Symptoms - Parkinson's Gait
Parkinson’s disease (PD) can affect the gait, or the way a person walks. The changes in gait may be called Parkinson’s gait or Parkinsonian gait. Gait alterations can be highly disruptive to people with PD and may interfere with the ability to work, exercise, or engage in everyday activities. It is also a symptom that is very outwardly visible and can attract unwanted attention.1,2
The gait impairments may also be classified as:
- Freezing of gait – Freezing of gait is characterized by a hesitation before stepping forward, or difficulties when initiating walking. Some people with PD report it feels like their feet are glued to the floor. The freezing is frequently temporary, and the gait may be at a normal pace after a step or two. Freezing may occur only in specific situations, for example: when starting to walk, when turning, or when walking towards a particular goal, like a doorway or chair. It can also occur when walking through a doorway or when changing directions. Freezing may also occur when a patient feels like he/she is being rushed or trying to cross a busy street. Freezing can be a potentially serious problem for people with PD, and it may increase the risk of falling.2
- Shuffling gait – Shuffling gait appears as if the person is dragging their feet as they walk. Steps may also be shorter in stride (length of the step) in a shuffling gait. The shuffling gait is also seen with the reduced arm movement during walking.3
- Festinating gait or festination – A quickening and shortening of normal strides characterize festinating gait. While the steps are quicker, the stride is shorter, causing this to be a very inefficient gait, which can be frustrating and tiring for the person experiencing it.1
Why does Parkinson’s disease cause changes to gait?
PD causes damage to the nerves in the brain and in the body, as well as causing accumulations of the protein alpha-synuclein, called Lewy bodies. The motor symptoms of PD, like Parkinsonian gait, are caused by damage to the part of the brain called the substantia nigra pars compacta. The neurons (nerve cells) in the substantia nigra produce dopamine, a neurotransmitter (chemical messenger) that transmits signals from the substantia nigra to other parts of the brain to produce smooth, purposeful movement. Damage to the neurons in the substantia nigra causes a reduction in dopamine, creating the motor symptoms seen in people with PD.2,4
Treatment of Parkinson’s gait
Treatment for PD is customized to the individual patient and their symptoms and may include medications, surgery (deep brain stimulation), physical therapy, and complementary or alternative therapies. There is no known cure for PD, and there are currently no treatments that slow or stop the natural progression of the disease.
Most patients with PD are started on medication to help manage their symptoms. Initial therapy is usually levodopa (administered with carbidopa), dopamine agonists, and/or monoamine oxidase-B (MAO-B) inhibitors. The combination of levodopa and carbidopa is the most effective treatment available for the management of motor symptoms of PD, including rigidity. However, it can cause a side effect known as dyskinesia, which is abnormal involuntary movements. Dopamine agonists are less effective on the motor symptoms of PD but have a lower rate of causing dyskinesia, although they have other side effects. MAO-B inhibitors are less effective than levodopa or dopamine agonists, however they have fewer side effects. Choice of therapy should be customized to the individual patient with an understanding of the risks and benefits of each class of medication.6
Carbidopa/levodopa helps alleviate symptoms of PD; however, “freezing of gait” may occur more often when a dose is missed or the interval between does is too long. A physician can help adjust the doses of medication to prevent gait problems from occurring.
In addition to medication, physical therapy can help with walking. There are several strategies that can be used to overcome freezing episodes, including taking a high marching step, counting to three before stepping, or walking along to the rhythm of a metronome. Using visual cues such or stepping over a target such as a laser beam or line on the floor can also help with gait.