- People with Parkinson’s disease who have trouble walking often invent ways to help them manage the changes to their gaits.
- A new study suggests that familiarity with these techniques should be more widespread.
- There is no one-size-fits-all solution, but a wide array of gait compensation strategies may help many with Parkinson’s.
The rigidity and muscle stiffness associated with Parkinson’s disease can cause a person to take small steps and walk slowly, among other challenges.
As the disease progresses, episodic problems, such as freezing, may occur. Freezing makes it difficult to keep moving, to get going again, and to manage narrow spaces or turns.
This lack of responsiveness of the body can contribute to falls and related injuries.
People with Parkinson’s may either invent their own strategies for overcoming gait impairment or learn these techniques from specialists.
A recent survey-based study from researchers at the Radboud University Medical Centre, in Nijmegen, the Netherlands, has investigated how widely known and used these strategies are, as well as how effective they are and why.
According to study author Dr. Anouk Tosserams, “We know people with Parkinson’s often spontaneously invent creative ‘detours’ to overcome their walking difficulties, in order to remain mobile and independent.”
“For example, people walk to the rhythm of a metronome, by mimicking the gait of another person, or by counting in their head. We found that people are rarely educated about all the different compensation strategies. When they are, people often find strategies that work better for them and their unique circumstances.”
The study appears in Neurology.
According to the study, gait compensation strategies fall into these seven categories:
- External cueing — using auditory, visual, or somatosensory cues such as a metronome, laser shoes, or vibrating socks, respectively
- Internal cueing — focusing on one’s gait, by counting, for example
- Changing the balance requirements — making wider turns, making strategic weight shifts before stepping, or using a walking aid
- Altering the mental state — practicing relaxation techniques
- Action observation and motor imagery — visualizing movement or watching someone else walking and imitating their gait
- Adapting a new walking pattern — such as by jumping or walking backward
- Using the legs in a different way to move forward — such as by riding a bicycle or skateboard or by crawling
The researchers surveyed 4,324 people with Parkinson’s disease who had disabling gait impairments. Of those surveyed, 52% reported having fallen at least once in the last year, and 35% said their gait interfered with their ability to do their usual daily activities.
Individuals with Parkinson’s often report difficulties with balance, falling, shuffling, staggering, and freezing of gait, the team noted. Freezing may result from a challenging course, anxiousness, or being distracted by a secondary task, such as carrying a tray.
While the surveys revealed that many people regularly use gait compensation strategies, they were often unaware of all the different types. Only 4% were familiar with all seven, and on average, respondents knew of about three.
Among the respondents, 23% had never tried any gait compensation strategies, and 17% had never heard of them.
The strategy with which most participants were familiar — 47% — was external cueing, and 45% were familiar with internal cueing. Only 14% had heard of action observation and motor imagery.
Most of the participants who were familiar with a strategy and had tried it and found it helpful.
External cueing was reportedly slightly less effective than the other strategies, but in general, all the strategies were useful.
Dr. Tosserams and co-author Dr. Jorik Nonnekes, also of Radboud University Medical Centre, suggested to Medical News Today that “Other strategies may also be preferred because they are relatively less noticeable to bystanders, avoiding stigmatization or feelings of embarrassment.”
The team found that the reported efficacy of a strategy depended on the circumstances in which people used it.
Internal cueing was useful 73% of the time when respondents used it to start walking — but only 55% of the time when they wanted to stop. Similarly, visualizing movement worked best outdoors and not nearly as well indoors.
According to Dr. Tosserams:
“Our findings suggest that a ‘one-size-fits-all’ approach doesn’t work because different contexts might require different strategies or because individuals simply respond better to one strategy, compared to another.”
Dr. Michael S. Okun, national medical advisor at the Parkinson’s Foundation, who was not involved in the study, described to MNT the difficulty of disseminating information about the techniques:
“There are so many gait compensation strategies employed by persons with Parkinson’s disease that it will prove challenging for people to locate a truly comprehensive source. There are no existing scientific data including careful comparisons of known compensation strategies.”
“We need to go a step further,” said Dr. Tosserams, “and teach people about all the available compensation strategies, for example through a dedicated online educational platform. This may help each person with Parkinson’s find the strategy that works best for them.”
Dr. Tosserams and Dr. Nonnekes told MNT, “We are currently working on the development of such a dedicated, online, video-illustrated platform, where people with Parkinson’s disease and healthcare professionals can learn about and share gait compensation strategies.”
Dr. Okun noted, however, the importance of working with a Parkinson’s specialist:
“The important message here is that compensatory strategies may work for some folks and that the choice of strategy needs to be tailored to each person. Instruction on how to safely employ each strategy should come directly from physicians, physiotherapists, and well-trained healthcare practitioners possessing adequate Parkinson’s disease expertise.”