By Dr. Alexander M. Zwick DPT, CSCS

(note: “her” and “she” will be used for simplicity of usage)

If you’re someone who’s been taking care of an elderly person, chances are you’ve witnessed the phenomenon of retropulsion, the tendency of a person to lean backwards, and/or to consistently lose balance backwardly, or the inability to walk forward because of an involuntary failure in muscle coordination to produce forward strides.

You may have observed this phenomenon when trying to get your client out of a chair, where she will appear stuck in place, unable to lean forward or to get up.  Despite telling the client what to do, she is not able to move her trunk forward enough to get her weight over her feet.  When walking, the client may be unable to initiate forward steps, and may fall backwards when standing.   Retropulsion will significantly affect your client’s safety and management will be more difficult.  Although in many cases the cause of retropulsion is unknown, the following causes have been identified:

Low blood pressure: the client’s blood pressure is below the appropriate level as recommended by her physician.

Ankle tightness: the muscles of calf are tight and/or the patient’s heels are unable to touch the ground when standing.  This is particularly common in persons who spend a lot of time in bed.

Neurological conditions: clients suffering from dementia, stroke, or Parkinson’s disease may exhibit retropulsion.

Prolonged bed rest:  this relates more to the client who spends as much as 24 hours a day in bed continuously.

WHAT CAN YOU DO TO PREVENT RETROPULSION, OR TO RETARD AND MANAGE THE CONDITION?

Maintain good ankle flexibility: frequent stretching of  the ankle muscles, or basic, erect standing will help to maintain proper ankle mobility.

Reduce anxiety: the client may be afraid of falling out of her chair or falling forward. Make sure she feels safe.  Giving your client the proper assistance and reassurance that she isn’t going to fall can be helpful.

Have a properly sized assistive device (e.g., cane, walker): the device should be no higher than the patient’s wrist crease with the client standing erect.  An improperly fit assistive device, especially one that’s too high, can predispose your client to losing her balance backwards.

Practice standing: stand with your client as erect as possible at the kitchen counter, or with the client holding onto a sturdy chair.

Monitor blood pressure: Make sure it is within safe guidelines as recommended by her physician. An electronic blood pressure cuff is automatic, cheap and available at your local pharmacy or grocery.

Practice good body mechanics:  in order for your client to get out of a chair successfully, she must have her center of gravity over the base of support.  In layman’s terms, she must have her weight over her feet to minimize the tendency to fall backwards.  A useful saying is “keep your nose over your toes”.

Maximize independence: when helping your client up from a chair, your assistance should be directed at getting her to lean forward, and not just to lift her up.  In many cases, the patient has the strength to sit up, but body mechanics is faulty.  Lifting her might not be necessary.  A higher seat might also make getting her out of the chair easier.

Things to remember:

• If the phenomenon of retropulsion happens for the first time, out of “nowhere”, it may be worth seeing a doctor
• Work smarter, not harder.  Raise your client’s seat; give her verbal or tactile cues to assist her body mechanics; assist her in a way that also helps you.
• Don’t get frustrated.  The client is usually very afraid of falling and has no control over her balance.  Patience and knowledge can go a long way.