How do I help my patient with Parkinson’s disease (PD) overcome freezing of gait?
Contributed by Casey Brennan, PT, Clinical Mentor
Freezing of gait is common and becomes more prevalent as PD progresses, affecting up to 50% of patients. Common triggers for freezing gait include a change in terrain, obstacles in the pathway, or narrowing of the pathway. Telling a patient to walk faster can increase shuffling gait and festination.
Evidence supports external cueing to promote unfreezing of gait. Patients with PD often have an increase in freezing of gait when they try to fight through it, so tapping into other motor processes including sidestepping around an object, alternating kicking, blinking, or humming may facilitate unfreezing. Auditory cues including use of music or a metronome can improve stride length, cadence, and velocity. Visual cues including marked targets on the floor transverse to the patient can have a carryover effect with stride length. And verbal cues including exaggerated steps and arm swing have been shown to facilitate a more normalized gait pattern for patients with Parkinson’s disease.
There is also high evidence for community based exercise in reducing motor disease severity in PD. Rock Steady Boxing is an evidenced based, community exercise program for people with PD which uses non-contact, boxing based fitness curriculum to help manage Parkinson’s symptoms and improve quality of life. There are Rock Steady gyms worldwide, including in AL, AR, FL and MO. Check out their website for locations and inspirational videos at rocksteadyboxing.org.
References
Fasano A, Lang AE. Unfreezing of gait in patients with Parkinson’s disease. Lancet Neurol. 2015(7):675-7.
Spaulding SJ, Barber B, Colby M, Cormack B, Mick T, Jenkins M. Cueing and Gait Improvement Among People with Parkinson’s Disease: A Meta-Analysis. Arch Phys Med & Rehabil. 2013. V94(3):562-570.
Osborne JA, Botkin R, Colon-Semenza C, DeAngelis TR, Gallardo OG, Kosakowski H, Martello J, Pradhan S, Rafferty M, Readinger JL, Whitt AL, Ellis TD. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther. 2022 Apr 1;102(4).
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