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Freezing Of Gait Not Parkinson’s

Neurophysiology Studies Of Fog

Freezing of Gait FoG in Parkinson’s Disease

Recent advances in wearable electronics and computing have allowed for the miniaturization of electronics and the transition from bulky instrumentation to wearable and non-intrusive tools. This shift has allowed for neural biomarker explorations in environments that closely match everyday activities and even allowed for the implementation of protocols during states of high activity, such as walking and cycling . Such daily activity paradigms allow for more precise interpretation of results because parallel functions in studies using motor imagery or treadmill walking have to be considered. Furthermore, the constraints of simplified tasks of finger/wrist flexion to avoid motion artifact are no longer a big concern . Although some of the studies resulting from the PubMed query did not rely on wearable systems for their instrumentation, their findings can be translated into current and future studies using such wearable technology. This review begins with the cortical studies that use EEG to explore neural biomarkers and/or behavioral measures, then moves more deeply into subcortical studies while discussing the relevant cortical and subcortical loop connections.

What Triggers Freezing Of Gait In Someone With Parkinsons Disease

There are many possible triggers for freezing of gait in Parkinsons disease. Some common triggers include:

  • Walking on uneven or slippery surfaces
  • Turning around to look behind you
  • Starting to walk from a standing position
  • Approaching an obstacle in your path
  • Trying to walk faster than your usual pace
  • Changes in the environment
  • Stress or anxiety
  • Low blood sugar levels
  • Strong emotions

For most people with Parkinsons disease, freezing episodes are brief and resolved without any assistance. However, for some people freezing can be a more chronic and disabling symptom.

Do All Parkinsons Patients Suffer With Movement Disorders

Parkinsons disease is considered a movement disorder and is often associated with symptoms like tremors, decreased walking speed, narrower step length, etc. However, not all patients with Parkinsons disease experience movement disorders. In fact, some people with the disease may not have any noticeable symptoms at all.

One thing I learned as an Occupational Therapist is that when it comes to disorders of brain regions, no two individual persons will be exactly the same even though they may share the same diagnosis.

There are many different types of movement disorders, and they can vary widely in severity. Some people with Parkinsons disease may only have a mild tremor, while others may experience more severe symptoms like muscle stiffness and difficulty moving.

In people with Parkinsons, the cells that make dopamine are impaired. As Parkinsons progresses, more dopamine-producing brain cells die. Your brain eventually reaches a point where it stops producing dopamine in any significant amount. This causes increasing problems with movement.

The cause of movement disorders in Parkinsons disease is not fully understood, but it is thought to be related to the loss of nerve cells in the brain that produce a chemical called dopamine. Dopamine helps to control movement and balance, so when it is depleted, movement can become impaired.

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Treatment Of Advanced Motor Symptoms

In more advanced Parkinsons disease, patients will often experience a shorter window of time in which levodopa / carbidopa is effective, and tend to develop on / off fluctuations in which they experience wearing off of the medication towards the end of the dose . This is because levodopa has a short half life in the blood while in earlier stages of Parkinsons disease the body can accommodate this, in later stages the accommodation is less robust, and wearing off will occur. Additionally, when patients do take enough medication to achieve an on state, they may exhibit too much movement, known as levodopa-induced dyskinesias , which can include writhing, swaying, and bobbing. Thus, the challenge in managing motor symptoms in advanced Parkinsons disease is trying to strike a balance between wearing off and levodopa-induced dyskinesias When patients reach this point, a movement disorder specialist should be involved in management.

In thinking about management of advanced motor symptoms, Dr. Hung notes that thinking about pharmacokinetics is key: essentially, considering how to stretch out the duration of action of levodopa to prevent so many highs and lows. There are several strategies in treating motor symptoms in advanced Parkinsons disease:

Freezing Of Gait In Parkinsons Disease: An Overload Problem

Device Provides On
  • Affiliations Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada, Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada

  • Affiliations Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada

  • * E-mail:

    Affiliations Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada, Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada

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Can I Get A Disabled Parking Permit

If you have trouble walking short distances, you may be eligible for a parking permit for people with disabilities.

Talk to an SAAQ authorized health care professional. They will assess your situation and fill out the disabled parking permit application form if necessary. You will then need to send the form to the SAAQ

The idea that you may one day have to stop driving can be difficult to accept, but being involved in an accident can have a serious impact on you and others.

You and your loved ones can monitor your driving and regularly assess whether you should stop.

Some signs that may be alarming:

  • Driving too slow

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Why Do People With Parkinsons Freeze

Some people are more prone to freezing than others. It tends to occur with increased frequency as Parkinsons progresses and appears to be linked to long-term use of levodopa. It can be experienced by people who do not take levodopa, so it is not simply a side effect of medication.

Whatever the cause, not everyone with Parkinsons will experience freezing and it is impossible to accurately predict those who will. Freezing seems to be more prevalent in those whose initial symptoms included gait problems, and less prevalent in people who initially present with tremor.

The exact cause of freezing is unclear, but it is thought to occur when there is an interruption to a familiar or automatic sequence of movements. During walking, freezing is mainly observed when:

  • you are walking towards doorways, chairs or around obstacles
  • you are turning or changing direction, especially in a small space
  • you are distracted by another task when you are walking
  • you are in places that are crowded, cluttered or have highly patterned flooring
  • the flow of your walking is interrupted by an object, by someone talking, or if you begin to concentrate on something else. All of these will stop you from being able to keep a rhythm going
  • your medication is wearing off and no longer controlling symptoms as well
  • youre in a group situation or in conversation.

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How Do These Findings Fit Within Existing Models Of Freezing Of Gait

It is important to consider how some models of freezing of gait describe a downstream effect, without addressing the upstream cause. This might be why other models are not able to explain how anxiety or other processes might overload the basal ganglia, leading to increased freezing of gait. For example, the threshold model predicts that a motor deficit can accumulate to the point that reaches a threshold and freezing occurs . This model does not identify a root cause of the initial motor deficit. According to the current results, anxiety might be the key factor that initiates the motor deficit in the first place, and thus this model would be incomplete without the upstream cause having been identified. Similarly, the decoupling model does not identify the initial upstream event that leads to decoupling between preprogrammed and intended motor responses . Thus, in both cases identifying the upstream cause can elucidate why freezing of gait is the resultant behaviour.

New Drug To Treat Parkinsons Disease To Be Introduced In India

Overcoming Parkinson’s Freezing of Gait NexStride Explained

Apomorphine, which is derived from the water lily plant, has been found to control several neurodegenerative symptoms of Parkinsons and aid in improvement of the condition in many cases.

The blue water lily was used by ancient Egyptians as a sedative and intoxicant. Centuries later, scientists have now discovered that a derivative of the plant has a significant role to play in the treatment of Parkinsons disease. Apomorphine, which comes from the plant, has been found to control several neurodegenerative symptoms of Parkinsons and aids in improvement of the condition in many cases. This drug is now set to be available for the first time in India to treat those suffering from Parkinsons disease.

Around 300 to 400 people for every 100,000 population are diagnosed with Parkinsons in India, states Dr Shivam Om Mittal, Parkinsons Specialist from Bengaluru. It is expected to more than double by the year 2030 and will be a major non-communicable degenerative disorder among the people in the country. Speaking to the media on Thursday at an event held at Vikram Hospital in the city, introducing the drug to the Indian market, he along with several other experts talked about the impact of introducing the drug in India.

What is Parkinsons disease?

It is not as though the drug is not without its drawbacks.

Apomorphine pens

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Why Does Freezing Of Gait Occur

It is not completely clear why some people with PD experience freezing of gait and others do not. Research suggests that there is a relationship between freezing of gait and cognitive difficulties. The brain circuitry that controls gait is extremely complex and involves multiple connections between various parts of the brain, including:

  • areas in the front of the brain that plan and initiate movement
  • areas of the basal ganglia where the dopaminergic neurons that refine and control movement are found
  • areas in the brainstem which modulate movement and wakefulness

Freezing of gait seems to be caused by short-lasting episodes of inhibition of these brain circuits that coordinate gait. The specific abnormalities that cause the problem may differ from person to person.

Walking With Parkinsons: Freezing Balance And Falls

Parkinsons disease can change the way a person walks. Movement Symptoms like stiff muscles, rigidity and slow movement make it harder to take normal steps. In fact, short, shuffling steps are a common sign of PD, as is freezing, the feeling that your feet are stuck to the floor, for people with mid-stage to advanced PD.

On their own, these changes are distressing enough. But add the fact that Parkinsons affects balance and they also become dangerous, putting people with PD at risk of falling. The good news is that with exercise and physical therapy, people with PD can improve their balance. What can you do to minimize freezing and avoid falls? Read on to find out.

The following article is based on the latest research and a Parkinsons Foundation Expert Briefings about Parkinsons-related freezing, balance and falls hosted by Fay B. Horak, PhD, PT, Professor of Neurology at the Oregon Health & Science University, a Parkinsons Foundation Center of Excellence.

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Consequences Of The Hypothesis And Discussion

Sensory perception and processing impairment are common in PD and FoG and highly correlated with motor impairments . The enhancement of plantar sensory information by textured insoles has been shown to alter gait patterns and improve walking Stability in PD through alternations in spatiotemporal gait parameters , sensorimotor function, and gait kinetics and kinematics . Therefore, different types of sensory interventions target the motor impairments in PD with careful consideration of the features and factors of motor impairment.

Textured insoles are designed to enhance the somatosensory input of the foot through cost-effective, easy, and accessible passive intervention that can be used during various daily living activities compared with other FoG interventions . For example, cue interventions that are widely used in FoG demand high cognitive load and show difficulties in delivering in clinical settings . It is recommended to wear a textured insole for long periods to prolong the retention of benefits . To overcome the potential sensory habituation, different textures of insoles, in terms of density and location of elevation, i.e., first or second half, can be used interchangeably. We think that a single-textured insole may be more beneficial for the less affected limb in advanced stages of PD and FoG, whichexhibit more asymmetrical PD patterns. Gait initiation by the less affected leg using a single-textured insole may have a better effect.

Identify Your Triggers And Retrain Your Brain

Figure 4 from Walking patterns in Parkinson

Your therapist will evaluate your unique triggers and symptoms and guide you through an exercise program that incorporates cognitive challenges and physical training. This will help retrain your brain to use more effective walking patterns and reduce freezing episodes.

Those with more intense freezing symptoms may benefit from short anti-freezing intensives, like the one they offer at the PWR!Gym in Arizona.

In addition to working with a Parkinsons physical therapist, here are five more general strategies you can try to help avoid a freezing episode.

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So Lets Simplify This Complex Of Freezing Of Gait Brain Scenario

  • So, it appears Freezing of Gait involves disordered communication and processing of information between networks involving the:
  • front of the brain that plan and initiate movement
  • basal ganglia where the dopaminergic neurons that fine tune and exert control over movement
  • parts of the brainstem which again refine movement and support wakefulness

Yes, its a complex scenario involving a breakdown in brain circuitry and processing.

Therefore, the response to this situation requires a multi-pronged and personalised response.

Red Flags For Other Parkinsonian Syndromes

Once drug-induced parkinsonism is ruled out, the next step is to discern whether the patient is more likely to have idiopathic Parkinsons disease versus another flavor of parkinsonism , as this distinction influences prognosis, likelihood of response to medication, and how to counsel patients. There are several red flags that point to another parkinsonian syndrome rather than idiopathic Parkinsons disease:

  • Early falls as well as abnormal eye movements suggest progressive supranuclear palsy
  • Early severe autonomic dysfunction suggests multiple system atrophy
  • Early cognitive issues suggests dementia with Lewy bodies
  • Very rapidly progressive, debilitating symptoms in a couple years is usually too fast for idiopathic Parkinsons disease

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How To Deal With Freezing

The management of this symptom is based on physical therapy with rehabilitation oriented towards gait disorders. The use of sensory cues can be used to support this management and to limit freezing of gait.

It is recommended to practice regular physical activity, and to favor activities involving the mobilization of motor and rhythmic abilities .

Here are some tips recommended by the American Parkinson Disease Association for returning to walking during a freezing episode :

  • Try to do another movement before moving on. For example, raise one arm, touch your head, point to the ceiling, then try to move again.

  • Change direction, or move to the side before moving again.

  • Visualize an object on the floor in front of you and try to walk on it.

  • Take a step backward and then forward.

  • Walk on the spot and then move forward.

  • Point with your arm in the desired direction and move forward, insisting on swinging your arms.

  • Tap the leg you want to move forward before starting the movement.

  • Count 1, 2, 3 and move forward.

  • Use a rhythmic sound to focus on the rhythm to restart and maintain a steady walk.

Technological solutions are being developed to offer rhythmic auditory stimulation at home. This technique can be useful to resume walking after a freezing and to limit its appearance in order to improve ones overall gait.

The WALK medical device is based on this technique and it is possible to try this innovation at home.

To learn more, visit our website

RESILIENT INNOVATION

Scientific And Medical Expertise

Freezing of gait

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Role Of Imaging In Diagnosis

For a patient presenting with symptoms of typical idiopathic Parkinsons disease and no other abnormal exam findings, imaging is usually not necessary.

Dr. Hung notes that he will typically order an MRI in the following situations:

  • Atypical symptoms some atypical parkinsonian syndromes can have particular MRI correlates that mary be useful
  • Lower-body predominant parkinsonism For patients with significant lower-body parkinsonism without significant tremor or upper-body bradykinesia, an MRI is important to obtain to rule out the following causes of lower-body parkinsonism : 1) Vascular disease significant frontal white matter disease can cause symptoms of lower-body parkinsonism, and 2) Normal pressure hydrocephalus can cause parkinsonian symptoms involving the gait.

Identify What Are Your Triggers

Am I Freezing? Is This Freezing?

Most questionnaires, or clinical assessments of people living with PD which checks for freezing will commonly observe a person performing a number of walking actions.

So, to do this ask yourself how is your movement performance in the following areas, do you have had problems with:

  • Being able to perform turns about furniture or obstacles
  • Getting into or out of a lift?
  • Moving over changes in floor surfaces, patterns or thresholds
  • Being able stop on command, like when some says look out for that xxxxx
  • Moving in and around narrow or cluttered passages,
  • Moving in crowded or public spaces
  • Able to walk and do another task at the same time, like walking and talking at the same time or braking and talking whilst driving? This is often referred to dual motor-tasking such as carrying a tray.
  • Walking when under pressure to get a task down, or when there is a lot on your mind like worry or being anxious.
  • Managing your balance whilst walking and doing daily activities?
  • Take a moment and consider your experiences here against this list.

    Do you have any symptoms?

    Do these symptoms they all the time, sometimes, occasionally or not at all?

    Connecting with a physiotherapist or occupational therapist maybe of help, and our suggestion is to do this early rather than later as the risk of having a fall increases when living with PD and Freezing.

    Heres a list of common factors that may add up to freezing episode happening more often.

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