Dr. Padiki Nagaraja Rao

Participant: The Author himself. In the past, we had people who injected themselves with blood from Syphilis patients and studied the effects of syphilis in people. There were doctors like Parkinson who studied themselves to educate others. I have conducted a study on myself to explore brain functions in old age and methods to overcome them.

About the author: I am a Medical graduate from Bangalore Medical College, India, in 1965. I have worked in New York, U.S.A., and obtained the American Specialty Board certificate. Then, I worked at a famous accident care hospital in India and taught medical students at Yoga University, including those with movement disorders. I had to resign from my job at yoga university as I was developing slurred Speech. Fast and illegible handwriting and falling (losing balance) repeatedly, I was doing everything very fast, and meanwhile, I developed swallowing problems.

Few experts in movement disorders saw me and diagnosed me with Parkinsonism, even though I did not have any resting tremors, rigidity, and the DAT scan was also normal. I wasn’t officially diagnosed with Parkinson’s disease by the doctors, but rather as Parkinsonism. One of them jokingly told me it must be a Rao syndrome; maybe he is right, but the examination was conducted by some of the experts in movement disorders, physicians, and otolaryngologists, and no definitive signs of Parkinson’s were found.

Things we learn in medical college: The Parietal lobe of the brain is concerned with “spatial awareness”. The human brain calculates several things in a fraction of a second and decides upon a response, such as directing our finger to a particular part of the body that is itching and needs to be scratched. The brain will choose and make a decision on several factors: It knows the fingernail length, the length of the arm to be stretched, and to which degree each joint in the limb has to move muscle strength to be used, number of motor units to be recruited and a whole lot of other things.

The cerebellum and the extrapyramidal system are also involved in assessing muscle tone and strength. Depth of perception is not given much importance. It is the depth of perception that is lost first in old age. The person will experience difficulty in assessing the distance between himself and the tap in a bathtub and the bed in the bedroom, particularly the obstacles in his path, which will make him fall. We do not know which part of the brain is responsible for this depth perception, nor whether the cerebellum or the substantia nigra is involved in old age. However, it is true that it is common to hear of falls due to a lack of balance in older people. However, it has become a common practice among various specialists to ask patients if they fell while walking, without offering any curative treatment. When we discuss depth perception, we are not merely thinking about vision (through reasonable eyesight, which is required). We are referring to the centers in the brain and their ability to make decisions in a fraction of a second.

Management: During physical therapy, the therapist should understand the reasons for frequent falls in older individuals.

The therapist must insist on:

1. Raising of legs while walking (military walking is good) to avoid obstacles.
2. The patient should be told about depth perception. They should stand close to the object they are about to catch to avoid falling. If the object is not reachable, do not bother with it again and again.
3. The patient should be advised not to bend too much, as this can often lead to falling.
4. The patient should also be advised not to walk on slippery surfaces and to exercise caution when using a bathtub for bathing.
5. Not to be overconfident at any time.
6. Not to be shy to ask for help.
7. Additional treatments, if necessary, for swallowing and slurred Speech, and occupational therapy, if needed, should be considered to seek help from medical professionals.
8. Regular exercise and getting up from a chair should be encouraged. When getting up from a chair, the feet should be positioned to match the distance between the shoulders.