Parkinson’s and Walking

One of the most common and possibly frustrating signs of PD is the freezing and/or festination (shuffling steps) of one’s walking. Not only are these symptoms incredibly frustrating for the individual, they can lead to instability and increased risk for falls.

Freezing - What Causes It?

• Freezing is the gait pattern in which a person experiences a sudden and temporary inability to move forward despite their intention.

• Freezing of Gait (FOG) most frequently occurs with any disturbance of walking. For instance, turning, stepping over a threshold between a door way, the change in surface walking on, increased anxiety or walking under a timed pressure.

Festination:

• Festination is characterized by a progressive increase in speed with decreased length of steps. In addition, individuals often have a forward posture which leads to increased festination. Often a cycle is created between forward posturing and shuffled steps. In other words, shuffling steps lead to a forward posture and the forward posture leads to shuffling steps. One may need external assistance or cues to break this cycle.

• Festination may be anteropulsive (forward) or retropuslive (backwards)

Common Triggers for Gait Instability:

Listed below are a few of the more common triggers reported in regards to freezing/festination. It is important to note that this is not an all inclusive list as triggers may be dependent to the individual.

• Narrow areas or thresholds

• Changes of surface (ie: carpet to hardwood)

• Dual Tasks (walking while completing another task)

• Walking under pressure (ie: being timed)

• The initiation of walking or changing direction while walking

• Change in attention demands

• Anxiety and/or stress

How Do We Address Freezing/Festination?

One of the most important strategies to combat gait instability is to identity one’s triggers. It is imperative to keep a mental note or even write down triggers you or your family have noted. If you are having trouble identify triggers, a Physical Therapist may be able to assist you.

The second step is to play to your strengths. In the following paragraph we will discuss various options that individuals have reported to be successful with breaking freezing and/or festinating. Once you have established what mechanisms work for you, it is imperative to use them consistently throughout your day to reduce the risk of instability and falls.

Assistive Devices:

There are many different assistive devices out there, especially for individuals living with Parkinson’s. Some walkers have the ability to project a laser on the ground for a visual target to improve the length of your step. Others can play an auditory metronome to have you walk to the beat. Some even have hand brakes that allow one to stop the walker from moving forward if festination occurs.

Because there are so many options, it is always recommend to talk with your physical therapist and doctor about which device is most appropriate.

Common Tips and Tricks to Counteract Gait Instability:

• Counting your steps aloud - has shown to reduce instances of freezing and improve step length.

• Standing tall and “reseting” - used after freezing has occurred, used as a mental reset prior to initiating walking.

• Marching your feet as high as possible - used to reduce freezing as well as, improve step length and height which leads to decreased risk of falls.

• Auditory cues - using a metronome has been shown to reduce instances of freezing.

• Visual cues - targets on the floor or elsewhere have been shown to increase step length and decrease instances of freezing.

• Assistive devices - provide external support to decrease risk of falls.