Vertical Ground Reaction Force
In normal gait, the vertical ground reaction force plot has two peaks one when the foot strikes the ground and the second peak is caused by push-off force from the ground. The shape of the vertical GRF signal is abnormal in PD. In the earlier stages of the disease, reduced forces are found for heel contact and the push-off phase resembling that of elderly subjects. In the more advanced stages of the disorder where gait is characterized by small shuffling steps, PD patients show only one narrow peak in the vertical GRF signal.
This Laser Pointer Stablizes The Laser From Hand Tremors
Date Published:
The SteadyLaser is a laser pointer that stabilizes the laser from your shaky arms and is perfect for anyone who suffers from Parkinsons disease and would still like to use a laser pointer, someone who gets very nervous and shaky during a presentation at the office, or anyone who just needs extreme precision when shining their laser pointer into their neighbors living room. The SteadyLaser laser pointer is made using a two axis inertial stabilization mechanism that filters out pan and tilt hand tremor disturbances, thus making it appear as if you are Cool Hand Luke himself, even if you are sweating profusely, on the verge of fainting, and shaking your hands back and forth at uncomfortable speeds.
The SteadyLaser laser pointer is currently in a funding phase on Kickstarter with an estimated delivery date of December 2015, so go reserve yours now, and be sure to check out the laser pointer in action via the video below.
Future Of Freezing Of Gait Treatments
Various research approaches may transform how freezing of gait is treated in the future. Cognitive training strategies are being studied to determine if they improve freezing of gait. Another approach is the development of wearable technology systems that can detect an imminent freeze and then automatically deploy a sensory cue. Novel deep brain stimulation targets are also being developed as a method of controlling freezing of gait.
APDA invests in research that may lead to new treatments for the gait disorders of PD. Here are some examples:
Christopher Bishop, PhD, at Binghamton University in Binghamton, NY, is studying an area of the brainstem known as the pedunculopontine nucleus, which plays a key role in movement and wakefulness. It has been an experimental DBS target for relief of freezing of gait and PD-related gait disorders with mixed results. Dr. Bishop is probing the specific functions of this key brain area to determine how they impact PD symptoms.
Aasef Shaikh, MD, PhD, at Cleveland VA Medical Center, University Hospitals Cleveland, and Case Western Reserve University in Cleveland, OH, is studying the complex interactions of various neurologic systems, their effects on gait and balance in PD, and how they can be modified by DBS. The systems that Dr. Shaikh studies include vision, eye movements, the inner ear/vestibular system, and proprioception.
Tips and takeaways
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Data Acquisition And Processing
The inertial sensors recorded triaxial linear accelerations and triaxial angular velocities at 128 Hz. The same axes of orientation of the IMU depended on the subject’s leg shape and how they walked. In a standing position with the feet parallel to each other, the y-axis was approximately vertical, and the positive direction pointed downward, the z-axis was approximately horizontal , the positive direction pointed forward, and the x-axis direction was determined by the right-hand rule a software code for the IMU -managed data acquisition. After the acquisition, the data were uploaded to a computer in a single file for each trial via Matlab. Offline, accelerometer, and gyroscope data were low-pass fourth-order zero-phase Butterworth filtered with a 60-Hz cutoff frequency. The beginning of the turn was defined by the moment when the vertical acceleration was higher than 5% of the maximum value.
In addition, one trial was acquired with the subject standing upright and as still as possible for 10 s, in case someone wants to calibrate the sensors.
Placement of the IMU and a flowchart with the preprocessing steps are presented in Figure 1.
Rhythmical Or Auditory Cues
- A steady beat from a metronome or suitable music can help. The rhythm should be a comfortable pace, the beat prompting you to lift your feet and step.
- Develop a trigger word such as go, step or march to re-start your walking.
- Try closing your eyes to take the first step, making sure it is safe to do so, then open your eyes to continue walking.
- Hum a tune or download music with a good beat onto an MP3 player to keep your walking pattern going. Remember though that you should not use your MP3 in busy places where you should listen for traffic.
- The cue timing can be varied according to where you are, for example you will probably walk faster when outside, and slower in your home. See our video – Coping Strategies: overcoming freezing by counting 1 and our video – Overcoming freezing by counting 2.
- A physiotherapist or occupational therapist may be able to advise on mini metronomes or similar devices that can be clipped onto clothing so can be taken with you anywhere.
Attentional strategies use your imagination
The weight shift method
Start hesitation
Touch
- Touching a particular part of the body can also sometimes be helpful as a cue to unblock freezing see our video: Coping Strategies: using touch as a cue.
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Measurement Accuracy For The Temporal Characteristics Of Freezing Of Gait
Our results indicated that the total duration of FOG and %FOG in FOG scoring based on videos had good intra-rater and inter-rater reliabilities because an ICC greater than 0.75 was considered good . The percent of freezing was demonstrated to have intra- and inter-rater agreement in a previous study . The study showed that ICC values were slightly lower than those in the present study. Possible causes were that this study was conducted in a single center moreover, the evaluators performed scoring in the same sequence.
Physical Therapy Can Help
In addition to medication, physical therapy can help with walking. There are several strategies that can be used to overcome freezing episodes.
Strategies include taking a high marching step, counting to three before stepping, or walking along to the rhythm of a metronome. Using visual cues such or stepping over a target such as a laser beam or line on the floor can also help with gait.
Assistive devices such as walkers or canes can be helpful in reducing the risk of falling.
Engage with the community by asking a question, telling your story, or participating in a forum.
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Directing Focus To Stay One Step Ahead
The subthemes focused attention internal dialogue and anticipating and planning group together to form this theme. Participants described having to place an increasing amount of conscious effort into dealing with the present moment and, more specifically, performing activities without falling. They were more careful and aware of challenging situations and had begun to implement a sort of strategic carefulness, which could entail staying seated on the bus until it had come to a full stop or walking on the middle of the train platform instead of near the edge.
Yes exactly, and at the same time, if I walk on a path and meet someone I let them pass in a way that I do not have to step aside, because then I would be afraid that I might fall.
While in the moment of performing a certain balance-demanding task, such as walking, participants described having to concentrate on this 1 task with undivided attention.
Yes I do that, when I walk from the kitchen counter to the sofa I do that. But the thing is that I concentrate on just that one thing that I am doing right then, and then when I sit down, then I relax a little. But I cant relax while Im walking.
The subtheme internal dialogue concerns how participants pep-talked themselves when faced with environmental demands such as icy streets, stairs, or an oncoming crowd of people. It also entails how they communicated with their body to prepare for and thereafter perform the action in a goal-directed manner.
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Freezing Of Gait And Balance Disturbances: Lumping Versus Splitting
The concurrence of FOG and balance disturbances in advancing PD is hard to ignore but for the purposes of computational modeling, knowing if these features are related neurobiologically or are discrete, is of critical importance. Previous studies have identified the overlap between poor balance and FOG , as well as identifying that a deterioration in balance may be a useful predictor for those patients developing FOG .
Anatomically, it would seem intuitive that the neural pathways serving gait and balance do demonstrate a degree of meaningful overlap that could link these processes but this does not necessarily represent a fixed anatomical connection and may perhaps be more functional. For example, dopamine loss is the hallmark of PD but can also be seen in some people with vascular parkinsonism and normal pressure hydrocephalus, who also experience FOG and falls . Indeed, whilst both FOG and balance disturbances are frequently related in PD, they can occur independently, suggesting that their pathophysiologies may, to some degree, be separable. In one recent study, PD patients reported that 61% of falls were due to FOG rather than being attributed to slips, trips, balance loss, or syncope .
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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.
How Can I Help Myself
Freezing in public places can be upsetting, embarrassing and even frightening. You may feel tempted to avoid situations that are more likely to make you freeze crowded rooms, narrow entrances etc but this may not always be practical. Social activities are important to quality of life and overall wellbeing so it is important to find out what strategies work best for you to prevent or overcome freezing. This will mean that you can continue to do things you enjoy.
The first thing to remember if you think you are about to freeze is to stop moving so that you have time to think about your balance. Stay calm and dont rush. You can then think about your next movement and plan how to carry it out before you actually move. Following these simple steps will allow you to put in place the strategies you have learned to overcome freezing and will reduce the risk of falling.
If you experience frequent freezing your doctor may suggest that you keep a medication or wearing off diary to help establish what might be causing these episodes. By keeping a diary, you can record the timing, duration and frequency of freezing episodes, as well as the timing and dosage of each medication, which can help your doctor in adjusting medication to try to overcome freezing problems. For a sample diary and information on keeping one, see Keeping a diary.
If you find that you freeze in busy places such as shops or public places you may find the following strategy helpful:
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What Does It Do
This laser light accessory provides visual and auditory cues, providing something to focus on that would naturally initiate the ability to walk again. It isnt uncommon for those with PD to suffer from reoccurring freezing episodes, theyre random at best and theres no real warning for when theyll come on. When the laser light accessory is attached, there are buttons near the handle to initiate the laser, after ten minutes of idle use, the laser will turn off automatically.
The theory behind these laser mechanisms is that the visible cue of the laser will bypass anything the brain might be telling the legs, resulting in the ability to walk towards the light. In some cases, it might not always work as there is no treatment for these freezing episodes, but it does help initiate the process of walking again.
While its very possible to simply just tape some laser pointers to your walker, we recommend using the actual product as it has better programming and is more functional to those with disabilities. Although, keeping a pocket laser here and there definitely couldnt hurt!
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Management Of Parkinson’s Disease
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In the management of Parkinson’s disease, due to the chronic nature of Parkinson’s disease , a broad-based program is needed that includes patient and family education, support-group services, general wellness maintenance, exercise, and nutrition. At present, no cure for the disease is known, but medications or surgery can provide relief from the symptoms.
While many medications treat Parkinson’s, none actually reverses the effects of the disease. Furthermore, the gold-standard treatment varies with the disease state. People with Parkinson’s, therefore, often must take a variety of medications to manage the disease’s symptoms. Several medications currently in development seek to better address motor fluctuations and nonmotor symptoms of PD. However, none is yet on the market with specific approval to treat Parkinson’s.
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The 5s Method Consists Of The Following 5 Sequential Steps:
If you are a Thrive patient, be sure to ask your therapist for your 5S magnet if you dont already have one.
Walking Therapy Aid For Parkinsons
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What Is Brain Surgery For Parkinsons Disease
Brain surgery for Parkinsons disease is done to balance the activity in certain areas of the brain that control physical movement. The surgery can involve placement of a stimulator device or creation of a surgical lesion in the brain.
The areas of the brain that are affected by Parkinsons disease are very small, and they are located deep within the brain. These procedures are done with precision and often with imaging guidance so your surgeon can see the structure of your brain with real-time pictures during the surgery.
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Insights From Reductionist Observations
As highlighted above, many reductionist studies comparing patients with and without FOG across clinical features and a range of biomarkers have provided insights into the role of many different physiological processes and anatomical regions. For example, a lesion analysis performed in a series of 14 patients who developed FOG, demonstrated discrete disturbances in the cerebellar locomotor region , an area functionally connected to the dorsal medial cerebellum . Work from a recent meta-analysis of neuroimaging studies in PD has also suggested that CLR activation may play a compensatory role in locomotion . As outlined above, other studies have suggested a more generalized pathophysiology, which has allowed a common final pathway to be postulated . However, the question must be raised as to whether all the relevant anatomical regions work together to produce a common input to this pathway or whether they speak separately to this single common pathway or multiple pathways.
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Tips For Coping With Speech Difficulties
- Exercise your voice by reading out loud or singing every day.
- Drink enough water, avoiding shouting and rest your voice when it is tired.
- Train your voice like an actorsit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
- Get feedback from friends and family members about how others perceive your speech develop a cue or code word you can use in public to make you focus on speaking clearly.
- If you have soft speech, use tools such as a voice amplifier , placed on your shirt, and on the telephone . Ask an occupational therapist about other tools.
- Make eye contact with the person to whom you are speaking.
- Reduce background noise.
- Socialize in small groups or one-on-one.
- If you experience a facial masking, use feeling words to communicate your emotions . Use practice physical gestures to help convey emotions.
- Determine which times of day your speech is best. Plan social engagements around those times.
Even in the early stages of PD, many report that their voices are too soft, causing others to ask them to repeat themselves. Other people with PD may have a gruff or hoarse quality to their voice. Try these strategies:
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
For more insights on this topic, listen to our podcast episodeImportance of Early Detection of Swallowing Disturbances or download our Speech and Swallowing book.