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Freezing episodes in Parkinson’s disease

“Freezing” episodes are a challenge that many patients with Parkinson’s disease struggle with. What is freezing? Freezing can be thought of as an inability of the body to start a movement sequence, such as when getting up from a chair or stepping away from the bathroom counter. These episodes can also occur when in the middle of a movement task, such as when walking through a doorway or getting on/off of an elevator. The unfortunate part of freezing during a movement task is that your risk of falling greatly increases. If the movement sequence does not start properly, then subsequent movements cannot occur in a coordinated fashion. This can result in shuffling, a loss of balance, or potentially embarrassing situations while in public.

There are many ways to deal with freezing. One of the strategies that I give my patients is to stop the task and try to restart the movement pattern. Stand tall and shift your weight from one foot to the other before trying to take a step. Sometimes stepping to the side can be easier than stepping forward. This requires mental effort, but with Parkinson’s you have less automaticity of movement., requiring that extra mental effort with movement.

The phenomenon of freezing through doorways and in tight spaces is not fully understood, but a narrowing of the visual field (via a change in the surface, clutter, etc) can be a trigger. Using visual cues can be very helpful, especially if freezing occurs while walking. Using the tile pattern on a floor can give you a cue for something to step over. I have had some clients place red tape over the threshold of a door (for example bedroom to bathroom) to give a target to step over. There are walkers and canes on the market that have a laser on them to make a red line on the floor, a target to step over that travels with you.

Auditory cues can also help. Some patients will walk to the beat of a metronome (you can use a bluetooth or headphones with a free metronome application on your cell phone), or have a loved-one count for them. Listening to music can also be helpful, as you can rock to the beat of the music (shift) to restart the movement (step).

Freezing can occur more frequently at the end of your PD medication’s dose. Tracking your freezing episodes and giving that information to your doctor can be very helpful with medication timing. Freezing can also increase in times of stress. Scheduling enough time to get to engagements or appointments can decrease this phenomenon, improving your quality of life and decreasing your fall risk. Working with a physical therapist that has experience with Parkinson’s disease can also be very beneficial.

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mydenverpt

1comments

30 Aug, 2014

Physical Therapy

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i have this occur at random. I have MS, is this something normal with this lovely disease? MS is full of surprises and I wonder if others have this as well. Thank you very much!!!

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