Assess Postural instability

• Ask the patient to stand with their feet comfortably apart
• Stand behind the patient and explain that you will deliver a quick pull back
• The patient should try to maintain their stability by either not moving their feet or using the least number of steps possible to stabilize themselves
• Be prepared to catch the patient under their arms should they fall backwards; it is also useful to have your back close to a wall, in case the patient falls on you
• An abnormal response is the inability to maintain stability and/or retropulsion (taking several steps backwards). This is a common feature of parkinsonian disorders, though in Parkinson’s disease it is typically seen in more advanced stages of the condition.