As anyone with Parkinson’s disease (PD) knows, one of the most frustrating and debilitating symptoms is the gait disorder called freezing of gait (FOG). This is when a person’s feet seem to get stuck to the ground, making it difficult or even impossible to walk.
A freezing episode can occur without warning and can last for just a few seconds or much longer.
What can help to stop the freezing of gait in Parkinson’s disease? – Anything from medication, physical therapy, and walking aids can help someone suffering from Parkinson’s to overcome FOG episodes when they occur.
As the name suggests, freezing of gait is a symptom of Parkinson’s disease in which a person’s ability to walk is significantly impaired. Freezing can occur suddenly and without warning, making it difficult or even impossible for a person to move their legs.
Freezing of gait can interfere with a person’s walking pattern, and make it difficult to simply move. The condition is often characterized by short episodes of immobility, during which time the individual may feel like their feet are glued to the ground.
In some cases, freezing of gait can be so severe that the person is unable to move at all.
Sometimes, PD patients are able to make a small step but not a big step. Sometimes they just aren’t able to take any steps at all. This can be a very distressing and debilitating symptom, and it can certainly contribute to causing someone to fall.
Freezing of gait (FOG) is defined as a brief, episodic absence or marked reduction of forward progression of the feet despite the intention to walk. It is one of the most debilitating motor symptoms in patients with Parkinson’s disease (PD) as it may lead to falls and a loss of independence.National Library of Medicine
In this article we’ll go over some information about FOG and Parkinson’s disease and what can be done to possibly help.
Do All Parkinson’s Patients Suffer With Movement Disorders?
Parkinson’s 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 Parkinson’s 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 Parkinson’s disease may only have a mild tremor, while others may experience more severe symptoms like muscle stiffness and difficulty moving.
In people with Parkinson’s, the cells that make dopamine are impaired. As Parkinson’s 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.parkinson.org
The cause of movement disorders in Parkinson’s 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.
What Causes Freezing of Gait in Parkinson’s?
There are significant differences between people with Parkinson’s who experience freezing of gait and those who don’t. However, there are some commonalities that may help to explain why some people with Parkinson’s disease develop this symptom while others don’t.
One theory is that freezing of gait occurs when certain brain areas are unable to properly process information from the body regarding movement.
This can be due to damage to the parts of the brain that control movement or it may be due to changes in the way that information is transmitted between the different parts of the brain.
Another theory is that freezing of gait may be a result of an imbalance in the neurotransmitters in the brain. Neurotransmitters are chemicals that help to transmit signals between the different parts of the brain.
If there is an imbalance in the neurotransmitters, it can lead to problems with movement.
Yet, another theory involves the contribution that step length has to FOG.
Freezing of gait (FOG) has been identified as one of the main contributors to gait disturbances in Parkinson’s disease. While the pathophysiology remains enigmatic, several factors such as step length and the sequence effect (step to step reduction in amplitude) may lead to the occurrence of FOG.Oxford Academic
There are many other theories about why freezing of gait may occur in Parkinson’s disease, but these are three of the most common ones.
It’s important to remember that this and other gait impairments can happen to anyone with Parkinson’s disease, regardless of the cause.
Freezing episodes can be triggered by factors such as fatigue, stress, anxiety, changes in the environment, or an uneven surface. In some cases, freezing may be a side effect of medication.
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…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 personadpaparkinson.org
Other studies have also found that their research indicates and supports the theory that the pathophysiology of FOG “…implicates a dysfunction across coordinated cognitive and motor neural networks.” – IOS Press Content Library
There is no single cause of freezing of gait in Parkinson’s disease, and it is likely that multiple factors contribute to the condition. Further research is certainly needed to determine exactly what is happening to cause this debilitating symptom.
What Does Freezing in Parkinson’s Look Like?
The primary symptom of freezing gait is an inability to take a step, even when there is a strong desire to do so.
This can happen when starting to walk or when turning around. Freezing episodes can last for a few seconds or minutes and may be accompanied by a feeling of uncertainty or anxiety.
It’s very easy to see or even imagine what this looks like. Imagine you’re at a football game. The crowd is roaring and you want to stand up to get a better view. But your legs just won’t move.
You try to take a step, but your feet feel like they’re glued to the ground. That’s what freezing of gait can feel like.
The basic science is that the message to move from the brain simply does not get to the muscles that are needed to make the motion happen.
Walking demands a complex and balanced recruitment of neuronal systems requiring attention, afferent information processing and intentional adjustments (15,16). The motor cortex, midbrain, hindbrain, and basal ganglia are all involved in the decision making and planning of locomotion.National Library of Medicine
It’s as if your brain is saying “Get up!” or “Take a step!” but your body isn’t getting the message. How annoying is that?!!
Here’s a video showing you what this exactly looks like:
It’s easy to see how this symptom can impede the person’s ability to walk and get around. So much so that they may require the physical assistance of someone to help them.
What Stage is Freezing in Parkinson’s?
Freezing typically occurs in the later stages of Parkinson’s disease, but it can occur in the early stages as well. Freezing episodes can be unpredictable and may happen without warning.
One thing to remember is that this condition often worsens as the disease progresses. But, not all persons with Parkinson’s disease suffer from the freezing of gait.
If you or your loved one suffers from this, please speak to your doctor, seek the help of a physical or occupational therapist, and take advantage of the tools that can help you.
What Triggers Freezing of Gait in Someone With Parkinson’s Disease?
There are many possible triggers for the freezing of gait in Parkinson’s 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 (new room, new walking surface, different lighting, etc.)
- Stress or anxiety
- Crowded places
- Low blood sugar levels
- Strong emotions
For most people with Parkinson’s disease, freezing episodes are brief and resolved without any assistance. However, for some people freezing can be a more chronic and disabling symptom.
How Long Does Freezing Last in Parkinson’s?
Freezing is a symptom of Parkinson’s disease. It can occur at any time but is most common when you are starting to walk. Freezing episodes can last for a few seconds or up to several minutes.
There is no cure for freezing, but there are treatments that can help reduce the frequency and duration of episodes. If you are experiencing freezing, talk to your doctor about the best way to manage your symptoms.
How Do I Stop My Parkinson’s From Freezing?
The freezing of gait can have a significant impact on the quality of life for people with Parkinson’s. So, it’s important to tailor the approach to the specific situation.
The types of treatments that can help with freezing of gait in persons with Parkinson’s disease range from medical to physical to adaptive equipment.
In some cases, deep brain stimulation (DBS) surgery may also be an option.
Although there is no one-size-fits-all solution to managing freezing of gait, there are some helpful strategies that may be recommended by your doctor including:
- Exercising regularly to improve your overall fitness and balance (consult with a physical therapist for the best types of exercises specifically for you).
- Music sometimes helps, even singing or humming a tune may help.
- A metronome can also help (anything that provides a beat).
- Practicing walking in different environments, such as on uneven surfaces or in narrow spaces.
- For some, taking a deep breath in and a shorter breath out helps.
- If you feel frozen and unable to move forward, try stepping to the side or backward.
- Taking small, shuffling steps when you start to walk from a standing position.
- Rock right to left, this may help to regain movement.
- March in place.
- Assistive devices such as a cane or walker.
- The doctor may recommend dopaminergic medication such as amantadine. Also, other medications such as anti-depressive drugs, acetylcholine esterase inhibitors, and methylphenidate may be helpful. (source National Library Of Medicine).
- Surgery involves deep brain stimulation which involves implanting electrodes in the brain.
- Swing your arms before taking a step.
- Wear shoes with good traction to prevent slips and falls.
- (some of these recommendations from parkinsonsdisease.net)
There are many rehabilitation programs available to help people with Parkinson’s disease. Some of these programs focus on helping people with freezing of gait and can be very helpful in reducing the symptoms of this condition.
Other programs focus on general fitness and exercise, which can also help to reduce the symptoms of Parkinson’s disease.
There are many different types of rehabilitation programs available, so it is important to speak with a doctor or medical professional to find the best program for you.
In many cases, a combination of different types of programs may be the most effective way to reduce the symptoms of Parkinson’s disease.
As you can see, there are many options that can provide a beneficial effect. Work with your doctor to find the best treatment plan for you.
What Helps Parkinson’s 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 Parkinson’s, 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.
A tool that may be very beneficial for someone with Parkinson’s is NexStride. You probably haven’t heard of it yet so let me introduce you to it.
Nexstride is the flagship product of De Oro Devices. They are currently partnering with Oasis Rehab and Nursing For Parkinson’s Rehab!
Freezing of gait is an incredibly debilitating complication, but it doesn’t have to be. That’s why we’re thrilled to partner with the skilled rehab team at Oasis Rehab and Nursing to advance our shared mission to help people move and live how they want to using NexStride. This partnership will provide patients with the best technology and the best care, opening new doors toward mobility and independence in their lives.Sidney Collin, CEO of De Oro Devices
This great little gadget easily and quickly attaches to your cane, your walker, or your walking poles. It is the ONLY product of its kind that attaches to any cane, walker, or poles!
This versatility makes NexStride a user-friendly and valuable tool because it allows you to continue using your very own walking aid.
The way NexStride works is that it gives the user visual cues as well as auditory cues which are adjustable to meet the needs of the user.
Bonus: NexStride is available for FREE for veterans through the VA (click here for information)
There’s no better way to show you how this great product works than to use a video so check it out!
Another tool that was created specifically for Parkinson’s patients is the u-step walker. This is a very maneuverable walker that allows the user to turn within 29 inches (vs. the standard 50 inches that other walkers require).
Here’s a video showing you what this walker looks like.
Researchers and health professionals continue to work on treatments for Parkinson’s and it’s many symptoms. The Michael J. Fox Foundation is one organization that is working on projects such as a vibrating shoe to help combat FOG.
There’s also a study by Exeter University (maybe more than one) that is using virtual reality tools combined with weight shift exercises to not only analyze what is happening during a freezing episode but how to overcome it as well.
Of course, future studies will continue to be conducted on these treatment possibilities and tools.
It is important for caregivers and every family member to be patient and understand that walking may take some time for your Parkinson’s patient to get used to.
With a little bit of help and encouragement, however, most people with Parkinson’s can continue to enjoy this wonderful form of exercise.