Maintaining Your Balance

Life is like riding a bicycle. To keep your balance, you must keep moving.

Albert Einstein

Several weeks ago, Sydney Collin, founder of Nextstride, and Erin McMullen, physical therapist at Northwest Rehabilitation Associates in Salem OR, spoke to my Sunday Mornings group about Balance and Parkinson’s Disease, a topic of great importance to those of us with PD. My fall last March, when I tripped on a sidewalk and fractured my shoulder, was a wake-up call for me. When you cannot move because of an injury, Parkinson’s takes the opportunity to swoop in and set you back significantly in your battle with the disease. Sydney developed Nexstride while a biomedical engineering college student to help people maintain their balance with visual cues so that accidents such as mine, can be avoided. She later formed De Oro Devices, a company inspired to build products that can improve mobility, independence, and quality of life.

By Sydney Collin and Erin McMullen, December 21, 2022

Staying Balanced with PD: How Simple Cues Can Help You Move Safely

Living with Parkinson’s Disease can present a wide range of challenges. Many of those challenges stem from one issue – a decrease of mobility – which is caused by the disease’s cruel attack on the brain and its ability to communicate with the body. While living with PD, a person’s mobility can be affected in a variety of ways, often damaging the body’s ability to balance and move normally. This, of course, can lead to a number of physical, mental, and emotional consequences – ranging from dangerous falls, to social isolation caused by immobility. But staying balanced and moving safely with PD is possible – especially when a person has a little bit of help.

Balance and Parkinson’s Disease

In order to understand why PD affects our balance and movement, we must first understand how our bodies process the act of balancing in the first place. At its base, balance is a combination of sensory information that is collected by our eyes, ears, and touch. That information is then interpreted by the brain, which calls on a person’s muscles to react accordingly in order to keep them upright. When people lose their balance, it’s because the process has been interrupted or damaged at some point, either when the body was collecting sensory information, or when a person’s muscles were trying to react to that information. 

Many symptoms of PD can directly interrupt our body’s ability to balance. Freezing of gait, for example, is a common symptom of PD in which a person loses the ability to take a step forward, oftentimes feeling as though their feet are “glued to the floor.” This can lead to balance issues, and potentially dangerous falls.

Freezing of gait is primarily caused by a lack of dopamine in the brain, which is critical for sending movement signals from the brain to the body. Without dopamine, the brain is unable to properly send electrical signals that trigger the body to move, making it very difficult for a person to maintain their balance.

Cueing Technology

The key to overcoming a freeze is to “jump start” the brain’s dopamine levels so that the brain and the body can properly communicate. Luckily, this is possible to achieve through goal-oriented movement. By focusing on specific movement goals – like stepping over a certain line – or taking steps at the pace of a specific beat – we can trigger the goal-oriented part of the brain, allowing the brain and body to once again move as one unit.

Recent developments in technology have used this approach to help people overcome freezing on a regular basis. NexStride is one example of a mobility tool that uses this approach.

NexStride is a small, versatile device that can be attached to a cane, walker, or other assisted walking device. The device works by projecting two external cues: a green laser line that shines on the floor, and a metronome beat that is easy to hear. A person can use these cues to trigger goal oriented movement – either by trying to step over the green laser line, or by walking to the beat of the metronome. This goal-oriented technique triggers the goal-oriented part of the brain, which then releases dopamine to allow the brain to properly send movement signals, thus stopping or preventing a freeze altogether. 

The effectiveness of cueing is backed up by research, which shows that the duration of freezing episodes is reduced by 69% while using cueing. Freezing also happens less often with cueing: data shows a 43% drop in instances of freezing when a person uses cueing to move. Naturally, this has a positive effect on fall rates too: cueing has been shown to reduce fall frequency by 40% for people with Parkinson’s freezing.

The full power of cueing is still being discovered by researchers, who are now using it to improve mobility for people with multiple sclerosis, cerebral palsy, progressive supranuclear palsy, and people recovering from a stroke. 

The Path Forward

For people with Parkinson’s, the benefit is clear. Among NexStride users, 93% reported increased confidence when using the device, while 86% say the device has increased their general mobility. These benefits aren’t just physical, either: 75% of NexStride users reported a decreased fear of falling as well.

Parkinson’s Disease – and the effect it has on a person’s ability to move and live how they want to – presents a challenge for everyone who is diagnosed. But thanks to new cueing technology backed by proven research – people with PD are regaining control of their own movement, and with it, their independence.

You can learn more about NexStride on their website or give them a call at (805)242-8015.

Nexstride is offering a $50 discount to readers of this blog. The discount code is TWITCHY50.


If you are interested in participating in a study to evaluate the effectiveness of an approved osteoporosis drug for preventing fractures in people with Parkinson’s, please consider the TOPAZ study.

Please use the code TWITCHY, which is used only for tracking purposes. Thank you.

A Note To My Readers

I love to see your comments and get your emails as we share our collective experiences. But based on a couple of private questions from some of you, remember, I am just a lay person and a patient like the rest of you. For medical and similar advice, you need to talk to your own doctor

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