Ways To Reduce Parkinsons Freezing Of Gait
Do you sometimes feel like your feet are stuck to the floor or your hips are glued to your chair, despite your best efforts to move them?
This symptom, called freezing, has been seen in 30-67% of people diagnosed with Parkinsons, with a higher rate of incidence in later stages.
While everyone has unique freezing patterns, some common triggers include: turning in tight spaces, walking through doorways, walking in narrow hallways or crowded places or changing walking surfaces .
As soon as you notice freezing symptoms creeping up on you, its important to address them so you can prevent them from worsening over time.
The first line of treatment is often dopaminergic medications that aim to keep you in an ON state for longer. However, evidence suggests there is a cognitive component of freezing that medication and deep brain stimulation do not address effectively.
This is why the best long-term treatment option for Parkinsons freezing is non-pharmaceutical, non-invasive and focuses on retraining your brain for success.
Here are six actions you can take to help minimize your freezing of gait.
Coping With Freezing In Parkinson’s Disease
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology.
Around half of people who have Parkinson’s disease experience freezinga temporary inability to move that occurs suddenly and without warning. Such episodes are short-lived, lasting from a few seconds to up to several minutes.
Parkinson’s freezing can affect nearly any part of the body and disrupt nearly any activitychewing for example, or writing. However, it most often occurs when someone is walking, causing them to feel as if their feet are glued to the ground even though the upper part of their body is still mobile. This sometimes is referred to as freezing of gait and can have repercussions ranging from a brief disruption in stride to an increased risk of falling that can lead to broken bones and other injuries.
The exact physiological cause of freezing in Parkinson’s has yet to be determined. What is known is that it’s often associated with lulls in the effectiveness of medication, particularly among people who have mid-to-late stage disease. There also are a number of common triggers of freezing while walking, such as changing direction, approaching a doorway, or navigating a crowded area. Although Parkinson’s freezing can have a negative impact on a person’s quality of life, there are simple and effective ways to manage it.
How Do You Get Unstuck From Freezing With Parkinson’s
Cueing training for Parkinsons disease is well known in physical therapist circles and widely accepted for its benecial eects on gait disturbances and as a powerful adjunct to physical therapy.
There are two strategies to using cues. The first is a prevention strategy focused on improving gait mechanics via physical therapy. Freezing often occurs when gait mechanics deteriorate. The second approach is a rescue strategy designed to assist someone who is currently experiencing this gait impairment.
This rescue strategy creates a specific focus that allows someone to shift their attention from an outside trigger to their walking. Research has shown that technology that provides external cues, such as a laser line on the floor or a rhythmic sound, can be very effective.
Both visual cueing and auditory cueing have been shown by research to be eective strategies for improving gait impairment such as stride length and stride rhythm . Cues can also reduce the impact or severity of freezing, by preserving optimal gait – by reducing the number of episodes and/or the duration of an episode once it occurs.
Researchers consistently cite the need for external cues which can be adapted to each person and controlled on-demand, and the importance of cueing training both in-clinic and at-home.
There are several non-invasive ways to incorporate visual and auditory cues: NexStride is one approach
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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.
Overcoming Freezing Of Gait In Parkinson’s Disease
Director at Anatomical Concepts Ltd
Parkinsons is a neurological disease that creates a lack of communication between the brain and the body and can cause a symptom of “freezing of gait”. Gait freezing is estimated to be experienced by approximately 80% of people diagnosed with Parkinsons at some point and the symptom is often described as feeling as if your feet are glued to the floor, causing stepping inconsistency and apparent hesitancy whilst walking – often leading to falls.
It is important that people with Parkinson’s stay mobile and get essential exercise. Exercise has been proven to slow the progression of Parkinsons Disease, so overcoming any movement disorder that is a deterent to walking is important. We can expect that the recent pandemic has done little to help these people maintain their levels of activity.
So, how do people dealing with Parkinson’s continue to exercise, if freezing of gait is an issue for them? Let’s look more closely at freezing of gait and NexStride – a product from De Oro Devices which is an effective assistive device that can help.
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Get The Most Out Of This Video:
1) Save this video and practice these techniques on a regular basis, not just when you’re in a freezing episode! The worst time to try and learn a new trick for the first time is when you need to use it.
2) with your family members or other people in your support system so they can help remind you of each of the five S’ next time you’re stuck. .
3);Print it off and put it in the place you’re most likely to get stuck so you can refer to it in a pinch.;
Making Strides For Walking And Balance Problems
We dont typically think much about walking or keeping balance unless we have trouble with these activities. Thats because we dont have to think about them. Our brains automatically coordinate our bodies to move steadily. Parkinsons can interrupt these automatic connections and cause walking and balance problems, especially in people who live with the disease for many years. People often walk more slowly and shuffle and sometimes stoop forward a bit. Freezing, the temporary inability to move, also may occur with progressing disease. Walking changes and freezing can lead to falls, limit the desire to be out in public with friends or make it unsafe to live at home alone.
These symptoms are, unfortunately, challenging to treat. Current Parkinsons medications may help somewhat, but surgical therapies such as deep brain stimulation dont typically offer much relief and may even worsen balance. Effective treatment usually involves regular exercise as well as physical or occupational therapy. While any exercise is good, walking, yoga and tai chi are especially helpful. Physical and occupational therapists can recommend an appropriate exercise regimen and design programs to improve walking and balance, lessen or prevent falls, and allow you to do daily activities more easily and safely. Therapists also can suggest ways to avoid freezing and cues to get unstuck. Cues can be visual ; auditory ; touch ; or physical movement .
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Treating Freezing Of Gait For People With Parkinsons
Freezing of gait episodes often occur when a person is under-medicated and can improve with increased amounts of their PD meds, usually carbidopa/levodopa. However, as mentioned earlier, the brain abnormalities that lead to freezing of gait are very complex, so giving more dopaminergic medication is only part of the solution. In fact, some people have what is referred to as ON freezing. This means that freezing of gait episodes occur even when other PD symptoms are well treated with their medication regimen.
Cueing, or the introduction of an external sensory stimulus to facilitate movement, has been identified as a way to break a freezing episode. Terry Ellis, PhD, PT, NCS, Director of the APDA National Rehabilitation Resource Center at Boston University, and Tami DeAngelis, PT, GCS, compiled this list of cues that can be used to get out of a freezing episode:
To Prevent Falls Exercise
Exercise is the only intervention that significantly reduces a persons risk of falling, among older people without PD as well as people with Parkinsons. Research is beginning to show how exercise changes the brain for the better and can help people with PD gain back some of their automatic balance reflex.
In a study, Dr. Horak and her team asked participants with PD to stand on a quickly moving treadmill, until they began walking. Participants initially took too-small steps, but with one hour of practicing, they improved, taking bigger steps to stay balanced while walking.
Many kinds of exercise can improve a persons balance. Consider trying:
- Tai Chi: a moving meditation where movements involve shifting the bodys center of mass back and forth over the feet. Studies found fewer falls among people with PD who practiced Tai Chi three times a week.
- Dance: to dance tango, a person has to walk backward and sideways, take big steps and both follow and lead good ways for people with PD to practice balance control.
- Boxing: the rapid arm movements provide good balance training.
- Agility boot camp: completing different tasks in a series of stations can improve balance.
Tip: People with PD may have other medical issues that affect their ability to exercise, such as arthritis or neuropathy. Work with a physical therapist to find an exercise that suits your needs.
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The Route To Better Walking
The good news for people with PD is that with exercise and physical therapy it is possible to cope better with freezing, turn and walk more normally and improve balance. Through practice and sessions, a physical therapist can help people with PD avoid tripping by helping them learn to take larger steps. Additionally, joining an exercise class tailored to people with PD can help. If you take levodopa, be sure to exercise while it is working the drug helps your body learn and remember motor skills.
Tricks that can help overcome freezing:
- Walk to a regular beat to help prevent freezing. Try a metronome.
- Take large, voluntary marching steps.
- Step over an imaginary line or laser pointer.
- Work with a therapist to find the solution that works best for you.
People respond differently to audio, visual or sensory cues. Dr. Horak and her team are testing a device that provides sensory feedback vibration on the foot to stimulate automatic stepping.
Another consideration for people who have freezing is anxiety, a common PD symptom. People who have anxiety experience freezing more often. It is a vicious circle being anxious about freezing can trigger it. Treating anxiety may help freezing.
Breaking A Freezing Episode
One in three people with Parkinsons experience freezing episodes, usually when doing repetitive activities, or when multitasking. But how do you break free?
Freezing of gait is the result of the degeneration of neurons in the substantia nigra which are responsible for initiating movement. Conditions that worsen freezing episodes in the brain are amplified when the person is experiencing fatigue, stress, or anxiety.
Freezing can happen anywhere and at any time, but walking through doorways and turning around are common triggers. For a person with Parkinsons, freezing is not simply frustrating, it can be dangerous by leading to decreased mobility and falls.
Giving your brain time to use another neural pathway is an effective way to come unstuck, as the automatic response is no longer readily available.
Typically, people start moving by making use of some cues. Cues could be something simple, like a laser pointer, or simply by concentrating on walking.
When attempting to break from a freezing episode, it is important to adopt a mindfulness approach of being more aware of the task at hand.
Apply the following four-step technique developed by Dr. Sarah King, a physiotherapist who consults for the Davis Phinney Foundation for Parkinsons Research:
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Therapist Who Can Help With Freezing Of Gait
A physical therapist or commonly known as physiotherapist whos skilled in working with people living with movement or gait disorders will be a great member of your team!;
As mentioned a lot triggers for Freezing of Gait episodes happen outside the clinic.;
Having an occupational therapist come to your home, community or workplace offers you a clinical perspective with a deeply pragmatic focus.;
The role of occupational therapy and Parkinsons disease is to help people live better with their PD symptoms.
You can expect from an occupational therapist services which focus on
- Home audit and design solutions
- Assistive technology for Parkinsons Disease
- Lifestyle prescription
- Tailored activity recommendations to support movement diversity and other goals
- Cognitive strategies for Freezing of Gait
- Caregiver education and training to assist people living with advanced PD who experience freezing of Gait.;
If theres a key takeaway to close this article on Freezing of Gait and what to do about its this:
Freezing in Parkinsons is a highly complex brain circuitry pathology which requires a multi-pronged and personalised approach.;
If youd like to explore strategies for your personal situation please do not hesitate to contact us at Occupational Therapy Brisbane today.;
Heres 13 Freezing Of Gait Tips To Help You Get Moving Again
1.Keep your movements BIG Scale Matters.
2. Develop the mindful skills to walk with purpose and with intent.
Using therapy programs to practice these skills there are emerging positive results using interventions like:
- treadmill training
- obstacle aquatic training a form of hydrotherapy
- slackline training
- walk bicycle
The findings of a large meta-analysis suggest that its a combination of approaches which are needed as in clinic exercises have a short term carry over. Meaning more sustained activities as well as in home work is needed as well.
3. Develop your circuit breaker toolkit.
Rather than trying to bust through the freezing, consider moving an alternative part of your body to circuit break the frozen movement. This may include:;
- Move another limb finger, move your gaze.;
- Take a deep breath in and shorter breath out.
- Auditory or visual cues also can be used as well and covered later in this list
4. Pick a Destination
- A point of focus, like ;a boat charting a course through difficult waters, map a path to get to your intended destination . This may be about the home for example. You want to get form the loving to that bathroom but you need to go through the kitchen to get there. Pick a visual target that leap fogs you to the next visual destination.;;
5. Verbal Cue and Prime yourself to GO!;
- This can be a countdown methods 3-2-1 GO! Please note the GO! is a LOUD and POWERFUL internal command you give yourself.;
6. Leverage Assistive Technology
9. Plan Your Day;
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How To Help Parkinson’s Freezing Episodes: 3 Great Tips
6 Ways to Reduce Parkinsons Freezing of Gait
- 1 Train with a Parkinsons Physical Therapist. The very best way to avoid a freezing episode is by working with a…
- 2 Wear the Right Shoes. Shoes that are easy to slide on may solve one problem but cause another. When your shoes are…
- 3 Walk with Intention. Walking has always been automatic, but due to lack of…
So What Can You Do To Manage Freezing
- If you find yourself getting stuck in particular places, try changing the layout of your living space. Freezing can occur because you have to pivot around furniture.
- Exploring rhythm helps you to maintain momentum where you previously got stuck. Some Parkinsons patients explore strategies like dancing, counting, marching, and shifting their weight from side to side.
Thinking outside of the box can assist you in unfreezing yourself. Dad finds that his posture can affect whether or not hes able to unfreeze himself: When I freeze, I stand up straight. If I move away from gravity, I can unfreeze. But if Im hunching over, gravity pulls me toward the floor and it takes longer to get out of the freeze. And once I move my left foot forward, I can unfreeze. Freezings scary. Thats why a lot of Parkinsons patients fall.
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Parkinsons Causes His Body To Freeze Up Only One Thing Gets Him Moving Again
Im on the heavy bag, throwing left jabs, ignoring the relentless blare of Kanyes Drive Slow, Homie played at a volume that would raise the dead. I punch to a one-two count: left jab, right cross. Im working as hard as Ive ever worked, and even in this unheated gym I sweat as if its a sauna.
Finally, the bell rings. It feels as if Ive been at it for an hour; actually, three minutes have passed. The ensuing one-minute break seems to last four seconds. Lets be clear: Boxing, even when the opponent is only a heavy bag, is a brutal sport. But brutality is needed, even welcome, when youre facing a progressive, incurable neurological disease. I have Parkinsons disease, and it causes my body to just freeze up. Weirdly enough, boxing helps me get unstuck.
All 12 of us in this class bear the unmistakable signs of Parkinsons disease. I spot a dapper, cheerful white-haired fellow shaking like a leaf . Next, a balding, heavyset guy stumbling forward awkwardly on his toes . Then I see myself in a mirror: a man in a white T-shirt, khaki shorts and Nike running shoes, standing still, seemingly paralyzed. Im in the midst of a Parkinsons freeze .
So last year, when I learned about a boxing program for people with Parkinsons, I had to investigate.
The brain has a remarkable ability to adapt to damage caused by disease or injury by growing new brain cells, the review noted, and goal-based exercise facilitates this ability.
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