Freezing in Parkinson's Disease

Freezing of gait is one of the most disabling symptoms in Parkinson's disease, it greatly increases the patient's risk of falling and negatively impacts his quality of life.


70% of patients with more than 10 years of Parkinson's disease are affected by this symptom.


What is freezing of gait ?

Freezing is an inability to initiate movement, a feeling of "feet stuck to the ground" and an abrupt stop in motion. This symptom can be triggered by initiation of walking, narrow passages (e.g. doorways), crowds and stressful situations. It is often correlated with bradykinesia.


brain area freezing of gait parkinson disease

What neurological mechanisms are involved in freezing ?

Freezing is a complex phenomenon to understand and manage because the neurological mechanisms involved in its onset are currently poorly defined. Studies suggest that a disorder within the limbic and cognitive systems may be involved in the onset of freezing.



The structures potentially involved in the appearance of freezing are the following :

  • The supplementary motor area, which is the area of the motor cortex that manages the planning and coordination of complex gestures;

  • The precuneus involved in memory and visual-spatial processing;

  • The basal ganglia, a group of brain structures involved in the initiation and coordination of movements. The substantia nigra is the brain area most affected in Parkinson's disease.

  • The cerebellum, which plays a role in the control of motor skills and balance.

Although the occurrence of this phenomenon is not well understood, it has been possible to identify certain situations, related to the environment and the mental state of the patient, that favor the occurrence of this phenomenon:

  • obstacle

  • stressful situation

  • dense crowd

  • doorway, door frame

  • change in floor color or surface

Unfortunately, there are few effective long-term solutions to address this symptom, although appropriate treatment, particularly physical therapy, can help reduce its impact.

How to deal with freezing ?

The management of this symptom is based on physical therapy with rehabilitation oriented towards gait disorders. The use of sensory cues (auditory or visual) can be used to support this management and to limit freezing of gait.

It is recommended to practice regular physical activity, and to favor activities involving the mobilization of motor and rhythmic abilities (adapted physical activity, dance, tai-chi, Nordic walking).


Here are some tips recommended by the American Parkinson Disease Association for returning to walking during a freezing episode :

  • Try to do another movement before moving on. For example, raise one arm, touch your head, point to the ceiling, then try to move again.

  • Change direction, or move to the side before moving again.

  • Visualize an object on the floor in front of you and try to walk on it.

  • Take a step backward and then forward.

  • Walk on the spot and then move forward.

  • Point with your arm in the desired direction and move forward, insisting on swinging your arms.

  • Tap the leg you want to move forward before starting the movement.

  • Count "1, 2, 3" and move forward.

  • Use a rhythmic sound to focus on the rhythm to restart and maintain a steady walk.

Technological solutions are being developed to offer rhythmic auditory stimulation at home. This technique can be useful to resume walking after a freezing and to limit its appearance in order to improve one's overall gait.


The WALK medical device is based on this technique and it is possible to try this innovation at home.


To learn more, visit our website 👇

Sources

  • Fasano, A., Herman, T., Tessitore, A., Strafella, A.P., Bohnen, N.I., n.d. Neuroimaging of Freezing of Gait. J Parkinsons Dis 5, 241–254. https://doi.org/10.3233/JPD-150536

  • Freezing of Gait & Parkinson’s Disease, 2019. . APDA. URL https://www.apdaparkinson.org/article/freezing-gait-and-parkinsons-disease/ (accessed 7.30.20).

  • Ge, H.-L., Chen, X.-Y., Lin, Y.-X., Ge, T.-J., Yu, L.-H., Lin, Z.-Y., Wu, X.-Y., Kang, D.-Z., Ding, C.-Y., 2020. The prevalence of freezing of gait in Parkinson’s disease and in patients with different disease durations and severities. Chinese Neurosurgical Journal 6, 17. https://doi.org/10.1186/s41016-020-00197-y

  • Heremans, E., Nieuwboer, A., Vercruysse, S., 2013. Freezing of gait in Parkinson’s disease: where are we now? Curr Neurol Neurosci Rep 13, 350. https://doi.org/10.1007/s11910-013-0350-7

  • Sawada, M., Wada‐Isoe, K., Hanajima, R., Nakashima, K., 2019. Clinical features of freezing of gait in Parkinson’s disease patients. Brain Behav 9. https://doi.org/10.1002/brb3.1244

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