Attempting to hold a person up, or stopping a fall can very easily strain muscles or cause you to fall. Be extremely careful, plan ahead and stay aware with constant vigilance.

If you are assisting a person to walk, research and learn the best posture for you to assist, proper ways to hold them, support devices like belts with looped handles, and other methods. Each individual differs: every scenario cannot be covered here – it is best to seek out the appropriate information yourself, to suit your exact situation. An Occupational Therapist or Physiotherapist should be able to assess and help you with this. Acting on a personal assessment will help your loved one keep mobile longer.

Canes = Danger. They Give A False Sense of Safety.

Canes provide a false sense of security. Even when our loved one was using one cane in each hand, the Lewy Lean and postural instability made her highly unstable. Even using two canes (with four legs on each cane) had virtually no benefit. Once balance or concentration has been compromised, which can be very early in the Lewy timeline, canes absolutely will not prevent a fall. Don’t be fooled into thinking they’re a great source of stability or safety. They might be fine for someone with perfect cognition, but not with LBD.

Walkers and Rollators Usually Better Than Canes

Rollators and walkers are vastly more effective than canes. Care must be exercised to ensure that your loved one has enough comprehension and concentration to focus on how these devices are used to get any benefit from them. Reassess this ability regularly, since cognition with Lewy Body Dementia fluctuates radically, and sometimes declines rapidly.

You may need to help steer their rollator to avoid collisions. Vision problems will likely become apparent when using a rollator, because the placement of objects, distances, heights and textures will be misjudged. If they will tolerate your assistance, placing one hand on the rollator, or on their arm or back will help t0 gently guide the device, and make the experience safer. It will also make it less frustrating, since there will be less collisions with curbs, door-frames, etc.

Rollators and Walkers: What’s The Difference?

Walkers are lightweight frames that have four legs that terminate at the bottom with rubber pads, similar to a cane, sometimes replaced with two skis and two tennis balls, depending on use, terrain, etc. Rollators have a seat, four wheels, and hand-brakes to stop the device, and which can usually be locked to allow the person to use the the rollator as a chair.

Walkers are more stable, but unwieldy, slow and sometimes awkward, generally used for shorter distances only. Rollators are more difficult to handle, since they can run away on you since the wheels – by design – roll easily, and because your loved one may not understand how to use the brakes.

There is a newer style of Rollator that are also a transport chair, which is a great improvement. Basically, they function as a typical rollator, with small wheels, handles and brakes, but the seat faces forwards (instead of backwards in most rollators), and there are foot- and arm-rests so another person could propel and steer the rollator with an occupant safely in it. Usually, the seats of rollators are not very comfortable or stable.

Choose Clothes for Protection

Depending on the condition of the person, you may want to get clothes to reduce potential injury in case of a mishap. We’ve used a knee-length feather-down-filled coat that looks (rather comically) much like the Michelin Man, but which has definitely helped avoid injury on a couple of occasions, just by the extra padding it offers. Thicker mitts or gloves can help protect hands. A thick hat that’s tied under the chin can protect the head, and won’t fly off if a fall does happen. And careful selection of footwear is also important because the shuffling gait that is a hallmark of Lewy Body Dementia can also have “scissoring”, where the feet scrape against each other on every pass as the muscle control diminishes. The smoother the top and side parts of the shoe are, and the less aggressive the tread is of the sole, the less likely they will bind as one scrapes past the other.

Get Outside. Even If Walking Is Impossible

At some point, for any number of reasons, walking will become unsafe or impossible. I hope you will be able to facilitate excursions outside the normal environs for a long while, by taking your loved one out in a wheelchair, or seated on a rollator. A change in their environment and the new perspectives it brings seems critical to their well being. Nature heals. I intend to keep the gentle stimulation and activation of a change of scenery going for as long as possible. I hope you can as well.

My father, born in 1920, is still walking…every day: on only one leg, using crutches! He has inspired our family’s unshakable faith in the benefits of walking. It is hard not to be inspired by such unrelenting self-motivation and tenacity. And that’s what we all need on this rough road of Lewy Body Dementia.

Strength!
Timothy Hudson.

Updated January 31, 2016

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Postscript.

If you are interested in a couple of very illuminating pieces to help motivate you, these are the best I know of:

• this ten minute video shows how 30 minutes of exercise daily walking will solve just about every problem, and
• this short article from a 91-year-old Occupational Therapist shows how how walking and good posture are the keys to a healthy life.

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You can listen to the story above by clicking the red “play button” below.