Many people with Parkinson’s experience walking or balance problems, which can occur to different degrees. Gait problems can range from slowed speed, decreased arm swing and shuffling steps to difficulty getting started or freezing in place. Balance problems can cause unsteadiness and falls that make everyday tasks challenging.
These symptoms can be tough to treat, but there are ways to manage them: medication adjustment, exercise and physical therapy, or a home safety evaluation.
In this video, Rachel Dolhun, MD, movement disorder specialist, board-certified neurologist and vice president of medical communications at The Michael J. Fox Foundation, discusses how Parkinson’s can affect walking and balance and how to manage these symptoms. She also talks about ongoing research toward better understandings of and more effective therapies for these hard-to-treat symptoms.
Freezing of Gait (FOG) occurs when patients are unable to move their feet when trying to walk. It can be a distressing symptom that affects half of all people who have Parkinson’s disease. The mechanisms underlying Freezing of Gait (FOG) are not well understood and current treatments are often ineffective in controlling this symptom. PD Warrior describes this as a “sticky feet” sensation, where it feels like your feet are glued to the floor. It can lead to falls, decreased mobility, and a significant decline in confidence and quality of life. Early understanding and intervention are key to managing FOG effectively.
FOG may also occur while patients are walking. There is an abrupt decrease of step length and increase of step frequency and step-to-step variability that precedes a complete blockade of gait and falls. Another important characteristic is the occurrence of an irregular rapid trembling in both knees.
FOG is often triggered by characteristic circumstances such as a half or 360°-turn, obstacle (doorway) clearance, spaces with a narrow passage or unexpected visual or auditory stimuli. Fatigue, stressful situations, cognitive load anxiety and depression may also elicit FOG.
Usually, FOG is improved by visual (eg, marks on the ground) or auditory cueing (rhythmic sounds). Paradoxically, running, cycling or climbing stairs are performed more easily than usual gait.
PD Warrior notes that early identification of FOG is crucial for reducing its impact and shares these tips for how you can recognise it:
Patient Self-Reports: Many describe FOG as a sudden inability to move their feet, as if they’re glued to the ground. It’s like suddenly putting on the wrong shoes.
Clinical Observations: During gait assessments, FOG might be observed, particularly when turning, starting to walk, or navigating tight spaces.
Gait Analysis Tools: Wearable sensors and motion analysis tools can detect subtle changes in gait that may indicate the onset of FOG.
Non-Motor Symptoms Correlation: FOG often occurs alongside non-motor symptoms such as anxiety, depression, and cognitive changes, which can help in its identification.
“Maintaining a record of your FOG episodes, including the circumstances and potential triggers, can be highly beneficial in managing the condition”, Dr Melissa McConaghy says.
In this video by the ABC Catalyst program, Professor Simon Lewis at the Brain & Mind Research Institute takes a look inside the brain to understand why freezing of gait (FOG) occurs.
In 2024, Shake It Up Australia Foundation is excited to announce that a groundbreaking paper, led by The Michael J. Fox Foundation (MJFF) and international experts, has been accepted for publication in the prestigious Journal of Parkinson’s Disease (JPD).
This paper introduces a standardised protocol for assessing gait impairments in Parkinson’s disease (PD). Gait impairments—such as slowed walking, shorter steps, and freezing—are hallmark symptoms of PD and play a crucial role in diagnosing the disease, monitoring progression, and evaluating the effectiveness of treatments. However, inconsistent data collection methods across studies have hindered progress in this area.
To address this, the Gait Advisors Leading Outcomes for Parkinson’s (GALOP) committee, led by MJFF and supported by global Parkinson’s organizations including Shake It Up, worked collaboratively to develop a unified protocol. This new approach aims to ensure consistency in gait assessment, making it easier for researchers to compare data, accelerate clinical trials, and uncover new insights into the progression and treatment of PD.
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