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Strategies to Combat Freezing in Parkinson’s Patients

Strategies to Combat Freezing

Freezing” is when an individual suddenly feels like they’re glued to the ground. Parkinson’s disease patients often experience freezing during the late stages of the disease. It can occur while the person is in motion or after they’ve been stationary and then attempt to move. It’s associated with complicated movements like dodging obstacles or getting up from a chair.

The loss of automatic motor skills affects one’s sense of control and even their safety, as about 38 percent of Parkinson’s patients fall each year. Tracking when your struggles occur can help you to manage them, allowing you to challenge how frequently freezing occurs.

What causes freezing?

Not everyone with Parkinson’s experiences freezing, and the exact cause of freezing is unknown. But our relationship to balance gives insight into potential causes. Parkinson’s patients experience changes in the brain that affect the way they walk.

Dr. Howard Weiss, in his blog for the Parkinson Foundation of the National Capital Area, writes, “’Freezing of gait’ is often triggered by specific activities or circumstances that demand switching between motor actions.” While learning to walk, we strengthen the neural pathways that allow us to balance. But Parkinson’s patients see a degradation of these pathways, leading to difficulty in stabilization.

What freezing is like for my dad

Like many Parkinson’s patients, my dad notices that he usually only freezes when he’s not on his medication. It usually happens while he’s moving through doors: “When you pivot you’re worried about losing your balance. That’s why we shuffle our feet and take baby steps initially. Once I’m moving I’m fine,” he says.

Since he’s worried about maintaining balance while navigating, it’s possible that there’s a connection between fear and freezing. Continuous motion seems to bypass the risk of freezing, while shifting motion types can present challenges.

But curiously, stairs are rarely problematic: “I freeze just before I’m ready to go down the stairs. But when I’m actually walking downstairs I don’t have a problem. I can practically hop down them once I’m in motion. And going upstairs is fine,” he says. Getting started can prove challenging, but the act of walking up and down the stairs is still relatively easy.

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 Parkinson’s 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 he’s able to unfreeze himself: “When I freeze, I stand up straight. If I move away from gravity, I can unfreeze. But if I’m 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. Freezing’s scary. That’s why a lot of Parkinson’s patients fall.”

Exercise and physical therapy can be game changers

Joining a Parkinson’s-specific fitness program like Rock Steady Boxing helps you to strengthen your motor functions. This ultimately allows you to stabilize with more ease. Since Parkinson’s patients often see a decline in motor skills, exercise can offer a good option for strengthening those skills. Rock Steady also uses portions of the class to teach Parkinson’s patients how to fall.

According to Dad, “About once a month or so, they’ll put mats on the floor and show you proper falling and rolling technique. They try to do things in boxing that’ll help people with different stages of Parkinson’s.”

While the exercise portion of Rock Steady Boxing is valuable in itself, learning how to fall helps mitigate risk as much as possible.

Freezing is a frightening phenomenon, but there are ways you can manage this symptom. Stay positive! Try to find Parkinson’s fitness classes or challenge yourself with rhythmic solutions to freezing. Other patients have found that these strategies can assist in the management of motor-related functions.

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Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Treadmill Incline Training Improves Walking Speed of Parkinson’s Patients, Study Finds

treadmill incline training

Eight weeks of training on a treadmill with continuously varying surface inclines improved gait disturbances, particularly walking speed, in Parkinson’s disease patients, researchers report.

Their finding were published in the study, “Exploring gait adaptations to perturbed and conventional treadmill training in Parkinson’s disease: Time-course, sustainability, and transfer,” in the journal Human Movement Science.

As the disease progresses, Parkinson’s patients experience an increase in gait difficulties and balance problems, lowering their mobility and quality of life.

In addition, studies have shown that Parkinson’s patients take shorter and slower steps, and have high stride-to-stride variability.

Because some gait disturbances are drug-resistant, nonpharmacological treatment options are needed to improve these patients’ quality of life.

“Improved stride length and stride-to-stride variability have been demonstrated following several weeks of treadmill practice for both, overground and treadmill walking, respectively,” the authors wrote.

Researchers had recently demonstrated that eight weeks of treadmill therapy with additional postural perturbations (i.e., varying surface inclines) improved overground gait speed and dynamic balance control in Parkinson’s patients.

Now the same team at Friedrich-Alexander University Erlangen-Nürnberg has analyzed spatiotemporal gait adaptations to treadmill training — with and without an incline — both on and off the machine.

They used data from a randomized controlled Phase 1 trial (NCT01856244) aimed at investigating the effectiveness of a sensorimotor treadmill intervention to improve walking and balance abilities in people in the early stages of Parkinson’s disease.

Sensorimotor treadmill training was conducted on a special machine that challenged the participants through small oscillations, simulating walking on natural, uneven surfaces. This intervention was compared with conventional treadmill training without surface perturbations.

Thirty-eight Parkinson’s patients were randomly assigned to 40 minutes of treadmill training two times per week for eight weeks. Of these patients, 18 performed treadmill training with continuously varying surface inclines, while the other 20 walked on the treadmill without surface perturbations.

Patients were assessed every week during training protocol (prior to the training sessions), within one week after the intervention, and at a three-month follow-up.

Gait variability significantly decreased in both training groups. Nonetheless, longer stride length and time, stance time, and swing time were significantly improved only in the treadmill incline training group.

For reference, one gait cycle consists of two phases: stance, or the period of time that the foot is on the ground, and swing, meaning the period of time that the foot is off the ground moving forward.

Researchers then investigated the sustainability of gait changes over three months.

At the three-month follow-up, there were significant changes between the groups in stance and swing time, which were due to a much higher variability in the conventional treadmill training group. Statistical comparisons within the groups revealed no significant changes in the treadmill incline training group.

Additional statistical analysis also showed decreased step length asymmetry in the conventional treadmill training group.

The team then assessed the extent of transfer effects to overground gait in both training regimes.

“When considering the entire sample, significant changes in overground gait parameters at [week 8] were observed only for stance- and swing time, with a significantly decreased stance time … and a corresponding increase in swing time,” they wrote. However, these findings were statistically significant only in the treadmill incline training regime.

“[Parkinson’s disease] patients demonstrated marked gait adaptations to the eight-week treadmill intervention, which were partially retained after three months follow-up,” they noted.

Treadmill training with small oscillations seemed to reduce gait disturbances, but the transfer of such changes to overground walking was limited in most evaluated variables.

Further research is still necessary to corroborate these findings.

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Changes in Gait, Cognition May Be Early Signs of Idiopathic Parkinson’s, Research Suggests

gait and Parkinson's

Changes in gait and cognition precede a diagnosis of idiopathic (without known cause) Parkinson’s disease, and may occur earlier than typical non-motor symptoms, a study has found.

The study, “Prediagnostic markers of idiopathic Parkinson’s disease: Gait, visuospatial ability and executive function,” was published in Gait & Posture.

Motor symptoms in idiopathic Parkinson’s disease (IPD) are identified relatively late in the disease course, reducing the odds of neuroprotective benefit from available treatment options. Identifying individuals during the prodromal (early) period that precedes motor symptoms could be of great use for clinical studies seeking new therapies to prevent or delay disease progression.

A team of French researchers sought to determine the existence of any subtle gait disorders or other signs that precede the diagnosis of IPD, based on data from a long-standing study of human aging across the adult lifespan: the Baltimore Longitudinal Study of Aging (BLSA).

Conducted by the National Institute on Aging (NIA) Intramural Research Program, the BLSA continuously enrolls healthy volunteers age 20 and older who are followed throughout their life independently of the development of age-related diseases.

Ten pre-diagnosed IPD patients (eight men and two women) and 30 healthy control subjects were chosen for this study.

Subjects were assessed for the disease approximately 2.6 years before diagnosis. Clinical examination included gait speed, spatio-temporal gait parameters, balance, upper-limb motor skills, neuropsychological profile, and non-motor symptoms.

In comparison to the control group, IPD patients had shorter step length and reduced gait speed in a usual gait speed testing condition. Despite also having shorter step length when testing maximum gait speed, no differences between the IPD and control samples were found in walking speed.

Moreover, patients had worse mental rotation ability (the ability to rotate mental representations of two-dimensional and three-dimensional objects, which is related to the brain’s capacity for visual representation), and impaired ability to name different examples that could be inserted into a category (for instance, naming all types of flowers one can think of in one minute).

Compared to control subjects, IPD patients had no changes in upper-limb motor function, no depression, no sleep disturbances, no urinary symptoms, and no orthostatic hypotension (when blood pressure suddenly drops when standing up quickly).

Researchers concluded that the observed “changes might serve as markers to improve the early detection of IPD patients, who could then benefit from pharmacological neuroprotection trials and/or prevention trials of lifestyle-related interventions in order to delay, or even prevent, clinical manifestations.”

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