Changes in the brain as a result of Parkinson’s disease can cause changes in gait, which refers to the way a person walks. People may take small, shuffling steps or experience freezing when they cannot move their feet at all.
Changes in the brain that occur with Parkinson’s disease can cause loss of coordination and affect the ability to take smooth and purposeful steps. Some people experience slowing in their gait. Their arms may not swing as much or at all when they walk.
Up to 50% of people with Parkinson’s disease experience freezing. This is a gait in Parkinson’s disease, which causes the feet to feel as if they are stuck in place. However, the torso may still be able to move forward, which can lead to falls.
People with Parkinson’s disease experience bradykinesia, or slowness of movement. It is one of the main symptoms of the condition and one of the symptoms necessary for diagnosis, alongside tremor or rigidity.
A person with Parkinson’s disease may experience gait change due to bradykinesia affecting how they move their entire body, including the way they swing their arms, turn their torso, and move their feet.
Individuals with Parkinson’s gait will take slow, shuffling steps and may or may not swing their arms. Their feet may sometimes feel stuck to the ground — a condition called freezing.
Gait in Parkinson’s refers to changes in a person’s ability to take usual, purposeful steps after developing the disease. Their movements may be slow and stiff. Although the specific presentation may vary among people, a person’s steps will typically be smaller and shuffling in nature.
People also may have less arm swing, or arm swing may be absent altogether. There will be less rotation and movement of the torso. The feet will land flat on the floor rather than on the heel. Sometimes, the feet may feel stuck to the floor, a condition known as freezing.
When evaluating Parkinson’s gait, a doctor will look for a few common symptoms. They may include:
- taking smaller steps than usual
- slow speed
- less movement of the torso
- feet placed close together
- no or less arm swing
- issues turning
- feet land flat rather than on the heel
- small, quick steps
- freezing, which is an inability to move the feet off the floor
Freezing occurs most commonly when individuals are turning, just starting to move, moving through narrow spaces, or coming to their arrival point. It can also occur when something distracts a person’s attention.
In some cases, Parkinson’s is hereditary, and experts have found links with specific genetic mutations in a few other cases. However, it does not generally seem to run in families. A combination of genetic and environmental factors is most likely responsible for the development of Parkinson’s.
Parkinson’s gait is the result of bradykinesia, or slow movements, which is one of the main symptoms of the disease. The brain is less able to process what would normally be automatic movements like swinging arms when walking or moving one foot after another.
A person with Parkinson’s disease can improve the way they walk with targeted effort. Training that challenges motor and cognitive skills may have a positive effect on coordination.
What works for one individual may not work for another, so some trial and error may be necessary. A few strategies include:
Training with audio cues
Some people try walking to the beat of a metronome — a device that makes a frequent, repetitive sound — or with verbal counting. The audio cues can stimulate the brain to provide a signal to move the extremities.
Walking at low speed on a treadmill is another strategy. A person may use a harness for added support. As the user becomes more confident and stable, they can gradually increase their speed. Treadmill training allows a person to increase their stride length and step turnover rate over time. Changes should last at least
Nordic walking involves walking outdoors at a moderate pace using poles with wrist straps and rubber tips for support. A person can try to coordinate steps with the opposite arm swinging forward. For example, the left foot and right arm swing forward together, then the right foot and left arm.
The key to balance is to perform a motor-based skill while also performing a cognitive-based task. One
Among the participating group, there were significant improvements in gait speed and step length compared to a control group after 10 weeks. There were no changes in either group’s ability to perform cognitive tasks while seated following the balance training.
Tai chi is a specialized meditative exercise that combines movement and concentration. By moving the body back and forth over the feet, the body learns where it is in space, called proprioception, which is important to balance.
Virtual reality (VR) interventions
Research is underway to investigate the link between a person’s environment and gait. As part of this, one 2019 German study evaluated how 16 people with Parkinson’s disease responded to virtual reality manipulations.
Researchers used specialized laboratory equipment to evaluate the specifics of the participants’ gaits. They found that many had a significant difference in stride length between each leg.
They then used VR manipulations that included visual or proprioceptive signals to prompt a change in movement. While taking part in VR manipulation tasks, participants took wider steps of a more uniform length.
The researchers speculated that virtual reality may be helpful in making gait adjustments.
Dance requires movement in many directions, creating a challenge for both the mind and body. It also requires both large and small steps, and quick changes build muscle and neuroplasticity.
Positive gains from dance may last as long as
For others, gait abnormalities remain even when other symptoms are well-controlled by medications. Some other tips to assist a person with gait issues, particularly freezing, include:
- Focus on another movement, such as lifting an arm, touching something, pointing, then try to take another step.
- Change direction, such as stepping sideways if going forward is difficult.
- Use a laser pointer. If a step is difficult, a person can point the laser just in front of the foot and aim for the dot with the next step.
- Carry a small metronome or add an app on the phone. The auditory beat can provide a cue to step in time with.
- Count 1-2-3 and step on every count.
- Remain calm and do not get anxious. Shift focus to moving the arms to take pressure off the moment and the inability to take a step.
Other treatments that may help include:
Parkinson’s disease is a progressive, degenerative disease that does not have a cure. Parkinson’s gait starts to occur when nerve cells in the basal ganglia are damaged or die. These cells control motor function. Without them, it is difficult to move properly.
Treatments and therapies can help slow the progression of Parkinson’s gait and provide greater stability in a person’s movement for a longer period.
Parkinson’s gait occurs when an individual with Parkinson’s disease begins to take slower, shorter steps than they used to, often in a shuffling manner. They may not move their arms or torso as much as they used to. Sometimes they may feel that they cannot lift their feet off the ground at all, which is known as freezing.
Without treatment or therapy, Parkinson’s gait will worsen. With therapy, it can improve. Gait changes result from changes in nerve cells in the portion of the brain that controls movement. It is not a muscular disorder.
Performing exercises and therapies that stimulate the brain and neurological system can help.