FoG is a common symptom experienced by patients with Parkinson’s Disease (PD), affecting up to 50% of patients at some point. It is described as feeling as though your foot is suddenly “stuck” as if you are in mud or glued to the ground when you try to take a step. FoG most commonly occurs when preparing to take a first step after being seated or standing still. It is commonly triggered by walking through doors, being in small spaces, or with turning. It is oftentimes worse if you are anxious or sick.
Medications can have an effect on FoG. Typically, FoG worsens if your medications are underdosed or wearing off, but rarely this can be seen with excessive medication use. Sometimes, simple medication adjustments are very effective. While medications can help with FoG, the most helpful treatment is physical therapy and using special walking techniques. A physical therapist can teach you these special walking techniques that you must then practice to make perfect! You can also look online for exercises specifically for FoG.
YouTube is a wonderful resource that has both therapist’s and patient’s strategies (for example, “Treatment of Freezing of Gait and Movement with LSVT BIG”
You may read about the ABCDE concept:
A: Allocate enough time to plan movements.
• Plan your movement before doing it.
B: Break down complex tasks (like walking) into smaller, manageable steps.
• Simplify your movements. For example, focus on putting your heel down and then toe down.
C: Use conscious effort, focusing fully on each step.
• Fully concentrate when trying to perform each step.
D: Avoid dual-tasking (e.g., walking while talking).
• Only do 1 thing at a time. For example, avoid talking on the phone while walking.
E: Use external cues such as auditory rhythms or visual lines to help maintain proper walking rhythm and step length.
• Using cues can help maintain walking rhythm and step length. For example, auditory cues like counting to a steady rhythm, singing a song, humming, or use of a metronome can be helpful. Visual cues like looking for a target or lying to step over can be helpful.
If freezing or festination occurs, try the following:
- Stay calm and take deep breaths.
- Focus on using techniques like shifting your weight back-and-forth or taking a step backward before moving forward.
- Ensure each step is initiated with the heel firmly placed on the ground.
- If help from another is needed, they should guide you from the side rather than pulling on your arms. They can provide support, count rhythmically, or place their foot in front of yours to give you a target to walk over.
Author Mick Reedy, MD, is a Movement Disorders Specialist with
Inova Parkinson’s and Movement Disorders Center (IPMDC)