Sunday, April 7, 2024

Parkinson’s Freezing Of Gait Treatment

Is Freezing Related To The Intake Of Dopaminergic Medication

Overcoming Parkinson’s Freezing of Gait NexStride Explained

Some people with Parkinsons have on and off periods, when they switch from being able to move when their medication level is higher to being unable to move without difficulty when their medication level is low . Many people notice that freezing is worse when their medication level is low, when they are off. But freezing is not the same as being on or off.

Interplay Between Automaticity And Controlled Cognitive Processes

In this part, we describe why the interplay between automaticity and cognitive control might be crucial in understanding FOG. Several studies report that when task requirements are ambiguous or cognitively challenging, freezers seem to experience a complete breakdown in locomotor function, known as a FOG episode. These observations indicate that general cognitive resources are diminished in freezers compared to non-freezers. Lewis and Barker argued that an imbalance between motor, cognitive, and limbic activation is a key factor in explaining FOG episodes. Our aim is to analyze the role of specific processes in the occurrence of FOG. More specifically, we focus on the fragile balance between automaticity and control, regulated by the frontostriatal circuitry. To this extent, we constructed a model 1) describing the disturbed cognitive pathway leading to a FOG episode, based on previous studies examining controlled operations and automaticity in freezers. Two tracks can be discerned: a direct route requiring automatic responses regulated by the basal ganglia, and an indirect route eliciting a controlled response regulated by frontal cortical areas. When automaticity and controlled processes are hampered, and cognitive resources are insufficient to handle a cognitively challenging situation, a FOG episode could possibly occur.

Model demonstrating the interplay between automatic and controlled cognitive dysfunctions in the occurrence of FOG episodes. .

Inconsistency Or Lack Of Exercise Program

  • Are you challenging your movement patterns and elevating your heart rate on a regular basis?
  • Ill often speak about the imaginary fence line and giving up territory or PD.
  • The less we challenge this boundary which are your personal limits, the more likely youre to give up movement independence.
  • Thats why its important to maintain an active exercise and movement routine on a regular basis.
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    Music Exercise Therapy Group

    In addition to routine rehabilitation treatment, we will provide music exercise therapy, in which patients will perform scheduled exercises according to the rhythm of music. This will be performed 5 times a week for 4weeks, with 1h each time.

    Music selection

    Music therapists will screen musical tracks and rhythms according to the actual situation and music preferences of patients with Parkinsons disease. Thereafter, the therapists will create a personalized music playlist for each subject, because the lyrics in the music may distract attention of the PD patients, hence selection of music with lyrics will be avoided. Each playlist will be loaded into a personal music player, and subjects are allowed to choose earplugs or headphones for maximum comfort. The mode setting of the music player will be sequential play, and not random play. Moreover, music will be played by a designated music therapist, and subjects will be also told that they can request changes to their playlists at any stage during intervention.

    Exercise therapy

    While listening to music using earphones, the patients will be subjected to conduct flat start walking, turn around, and stop trainings, as well as narrow space walking and stair step training according to the beat in the music. The patients will be expected to simultaneously complete a cycle of exercise relative to completion of the music playlist.

    Points for attention

    Ways To Reduce Parkinsons Freezing Of Gait

    Freezing of Gait &  Parkinson

    Do you sometimes feel like your feet are stuck to the floor or your hips are glued to your chair, despite your best efforts to move them?

    This symptom, called freezing, has been seen in 30-67% of people diagnosed with Parkinsons, with a higher rate of incidence in later stages.

    While everyone has unique freezing patterns, some common triggers include turning in tight spaces, walking through doorways, walking in narrow hallways or crowded places or changing walking surfaces .

    As soon as you notice freezing symptoms creeping up on you, its important to address them so you can prevent them from worsening over time.

    The first line of treatment is often dopaminergic medications that aim to keep you in an ON state for longer. However, evidence suggests there is a cognitive component of freezing that medication and deep brain stimulation do not address effectively.

    This is why the best long-term treatment option for Parkinsons freezing is non-pharmaceutical, non-invasive and focuses on retraining your brain for success.

    Here are six actions you can take to help minimize your freezing of gait.

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    What Is Freezing Of Gait

    Freezing of gait is an abnormal gait pattern that can accompany Parkinsons disease as well as other parkinsonian disorders in which there are sudden, short and temporary episodes of an inability to move the feet forward despite the intention to walk. In a sense, youre stuck. This results in the characteristic appearance of the feet making quick stepping movements in place. However, while the feet remain in place, the torso still has forward momentum which makes falls unfortunately common in the context of freezing of gait. For some, these episodes can simply be frustrating, annoying and perhaps embarrassing for others freezing of gait can become incredibly disabling and lead to injury.

    Freezing of gait episodes tend to occur least often when walking on an unobstructed, straight path. Any deviation from that can induce freezing for example, when you first try to start walking, when you go to make a turn, or try to navigate around obstacles or through narrow spaces any of these can cause you to get stuck.

    The particular triggers for one person may be different than for another. An episode is typically very brief, often lasting only 1-2 seconds, although they can last longer. Freezing of gait can be affected by anxiety, so if a person feels rushed , freezing may be particularly prominent.

    Will Medication Help With Freezing Of Gait Episodes

    In a study of 593 patients living with PD found that 325 experienced freezing of whom 200 experienced FOG only during medication off state , 6 people experienced FOG only during on state and 119 either in on and off states or independently of dopaminergic response-related symptoms .

    Overall, the key findings of the study showed that

  • When comparing freezers vs non-freezers, freezers tend to have been living with PD for longer so they had a more advanced stage of PD, as well as, more advanced disease and greater disability.
  • Freezers also more frequently reported medication wearing-off and experienced worse quality of life.
  • Comparing onoff-freezers with off-freezers, they tend to be older, more severely disabled, less likely to experience wearing-off, treated with lower levodopa equivalent daily dose and with poorer cognitive performance.
  • In short, there is a trend to observe freezing of gait n later stages of the disease state, however those who experience FOG in both On and Off medication states are likely the result, according the researchers, to be under medicated

    TIP: If youre experience Freezing in both medication ON and OFF states be sure to speak with your doctor regarding your current medication regime.

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    Identify Your Triggers And Retrain Your Brain

    Your therapist will evaluate your unique triggers and symptoms and guide you through an exercise program that incorporates cognitive challenges and physical training. This will help retrain your brain to use more effective walking patterns and reduce freezing episodes.

    Those with more intense freezing symptoms may benefit from short anti-freezing intensives, like the one they offer at the PWR!Gym in Arizona.

    In addition to working with a Parkinsons physical therapist, here are five more general strategies you can try to help avoid a freezing episode.

    Why Does Freezing Happen In Parkinsons Disease

    Freezing of gait

    Its clear, anything to do with the brain is far from simple.

    When it comes to the brain networks which controls your gait, yep you guessed it, its complex.

    Your walking pattern relies on multiple connections and pathways between various parts of the brain.

    Freezing of gait can be viewed like a good detective novel.

    Movement is a dynamic activity. It adapts and responds to the world around us. As a result, there are a number of brain regions or characters implicated as being involved with Freezing of Gait in Parkinsons Disease.

    These brain areas are widely distributed and act in a synchronised and consistent manner.

    You could say movement involves dynamic brain network coordination, and its this circuitry, this network behaviour, which appears to be affected and in the end gives rise to Parkinsons freezing of gait .

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    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 Parkinsons 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 hes able to unfreeze himself: When I freeze, I stand up straight. If I move away from gravity, I can unfreeze. But if Im 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. Freezings scary. Thats why a lot of Parkinsons patients fall.

    Nutrition Hydration And Gut Health

    • A diet which supports your tummy motility can help avoid some of the associated complications of PD such as constipation.
    • Being consistent with a Mediterranean diet may also be positive step.
    • The problem with nutrition research to date is that there is a lack of quality and depth.
    • The recommended approach is to work with a skilled Dietician or Nutritionist to help provide you with a personalized plan.

    Also Check: Parkinson’s Disease Fun Facts

    Shake Off Your Stress

    Freezing episodes are more frequent and intense when youre anxious. Anxiety leads you to tense up your hands, arms, shoulders and jaw which raises stress in your body and feeds your freezing, making you even more anxious!

    To combat this vicious cycle, deliberately give your body a good shake before you start walking. Start with loosening and shaking your hands, arms, shoulders, neck and tongue. Take a deep breath, stay as relaxed as possible and set out towards your destination!

    Heres 13 Freezing Of Gait Tips To Help You Get Moving Again

    How You Can Overcome Parkinson

    1.Keep your movements BIG Scale Matters.

    Slowness of movements is one of the cardinal symptoms of Parkinsons disease. The sequence effect is a feature observed with Bradykinesia in which there is decline in amplitude and speed of repeated movements .

    So, as a person commences movement there is relative scale and as person continues with the movement it gets smaller and smaller. It is a major cause of disability in Parkinsons disease.

    Medication has had mixed results with this feature of PD though external prompts have shown to be beneficial .

    Like a bank account, movement appears to have an energetic cost and as a person progress in a movement, there is less and less available.

    Dopamine supporting medication allows the trigger for movement but appears to not maintain the vigor and size of movement according to research.

    What To Do:

    Aim to make over exaggerated movements, such as Big steps and Big arm swings. Its a way to retrain the muscles and slow down the progression of hypokinesia, the increasingly smaller, more shuffling movements that happen with Parkinsons.

    Working with someone else is important here and we offer this in our PD Functional Movement Programs

    2. Develop the mindful skills to walk with purpose and with intent.

    Using therapy programs to practice these skills there are emerging positive results using interventions like:

    • treadmill training
    • obstacle aquatic training a form of hydrotherapy
    • slackline training
    • walk bicycle

    4. Pick a Destination

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    Exercise And Physical Therapy Can Be Game Changers

    Joining a Parkinsons-specific fitness program like Rock Steady Boxing helps you to strengthen your motor functions. This ultimately allows you to stabilize with more ease. Since Parkinsons 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 Parkinsons patients how to fall.

    According to Dad, About once a month or so, theyll put mats on the floor and show you proper falling and rolling technique. They try to do things in boxing thatll help people with different stages of Parkinsons.

    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 Parkinsons 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.

    Predictors Of Freezing: When Are People Living With Parkinsons Most Likely To Freeze

    Freezing is common among Parkinsons patients, and is most often seen in those with long-standing symptoms.

    A survey of 6,620 people living with Parkinsons disease found that 47% reported experiencing freezing regularly. Further analysis of people who reported freezing showed

    • It was significantly associated with a longer disease duration and a more advanced stage of the disease.
    • Episodes were more likely in men than in women and
    • Finally, people who reported tremor as their main symptom were likely to also report freezing less frequently.

    The results underline the necessity to develop appropriate countermeasures against this phenomenon, which is widely known to cause significant impairment of patients quality of life and as our data also showed may cause traffic accidents in licensed patients.


    A previous study in 2001 has also established

    • Risk factors associated with freezing where found to be at the early stages of the disease 1. the absence of tremor and 2. PD symptoms being mostly as a gait disorder early in the disease experience.
    • The development of freezing over the course of the illness was also strongly associated with the development of balance and speech problems and less so with the worsening of bradykinesia , and was not associated with the progression of rigidity .

    A current study rigorously compared studies and found that strong evidence supports the following risk factors for freezing

    Read Also: Stage 4 Parkinson’s Disease

    References And Sources: Overcoming Freezing In Parkinsons

    The Occupational Therapy Blog is a news and health promotion initiative. It by no means aims to be a source of medical or therapeutic advice. We enjoy sharing information and will attempt to curate it as best we can. Youd appreciate we like to lighten our blog articles which often tackles very serious issues. Its our way of sharing. The information contained on this blog is not intended to be a substitute for professional advice, or intervention. Always seek the advice of your GP or qualified therapist with any questions you may have regarding your personal situation. Never substitute or delay seeking professional advice because of information youve read on this website.

    Common Triggers Or Causes Of Freezing Of Gait

    Freezing of Gait FoG in Parkinson’s Disease

    People who experience freezing may describe situations where they find themselves stuck, for example:

    • Narrow spaces or tapering corridors
    • A disruption to your walking pattern
    • Change direction: A change of direction can induce a freezing experience
    • Crowded places
    • Crowded rooms
    • Responding to unexpected events like being rushed or startled: Trying to get to the toilet on time
    • Changes in walking surfaces
    • Transitions between environments breaks or lines in the walking pathway be they inside or out. This may be experienced in shopping centres with the electric sliding doors or escalators. On and off public transport

    You can appreciate that in the spacious clinic, with uniform floor surfaces it is often hard to detect freezing of gait.

    It happens in everyday life away from the clinic.

    Thats why we offer in tele-therapy, in home and community consultations.

    It allows us to assess the impact of PD in your life and to design personalised plans with the goal to help you live a more independent life.

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    Clinical Molecular Imaging And Biomechanical Data

    Detailed demographic and clinical data are listed in . All subjects showed a sustained improvement from DBS , which was similar to the benchmark positive response from levodopa . This further supports the correct placement of the electrodes that were used for the recording of the STN neural activity.

    In comparison with healthy controls, all patients showed a significant bilateral reduction of striatal DAT binding, with one hemisphere more dopamine-depleted than the opposite one . The average asymmetry index of the striatum was 27 . The H was contralateral to the clinically most impaired body side in each patient. The individual values of striatal DAT binding were previously reported for all patients except Patient nwk01 .

    Biomechanics measurements showed reduced stride length and maximal velocity in subjects with Parkinsons disease with respect to healthy control subjects . All five subjects suffering from FOG showed gait freezing episodes during the study . We recorded 14 freezing episodes , clinically and biomechanically defined. All freezing episodes occurred while approaching a door .

    What To Do When You Freeze Or Cant Get Started

    If a movement isnt flowing well, making the effort to think about each separate part of a familiar or simple movement can help you get going.

    If your feet freeze you may fall over so make sure that any family, friends and carers know about your freezing and know how to help when it happens.

    The first thing to do when you feel yourself freeze is to stop moving, or to slow down. This gives you time to refocus on balance, think about your next move and prepare your body to start again, which can reduce any risk of falling.

    The plan method

    • STOP: calm yourself and take a breath.
    • THINK: what do you want to do?
    • PLAN: how are you going to do it?
    • DO: complete the task or movement.

    The weight shift method

    • When you freeze, dont try to move forward straight away. Instead, gently move most of your weight to one leg . Shifting your weight to your one supporting leg like this will let you step forward with the opposite foot. To help with this count one, two, three, step or say ready, steady, go to yourself to get moving again.
    • You may be able to re-start walking again by gently rocking your head and shoulders from side to side. This rocking can help you shift your body weight to your supporting leg.
    • It may help to say something to yourself as you do this, like move my weight to left leg, then step with right . You may have to rock from leg to leg to release the weight on each foot before stepping off.

    Sound and vision cueing methods

    Using your imagination

    Floor strips

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