Thursday, February 29, 2024

What Is Freezing In Parkinson Disease

Why Do People With Parkinsons Freeze

Managing Parkinsonâs: What Is Freezing?

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 Are Motor Fluctuations Treated

Motor fluctuations affect the quality of life of people with Parkinsons significantly by limiting their activities of daily living, mobility, and social interaction. The treatment aims to keep the person moving and make them carry their daily activities independently.

Doctors can use any of the following strategies to help the affected people to minimize or avoid motor fluctuations:

  • Adjusting the dose of levodopa: The doctor can either increase the dose or change the number of times the drug is taken in a day.
  • Introducing different medications: Adding different medications to the current medication can help maintain consistent levels of dopamine and thus, prevent off-times.
  • These medications include

Tips To Get Moving Again

When you get stuck, these tricks from the National Parkinson Foundation can help:

  • Be aware of freezing triggers and prepare strategies in advance.
  • Shift the weight of your body from one leg to another.
  • Listen to music and step with the rhythm.
  • Hum, sing, or count.
  • Imagine a line to step over or focus on a target on the floor to step on.
  • Use a mobile laser device to create a line in front of you to step over.
  • Turn by walking half a circle instead of by a pivot turn.

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The 5s Method Consists Of The Following 5 Sequential Steps:

  • STOP: Fighting the feeling of being stuck will make it worse. Stop where you are.
  • STAND TALL: Squeeze your shoulder blades back and Power Up your posture.
  • SIGH: Relax your body. Take a deep breath and sigh it out. Shake your hands to loosen them up.
  • SHIFT YOUR WEIGHT: Widen your feet on the floor and shift your weight side to side.
  • STEP BIG: Take a giant step forward and walk like you are on a mission!
  • If you are a Thrive patient, be sure to ask your therapist for your 5S magnet if you dont already have one.

    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.

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    Subthalamic Oscillatory Activity And Connectivity During Gait Freezing

    To investigate the role of the STN neural activity in gait freezing we compared the STN oscillations between walking and ongoing freezing episodes. We first studied power changes in low frequency and in the -frequency band of the two STN and did not find any differences during gait freezing in comparison to walking . We also assessed the duration of -burst and did not find a difference between walking and gait freezing . We finally investigated the subthalamic interhemispheric coupling in the -band and showed an increase of -coupling followed by a reduction in the synchronization between the two STN during gait freezing. However, this change did not reach statistical significance .

    Probing Significant Interactions In Amplitude Synchronization

    In order to distinguish significant from non-significant interactions between signals j1 and j2, we study how their amplitude-phase synchronization index R decays when shifting the signals against each other. Panels and in Fig. show examples of R versus the time shift and suggest that more synchronized signals have a marked decay of R ) that may not be seen for less synchronized signals ). To quantify this observation, we define a significance value W that normalizes the maximum phase synchronization index \ by the background noise characterized by the mean and standard deviation of R. Colloquially, W gives an estimate of how much \ stands out from the noise background. It can be defined by

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    What Is Parkinson’s Disease

    Parkinson’s Disease is a neurodegenerative disease where the connections between the brain and body progressively fail. The neural pathways between your brain and your foot muscles are no longer communicating effectively, causing problems such as Freezing of gait, also known as ‘Parkinson’s disease walk’ or ‘Parkinsonian gait.’

    According to the Parkinsons Disease Foundation, more than 10 million people worldwide currently live with Parkinsons Disease, and 70% of those individuals will fall, which further restricts activity due to fear of future falls. 1,2

    Individuals with Parkinsons have a 2-9 times increased risk of falls compared to healthy individuals of the same age.3

    PD is a complex disease that primarily affects motor function, but can also cause depression and cognition changes. Every person with PD presents differently, both in their symptoms and the speed of their progression.

    Parkinson’s Disease affects the neural circuits that allow the brain to function and enable automatic, smooth movements. As a result, many people with PD will likely show signs of altered walking mechanics at the initial stages of diagnosis, and as the disease progresses, they may experience something called freezing of gait.4

    Freezing of gait or Parkinson’s disease walk is a Parkinson’s patient’s inability to take the next step while walking.

    The Symptoms Of Parkinson’s Disease

    Freezing of gait

    Parkinsons Disease is a neurodegenerative disease, which means the symptoms can get worse over time. PD is also a very complex disease with both motor and non-motor symptoms, and the symptoms present differently in every individual. The most common symptoms of Parkinsons are discussed below. It is important to note that individuals with PD may not experience all of these symptoms, and symptoms will progress at a different rates in different people.

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    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!

    Why Its A Problem:

    Freezing is a very frustrating symptom of PD and can cause people to feel self-conscious and anxious about movement. This results in avoiding activity and movement, which unfortunately perpetuates the freezing tendencies even further.

    Freezing also contributes to a person having a higher risk of falling and can significantly limit them from participating in meaningful activities due to a fear of getting stuck. And while some people with Parkinsons never experience Freezing, it is estimated that approximately 80% of people with PD will develop challenges associated with Freezing.

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    Strategies To Combat Freezing In Parkinsons Patients

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

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

    Walking Aids To Help With Freezing Of Gait

    How to stop freezing with Parkinsons disease  Therapy ...

    Often freezing of gait cannot be overcome with medication adjustment and physical therapy, and a walking aid needs to be introduced for safety and walking support.

    There are many types of walkers that are available for people with walking difficulties. Here is a simple guide:

    • Basic walker this is usually just a metal frame without wheels
    • Wheeled walker a metal frame with wheels. The wheels may be on two or four legs and the wheels may swivel or be fixed
    • Rollator a walker with swivel wheels on all four legs and hand brakes. The brakes typically need to be engaged for the walker to stop. Often the rollator has a seat and a basket for convenience.

    A common concern with all these walkers is that there either is no braking system or the braking system must be engaged in order for the walker to be stopped. Therefore, if a freeze occurs with the feet stuck to the floor, and the person is not fast enough to engage the brake, the walker will continue to move, potentially precipitating a fall.

    Your physical therapist can help you determine the walking aid that is best-suited for your specific situation.

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    So Lets Simplify This Complex Of Freezing Of Gait Brain Scenario

    • So, it appears Freezing of Gait involves disordered communication and processing of information between networks involving the:
    • front of the brain that plan and initiate movement
    • basal ganglia where the dopaminergic neurons that fine tune and exert control over movement
    • parts of the brainstem which again refine movement and support wakefulness

    So, its a complex scenario involving a breakdown in brain circuitry and processing. Therefore, the response to this situation requires a multi-pronged and personalised response.

    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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    What Is A Parkinsons Disease Freeze

    Freezing in Parkinsons disease is essentially a motor block which happens suddenly. Parkinsons disease freeze is characterized by a brief moment of inability to start movement or even continue repeated movements which may be rhythmic in nature like writing, walking and so on. It has been seen that freezing mostly affects the patients ability to walk. It can also act as an obstacle for a patient to open or close his eyes. Parkinsons disease freeze develops at later stages of the disease.

    Freezing in Parkinsons disease can cause an extremely disabling effect on the patient. It affects a persons ability to walk causing the person stop as if his feet are glued to the floor. It can occur anytime and at any place. Parkinsons disease freeze results in quite injurious falls and even fracture at times. Its frequency increases if the patient is under stress or suffers from anxiety.

    What Freezing Is Like For My Dad

    Parkinson’s freezing

    Like many Parkinsons patients, my dad notices that he usually only freezes when hes not on his medication. It usually happens while hes moving through doors: When you pivot youre worried about losing your balance. Thats why we shuffle our feet and take baby steps initially. Once Im moving Im fine, he says.

    Since hes worried about maintaining balance while navigating, its possible that theres a connection between fear and freezing. Continuous motion seems to bypass the risk of freezing, while shifting motion types can present challenges.

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    What Is Dystonia And Freezing In Parkinsons Disease

    Along with motor fluctuations and dyskinesia, some people with Parkinsons disease experience problems with muscle contractions called dystonia and freezing.

    Dystonia is the involuntary, continuous contractions of muscles that result in repetitive movements, such as twisting or curling of one or more body parts.

    Dystonia may occur at various times, including:

    • When the medication is working at its full potential
    • When dopamine levels are the lowest
    • When the medication has just begun to exert its effect

    Freezing is the temporary and involuntary inability to move. People feel as if their feet are stuck to the ground. This can happen for several seconds to minutes. The phenomenon results from decreased levels of dopamine.

    Electrophysiological Signal Recording And Analysis

    The subthalamic LFP recordings were combined with measures of the cortical electrophysiological activity using a 64-channel portable EEG . EEG signals were acquired with the sampling frequency at 1000 Hz and resampled at 400 Hz to match the STN LFP sampling frequency and optimize signals alignment for connectivity analyses. Low frequency and high frequency were eliminated using a bandpass Kaiser windowed FIR filter . Power line noise was eliminated using a bandstop fourth order Butterworth filter. EEG channels affected by bad scalp-electrode were visually identified and replaced with spherical spline interpolation. Stereotypical artefacts were removed by independent component analysis . Laplacian montage was applied to reduce muscular artefacts . We ruled out the effect of movement artefacts by comparing the wavelet transformation of epochs of walking with epochs of gait freezing, focusing on the 13 Hz band. In this frequency band, the epochs of walking and gait freezing showed similar spectral profiles, thus further excluding a confounding effect due to movement artefacts.

    We first computed the power in the specific – and -frequency bands of the two STN and compared it between walking and the abovementioned time frames of gait freezing.

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    What Can Be Done About It

  • Optimize your Medications: Adjustments to your Parkinsons medication can help, so the first step is to speak to your neurologist about your Freezing experiences to make sure your medication doses and timing are prescribed as they see fit. And while Parkinsons medications can help Freezing, this is only part of the solution.
  • Physical Therapy: Physical therapists who specialize in Parkinsons disease are trained to evaluate Freezing of gait to prescribe the correct exercises and strategies to help you move your best. In addition to the underlying brain changes from Parkinsons disease, many people who freeze also have muscle imbalances including posture changes, tightness in the front of their hips, and very stiff ankles which makes Freezing even worse. Your Parkinsons physical therapist will be able to put together all the pieces of this complicated puzzle and tailor an individualized approach to help you overcome your freezing challenges. In addition to using external cues such as the metronome and visual targets , we also implement many rehabilitative strategies including practicing high amplitude stepping, and teaching turning techniques. We have seen tremendous success in treating freezing of gait in people with Parkinsons at Thrive Physical Therapy!
  • Some tricks people use include:

    • Humming or whistling their favorite song
    • Bending their knees up and down or marching
    • Visualizing themselves
    • Touching a body part
    • The 5S Method

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