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Freezing of Gait


26% of people with mild Parkinson's symptoms experience freezing of gait. 80% of people with advanced Parkinson's experience freezing of gait. Freezing of gait is the sudden, involuntary inability to move. Some people feel like their feet are glued to the floor and like they they are telling their legs to move but they won't listen. Freezing of gait is associated with a reduced quality of life, loss of independence, need for a wheelchair, increased rate of institutionalization, and mortality. While the science community does not fully understand the complexity of it all, let's cover what is known.





Common triggers

Walking through a doorway


Turning a corner


Transitioning from standing to walking


Turning around


Stepping from one type of surface to another (rug to hard wood floor)


Busy floors (rugs that have lines/blocks of different colors that go in different directions)


Multitasking


Navigating or experiencing a stressful situation


Walking in a narrow hallway



Treatment

Gait training on a treadmill

  • This can be done with or without a a body weight support system. A body weight support system may be found in outpatient facilities that are neuro rehab based (Sunnyview)

  • You can use a treadmill lines tapes to the treadmill to help take big steps. Talk with your physical therapist before attempting on your own.


General exercise

  • Improving endurance, flexibility, and strength will help tremendously. You will be more likely to freeze if you have endurance, flexibility, or strength deficits.


Physical therapy

  • Dual task training - working on two things at once like walking while putting a jacket on or climbing stairs while talking to someone on the phone

  • Balance training


External cueing

  • Using a metronome can help time when you should be taking steps

  • Listing to music of a certain speed/tempo can also help

  • Putting lines on the hallways or on the walls of your home if there are certain areas that freezing usually occurs

  • Using a laser beam on your walker to help take bigger steps. Click here for an example.

  • When turning around, pretend you are standing in the middle of a clock. Intentionally lift your leg high as you can and step to 12-9-6 when turning to the left. Step to 12-3-6 when turning to the right.


Cognitive behavioral therapy

  • If your freezing is triggered by stressful situations, working on stress management techniques can be helpful.



The 4 S's

The 4 S's are used in instances that you are freezing to help you move again. This may not help reduce instances of freezing, but it may help get you our of a freezing episode.

  • Stop

  • Stand tall

  • Sway (step backward or sway shift side to side before stepping)

  • Step big



If you are experiencing freezing, talk with your neurologist about seeing a physical therapist to help you reduce your freezing.



Sources



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