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Freezing of Gait
Freezing is a leg locking that prevents you from taking steps while walking. People usually describe it as a feeling of having their feet glued to the ground.
Freezing can occur when you want to start walking, while walking or when you turn around. You may also be affected during repetitive movements, such as talking, writing or brushing your teeth or hair.
Freezing episodes last a few seconds to a few minutes, though not everyone with Parkinson’s disease is affected by them.
1/3 of people with Parkinson’s disease have freezing episodes
In early stages of the disease: 27 %.
In advanced stages: 79 %.
More men than women are affected.
What situations can trigger freezing?
Freezing can occur at any time on a daily basis, but some situations increase the likelihood of freezing periods:
- Starting to walk
- Changing direction
- Turning around
- Walking towards a door frame
- Entering an elevator
- Walking from one type of surface to another (ex. tile to carpet, grass to pavement)
- Having a time constraint (ex. crossing the street or arriving to an appointment on time)
- Being stressed
- Being in a crowd
- Doing something else while walking
What are the causes of freezing?
The exact causes of freezing are unknown, but it is likely due to the degeneration of parts of the brain that manage automatic processes of walking.
When walking becomes more complex, for example in the situations mentioned above, walking automation is interrupted and a freezing episode occurs.
How do I know if I'm freezing?
If you feel like your feet are glued to the ground and prevent you from walking, you are probably experiencing freezing. The first signs of freezing can also be a hesitation to start walking rather than a full blocking.
Freezing is not the same as off periods, which are a decrease in medication efficacy. During these periods, people are incapable of moving and all movements are blocked, even in the upper body. On the other hand, freezing only affects gait.
What can I do during freezing episodes?
Freezing episodes are disturbing and sometimes anxiety-inducing. These episodes should not cause you to reduce your activities or avoid situations that give you pleasure. There are several strategies you can implement to help you continue your daily routine.
During freezing periods:
– Keep calm and do not try to fight freezing periods
– What strategy can I use?
– Perform the chosen strategy by choosing which foot you will continue walking with
Look at an object on the ground and imagine yourself trying to get over it by exaggerating the motion.
- Use lines on the ground, or imagine lines on the ground, as a target for your next step.
- Stick a piece of tape on the ground in locations where you tend to freeze.
- Start by imagining big steps, then attempt to take these big steps.
- Use the light of a laser as a target to guide your next step.
Use rhythms to help you initiate your steps or maintain your pace.
- Clap your hands to the beat of a song you like.
- Sing or whistle to create a rhythm.
- Give yourself commands out loud (ex: “GO, GO” or “1-2, 1-2”).
- Take steps to the rhythm of a song or metronome.
Weight transfer strategies
- Transfer your weight from one leg to the other a few times.
- Sway your head or shoulders.
- Take one step back or to the side before continuing walking forward.
- Walk with your knees high (military walk).
The goal of these strategies is to focus your attention on something other than your freezing. Do not try to fight the freeze as this will simply prolong the episode.
In any case, do not try to help yourself by hanging on to objects that are too far as this can result in falls.
Daily physical activity can also help you reduce freezing episodes, keep your balance and maintain your ability to walk normally.
What medications are available to treat freezing?
There is no medication to treat freezing. Dopaminergic drugs used for Parkinson’s disease (L-dopa) can help reduce freezing in some people.
The anxiety of missing a medication schedule and falling into an off period can also cause a freezing episode.
What can I do as a caregiver?
Freezing is completely involuntary. Rushing the person, getting impatient or saying things like “let’s go” or “hurry up” can prolong freezing periods.
Instead, wait a few seconds for the person to find and implement a strategy to overcome the episode. If they do not succeed on their own, help them. For example, you can put your foot in front of them so they can step over it, or you can sound out a beat or rhythm (ex. singing, counting, “right, left, right, left”, clapping, etc.).
Do not try to pull the person forward as they can fall, but you can help them with weight transfer movements from one leg to the other.
How does freezing progress?
Freezing periods become more frequent with the progression of Parkinson’s disease due to the gradual loss of antiparkinsonian medication effectiveness. With time, these episodes can last longer and strategies to overcome them are less effective.
Freezing episodes can therefore lead to falls. The use of walking aid equipment such as a cane or walker may then become necessary for safety purposes.
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