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My Mom (92) has recently had problems with falling backwards... She was actually holding onto her walker when she said she felt herself falling backwards without any warning. Her doc believes it could be related to a certical problem (or the artery in the back of her neck - not the carotids - is blocked). The doc balked at having an MRI done, because "there wouldn't be anything to do about it & it tends just to freak people out & make them fearful of "stroking out". Any thoughts/info? I found an article online on this, which was called Backward Disequilibrium - "BD" - but her doc just cut me off as soon as I mentioned the source & said "you can find anything online, so let's not go there!"

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First get another Dr. Any Dr who won't initiate investigation because it might ' freak people out' should not be ' practising'!
You and your mother deserve better.
Also , dismissing what you have found on the internet is contemptuous to say the least. Drs have to be prepared for what their patients find in magazines, internet, other media, and be respectful of the fact that the patient is doing their own research. If your mother keeps falling, she is at risk of a brain injury, and broken bones = pain, disability, morbidity !
Look for a more competent and intelligent Dr. Good luck. I hope your mother gets the support she deserves. Years ago, I worked with a Dr who told me that he always subscribed to the Reader's Digest, so he kept up with the illnesses that his patients would have next month. ( RD used to have an article ' I am Joe's or Jill's kidney / liver / thyroid etc.' )
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Dear Dunn, the following is my reply to similar question 3 months ago. PSP is not difficult to diagnose for an informed or specialized neurologist. That's why we changed neurologists. Dr Michael Au did not need tests, it was a 5 minute, clinical diagnosis. It is VERY frustrating to not have answers. Find a right neurologist, research, and watch for other symptoms. If you do find that mom has PSP I would suggest you make the most of your mom time now.
- - - Falling backwards? Not speaking, swallowing, reading, or walking well? Mom had it all plus seizures. Research PSP (Progressive Supranuclear Palsy), rare, and commonly misdiagnosed as the look-alike Parkinsons. Her dr offered pills, her neurologist offered mind deadening seizure meds and used the word Alzheimers. We found a new dr (never too late!) who referred us to an informed GERIATRIC neurologist. He was well worth the 2 hr drive and 5 min office visit for correct diagnosis. Mom matched every PSP symptom we found online. No, there is no treatment. But YES, huge relief to finally have an answer, to know what was going on w Mom, and what we could expect for the future. We let go of the worry, frustration, the running around for help from the help-less. Our last 3 years were spent enjoying and making the most of the time we had.
TerryinParadise
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Is Progressive Supranuclear Palsy difficult to diagnose? We have had every possible test know and seen a neurologist. He has ruled out Parkinson's. My mom is 76 and experiencing balance/backward falling. After a fall, she has no idea how the fall happened. We have had in-home therapy and while it has helped some, my mom is frustrated because there is no diagnosis or known cause for her falls.
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Falling backwards? Not speaking, swallowing, reading, or walking well? Mom had it all plus seizures. Research PSP (Progressive Supranuclear Palsy), rare, and commonly misdiagnosed as the look-alike Parkinsons. Her dr offered pills, her neurologist offered mind deadening seizure meds and used the word Alzheimers. We found a new dr (never too late!) who referred us to an informed GERIATRIC neurologist. He was well worth the 2 hr drive and 5 min office visit for correct diagnosis. Mom matched every PSP symptom we found online. No, there is no treatment. But YES, huge relief to finally have an answer, to know what was going on w Mom, and what we could expect for the future. We let go of the worry, frustration, the running around for help from the help-less. Our last 3 years were spent enjoying and making the most of the time we had.
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I'm a bit late to post here but falling backwards is a symptom of Progressive Supranuclear palsy, a little known degenerative neurological condition. It also causes issues with vision, swallowing, talking eventually etc but often initial onset is backward falls, slurred speech and problems focussing eyes. Thimblemoss especially please research this condition and check it's not this. It's under the umbrella of Parkinson's conditions but has very little similarity to Parkinson's.
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This ( backward disequilibrium) is so interesting. My aunt (89) complained that she was falling backwards several years ago. She never actually fell but felt like she easily could. She had pt at home and while it helped she said she still felt like she was tilted backwards. A therapist came in to do an evaluation and noted that her posture was such that she leaned back and also noticed that the converse sneakers she liked to wear were very flat, had no arch support and no heel buildup and were too long. All of this was true. They looked like clown shoes to me. She liked those shoes so much she had two pair of them. When we got her in better shoes the problem went away. She loves her new shoes. I never dreamed there was such a problem as backward disequilibrium. She has in home therapy sessions once a quarter and it really helps.
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My 88-yr-old mother has OA of right knee, COPD, CHF and AFib, and she had an ischemic stroke 2 yrs ago. She takes the anticoagulant Xarelto (rivaroxaban). and furosemide, among other medications. She has a significant balance problem and muscle weakness. She uses a walker 100% of the time. She lives in a retirement community and still insists in living in her "independent living" cottage. She recently had two backward falls in her cottage, once in October 2015 (hit back of head on wood dining table leaf, went to ER, CAT scan showed no injury), and the second time in February 2016 (hit left elbow on vinyl floor, went ER and had avulsion "glued" together and bandaged). I called the offices of her primary physician and her cardiologist. I will call her physical therapist also. Here is an article I found on pubmed: Backward disequilibrium in elderly subjects. Clin Interv Aging 2008 Dec;3(4):667-672. A comprehensive review also found on pubmed: Howe TE, Exercise for improving balance in older people. Cochrane Database Syst Rev Nov 9;(11):CD:004963. A third article in a physical therapy journal: What is backward disequilibrium and how do I treat it? A complex patient case study. J Neurol Phys Ther 2015 Apr;39(2):119-26.
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my aunt is 92 years old,she has been having trouble walking for about 2 years now,i have had her in re-hab off and on for those 2 years,every time she comes home from therpy she cannot do something that she could when she went,i told her that she is the only person i know that goes through re-hab and comes home worse,she is in re-hab now and cannot stand for very long,she can ride a bike in therpy and do a good job of it,but when she puts weight on her legs she cannot hardly move her feet,i have had every test we can think of but nothing,even had a stroke test and nothing,she was falling forward for awhile and now she falls backward when she is able to walk,I am so afraid that i am going to have to place her in a nursing home,but what else can i do?i would love to try and bring her home,but i have medical problems which limits my ability to lift and pull on her,does anyone know what her medical problem could be,since no doctor does,
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It can be neurologic, part of a parkinsonism picture either primary or secondary, and may respond to medication for that. If you think that's it and the regular nurse or doc can't feel it or see it, or is not familiar with how to treat it, get a good neurologist to take a look. Artane and Sinemet don't totally substitute for a functional striatum nigrum and basal ganglia, but they can be suprisingly helpful in some cases and often without a lot of side effects. YMMV!!
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Balance comes from mechanisms in the inner ear, and at 92 the machine is just plain worn out. She doesn't like PT, then don't force her to continue. She is headed for a wheelchair and 24/7 assistance. The MD was a little abrupt, but he may be frustrated as much as you are. The reality of old age is difficult to accept and not really repairable.
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I work with patients that keep the weight in their heels also! I am a home health PTA and this is so common in the elderly. I Work hard trying to get them to bring it forward. Lunges forward weight shifting and many other things. I feel sometimes it has to be neurological because even if one day they are successful the next time they may not be. They actually feel like they are going to fall on their nose when the opposite is more likely. Am I beating a dead horse?
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Since I wrote that last post, I have come to notice something about the mechanics of my Mother's balance: When she stands up (with assistance), she lifts the fronts of her feet off the floor, throwing her center of balance backwards.

I would be interested in knowing if anyone else has observed this.
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Sometimes this is "retropulsion" due to Parkinson's or parkinsonism. My mom had that, she could not help from pushing back and some people misinterpreted it as resistance. She had a florid cogwheeling tremor to boot so I knew what it was...I had once been able to talk a family practice doc into finding it on my MIL over the phone so he'd add a little Cogentin, but the nurse practitioner who examined my Mom couldn't seem to feel it even with me showing her in person, and I ended up having to go to a neurologist to get it confirmed and appropriate treatment (Sinemet). Hey, who's going to believe a lowly pediatric rehab doc about these things? The Sinemet was very helpful as without it she would have lost the ability to feed herself and that got her really depressed the few times she had to have someone feed her. The MRI might not be as helpful as a really good neuro exam, on the other hand if they are not already doing the maximum they can do to prevent strokes or extension of strokes, MRI findings might make a difference. My mom had really bad cerebral atrophy and going from antiplatelet agents to warfarin (Coumadin) was deemed too dangerous. But then we would not have known that without the MRI adn a couple CTs...and I needed to see it in black and white too, or I would have been running her around to even more eye doctors instead of knowing the very poor vision was due to stroke as well.

And I have to agree it takes someone special to do a good job with a less cooperative patient in therapy - we see that when "grown-up" PT or OT tries to work with young kids too, they don't know how to cajole or play along and get people to do what they need them to do if they don't follow verbal commands, and that's a shame because good therapy can increase strength and function and reduce pain substantially. Sitting still and letting muscles weaken is about the worst thing you can do for arthritic joints, yet that's what most of our elder's instinctively do when a joint hurts!
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Shame on your mother's doctor for dismissing the article that you read simply because it was on the internet. He should know by now that some of the most reputable sources - National Institutes of Health, PubMed, WebMD - draw their information from well-designed research and a thorough review of the the medical literature..

The authors are geriatricians, internists and a neurologist. Hardly an anonymous person mouthing off about something they know nothing about.

I found this article to be informative and probitive. Yes, you will have to look up a lot of medical terms to get the most out of it.

What it lacks is specific recommendations for therapy. My Mother is 87 and has just started falling backwards recently. This started shortly after there was a major change in her posture - she leans severely to the right when sitting, standing and walking, with or without her walker and is hunched way over. All of that started about 2 months after she fell backwards and fractured her sacrum, which caused severe pain.

In addition to an understanding of what causes this, we need to be able to do things that will help our parents who have this problem. We need to be reassuring, encouraging, kind and patient. Even if there is no improvement, imagine how it must feel like to be at least trying to do something about your bewildering and scary falls. My mother has kind, loving nurses aides who would faithfully carry out any instructions for physical therapy that might help her.

She is beyond being able to comprehend what a physical therapist is asking her to do. She had one or 2 good ones, but the others were impatient when she did not progress as quickly as a younger person would. My heart goes out to the last poster who;s therapist recommended that her mother's therapy be discontinued. Therapy shouldn't just take place in a therapy facility. Physical therapy needs to include providing the patient with things to do at home, whether there is significant improvement or not.

So what will I be doing about my Mom's problem? I will not be hauling her around to a lot of different specialists or subjecting her to a lot of tests that provide no direct benefit in terms of alleviating her condition. It seems like we are all agreed on that point. I will take her to her orthopedist, who has handled her sacral fractures and let him observe the changes in her posture.

So. We have no definitive treatment or even a complete understanding of what is going on. I alleviate my own frustration and anxiety by reading and trying to understand. I am going to press the orthopedist hard for things to do that will at least make things no worse or cause harm.

And if you want your doctor to pay attention to an article you feel may be important to your parent's care or treatment, make a copy of it and take it with you to the appointment.

Bless you all for caring.
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We got a call from a physical therapy facility because my Mom's doc thought maybe it would help if Mom could build up her muscles, etc. I'm really glad, & hope it DOES help. A few years ago, Mom fell & broke her arm at the shoulder (she'd already done the same to the other one a few years before), and she went to this same phys ther facility then. She really liked the first therapist who worked with her, & was making progress (both her opinion & the therapist's); however, that gal transferred to Salem & they assigned a young guy to her case. Mom said he just cursorily would say "do 10 of these and 10 of those and 5 of these, etc." Then he'd wander off and different therapists were gathered yacking... He'd come back, and just assign more exercises, but not stay at all and/or give advice, encouragement, or check that she was doing them correctly. He pretty quickly said "I don't think there's much we can do for you, so I'm recommended your therapy be discontinued..." Mom was devastated, & angry (she still does the exercises the first gal gave her on a typed-out sheet). Now, what Mom said when I told her about going back was "I'd better not get that same guy - this is probably a waste of time - etc. etc." She's totally negative - and she tends to be negative in general a lot - which makes it really hard for me to be upbeat...
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I'm of two minds on this. Having expensive tests done when there isn't going to be any change in treatment as a result of the tests seems to me a waste of money and time and anxiety. So I am kind of with the doctor on that.

But I'd want to know if there are other possible causes for the problem, and whether any of them are treatable. How could those alternate causes (if there are any) be tested for?

I guess that is where your internet research comes in. Are there reputable sources that list other causes and more importantly other treatments?

Im sure that getting a label for this problem is not your goal. You just want to know what can be done to keep Mom from falling over backwards, right? If your resarch (including posting your question here) gives you reason to think this might be treatable, depending on the cause, then getting a second opinion makes a lot of sense.

Good luck!
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Something interesting, there's an old man in my friends building that can ONLY walk backwards. He is physically unable to walk forward without falling, so she says that he walks everywhere backwards! That was due to a stroke he'd had a decade ago or so, leaving him totally off balance while facing forward. Weird but true. As for your mom, I'd say get a second opinion from a doctor that isn't a dipwad.
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