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:
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.
What Helps Parkinsons Patients Walk
One of the best things that you can do to help your loved one is to encourage them to stay as active as possible. Walking is a great exercise for people with Parkinsons, as it can help to improve balance and coordination.
A physical therapist may encourage you or your senior loved one to increase your stride length. This can be done by placing a line on the floor and having the patient walk back and forth along it. The line will help to increase the stride length and prevent freezing.
The Symptoms Of Parkinsons Disease
Parkinsons Disease is a neurodegenerative disease, which means the symptoms can get worse over time. PD is also a very complex disease with both motor and non-motor symptoms, and the symptoms present differently in every individual. The most common symptoms of Parkinsons are discussed below. It is important to note that individuals with PD may not experience all of these symptoms, and symptoms will progress at a different rates in different people.
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Shake Off Your Stress
Freezing episodes are more frequent and intense when youre anxious. Anxiety leads you to tense up your hands, arms, shoulders and jaw which raises stress in your body and feeds your freezing, making you even more anxious!
To combat this vicious cycle, deliberately give your body a good shake before you start walking. Start with loosening and shaking your hands, arms, shoulders, neck and tongue. Take a deep breath, stay as relaxed as possible and set out towards your destination!
Analysis Of Primary And Secondary Outcome Measures
Analysis of categorical variables will be performed using the Pearsons 2 or Fishers exact tests, whereas continuous variables will be analyzed using a Students t test or appropriate non-parametric methods. All datasets will be analyzed at 95% confidence interval and will be tested by double-sided statistics. Data will be expressed as means ± standard deviation . Data will first be tested for normality and homogeneity of variance prior to analysis, and if the normal distribution is satisfied, a t test will be used to compare 2 groups, whereas analysis of variance with LSD or SNK methods will be used for multiple comparisons. Datasets that are not normally distributed will be analyzed using a rank sum test.
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Strategies To Combat Freezing In Parkinsons Patients
Freezing is when an individual suddenly feels like theyre glued to the ground. Parkinsons disease patients often experience freezing during the late stages of the disease. It can occur while the person is in motion or after theyve been stationary and then attempt to move. Its associated with complicated movements like dodging obstacles or getting up from a chair.
The loss of automatic motor skills affects ones sense of control and even their safety, as about 38 percent of Parkinsons patients fall each year. Tracking when your struggles occur can help you to manage them, allowing you to challenge how frequently freezing occurs.
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.
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Balance And The Brain
Difficulties with balance and walking are linked to the brain changes that take place with PD. For people who dont have PD, balance is automatic, a reflex. But Parkinsons affects the basal ganglia . To compensate, the brain assigns another brain area an area used for thinking to take over. The thinking part of the brain, mainly the frontal cortex, cant control balance automatically. The result: for many people with PD, balance becomes less automatic.
This means that when people experience freezing and fall, they cant adjust their balance automatically. Taking small steps to try and regain balance can make things worse, because it involves shifting weight with each step. The brain changes from PD inhibit their ability to take a big step to catch their balance and avoid a fall. For some, the drug levodopa can help prevent freezing, but does not improve balance.
A person whose balance is less automatic must pay more attention while walking. For everyone, walking slows down when were talking and thinking slows down when were walking. This is called the dual-task cost and its higher in people with PD. That tells us that people with PD are using more attention and more cognitive control for balance and gait.
And If You Realize That An Episode Of Fog Is Ongoing
First of all, dont panic: theres a number of tricks that you can use to overcome an ongoing Freezing of Gait episode. Most of them are simple strategies that shift your attention away from the main cause of freezing and help your brain to focus on the important actions needed to restore a normal walking. For example:
Walking is a rhythmic action and every occurrence that breaks your rhythm can, potentially, trigger FOG. If you block in front of a closed door or you cant start walking again after you stopped for any reason, just try to pull your legs up one at a time, . This simple action will help you to regain fluidity and to start walking again If your hands are free, you can also swing your arms while standing still.
As you walk, count or repeat left, right, left, right while staying focused on the action. Take your next step at a specific point on the floor. To unblock your feet during a FOG episode, you can try to say loud in your head 1, 2, 3, GO! and take a big step forward on GO. Listening to some music is a great way to naturally walk on a regular rhythm: bring your earphones with you each time you go out for a walk!
Database Management And Quality Control
Our research team will take effective measures to ensure the quality of research. Particularly, we will adopt the double entry method in order to ensure quality of data. The statistician will compare the two databases through the program, and in case of inconsistencies in the input results, he/she will check to identify the error. After final confirmation, the database will be saved and kept by a special person. Any future changes to the database shall be agreed upon, in writing, by the clinical study director, statistician, and data manager.
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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Techniques To Overcome Freezing
Physical therapy and occupational therapy can be helpful to reduce or overcome freezing episodes. Physical therapy focuses on the physical rehabilitation of people recovering from injuries or disease with the goal of restoring mobility, as well as educating patients on managing their condition to maintain long-term benefits. Occupational therapy also deals with rehabilitation and motion but is focused more on enabling the person to engage in daily activities as seamlessly as possible. Occupational therapists also suggest adaptations and modifications to the persons environment.3
There are several techniques that can help people with PD overcome freezing, including:
As with any symptom, patients who experience freezing episodes should mention this to their neurologist who is managing their care. The neurologist may make changes to medication or provide a referral to a physical or occupational therapist.
The In Step Lasercane
This is achieved through the In Step LaserCane, which is one of the only canes on the market that projects a red line onto the floor, providing a goal for the user to walk toward. It only requires two AA batteries to power the laser function.
The In Step LaserCane is useful especially for people with Parkinsons, but can also help rehabilitate stroke recovery patients and assist people with ALS, abnormal gait and similar issues.
Dont let Parkinsons disease hold you back. Walking independence can be achieved just like other things in life one step at a time!
Articles may only be redistributed in its unedited form. Written permission from The Wright Stuff, Inc. must be obtained to reprint or cite the information contained within this article.
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Strategies For Improving Adherence To Interventions
We will adopt a variety of strategies to improve adherence to interventions. For example, we hope to establish a good relationship with the participants and fully simplify the intervention program to win their trust and cooperation. In addition, we will strengthen guidance to the participants and strive to understand and solve their problems in time to eliminate any concerns.
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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Freezing Of Gait & Interventions For Freezing Triggers Tips For People With Parkinson’s
Miriam “Mia” Boelen, PT, specialized in the treatment of those with PD from 1990 until her retirement in 2019. In this 27-minute video she demonstrates a 4-step method of specific maneuvers to break a freezing of gait episode. She also discusses common triggers and situational freezing, like crowded areas with tips for overcoming freezing in every case.
Music Exercise Therapy Group
In addition to routine rehabilitation treatment, we will provide music exercise therapy, in which patients will perform scheduled exercises according to the rhythm of music. This will be performed 5 times a week for 4weeks, with 1h each time.
Music therapists will screen musical tracks and rhythms according to the actual situation and music preferences of patients with Parkinsons disease. Thereafter, the therapists will create a personalized music playlist for each subject, because the lyrics in the music may distract attention of the PD patients, hence selection of music with lyrics will be avoided. Each playlist will be loaded into a personal music player, and subjects are allowed to choose earplugs or headphones for maximum comfort. The mode setting of the music player will be sequential play, and not random play. Moreover, music will be played by a designated music therapist, and subjects will be also told that they can request changes to their playlists at any stage during intervention.
While listening to music using earphones, the patients will be subjected to conduct flat start walking, turn around, and stop trainings, as well as narrow space walking and stair step training according to the beat in the music. The patients will be expected to simultaneously complete a cycle of exercise relative to completion of the music playlist.
Points for attention
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What Does Freezing Of Gait Look Like In Daily Life
If youre scratching your head about what freezing of gait means, youre not alone. In fact most health professionals need to google it.
When it comes to walking, some people living with PD experience this sense of being stuck, or my feet are stuck to the floor which describes the disrupted gait in patients living with PD.
- Freezing: These are brief or prolonged episodic phenomena of not being able able to step, or move your feet forward despite the mind being willing and having the conscious intention to walk.
- Gait: Refers to the pattern of walking.
Whatever your experience of FoG is, there are some common features of this gait pattern.
- Firstly, FoG is defined as a brief episodic absence or marked reduction of forward progression of the feet despite the intention to walk .
- Freezing of gait is a major disabling motor symptom that affects the daily quality of life of Parkinsons disease patients.
- FoG appears commonly at advanced or later stages of the disease experience: Prevalence of FoG increases with longer disease duration. It has been reported that 81% of PD patients experienced FOG after a disease duration of 20 years.
- BUT a mild form can be seen in the early stages.
- Moreover, clinical features cited are: motor dysfunction, sleepiness, fatigue, and cognitive dysfunction
- And this differs to what the patient reports such as postural instability and walking pattern difficulty.
Plans For Assessment And Collection Of Outcomes
All information shall be truthfully and accurately recorded in case report forms , at baseline and at 4weeks after intervention. The evaluation of three-dimensional gait analysis and UPDRS will be conducted by a specially-trained evaluator, who is not clear about the trial group. The CRF and trial summary shall be submitted in time, at the end of the trial, to facilitate completion and accuracy of CRF examination.
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Predictors Of Freezing: When Are People Living With Parkinsons Most Likely To Freeze
Freezing is common among Parkinsons patients, and is most often seen in those with long-standing symptoms.
A survey of 6,620 people living with Parkinsons disease found that 47% reported experiencing freezing regularly. Further analysis of people who reported freezing showed
- It was significantly associated with a longer disease duration and a more advanced stage of the disease.
- Episodes were more likely in men than in women and
- Finally, people who reported tremor as their main symptom were likely to also report freezing less frequently.
The results underline the necessity to develop appropriate countermeasures against this phenomenon, which is widely known to cause significant impairment of patients quality of life and as our data also showed may cause traffic accidents in licensed patients.
A previous study in 2001 has also established
- Risk factors associated with freezing where found to be at the early stages of the disease 1. the absence of tremor and 2. PD symptoms being mostly as a gait disorder early in the disease experience.
- The development of freezing over the course of the illness was also strongly associated with the development of balance and speech problems and less so with the worsening of bradykinesia , and was not associated with the progression of rigidity .
A current study rigorously compared studies and found that strong evidence supports the following risk factors for freezing