We honestly don't know why freezing of gait happens. Sadly, even the greatest minds out there in clinical research with Parkinson's disease still don't have an explanation of exactly why freezing episodes happen. What we do know is that there's a correlation between freezing of gait and off times when it comes to medication dosages for Parkinson's, off-times being the the peaks and valleys of medication effectiveness. Basically, there are peaks and valleys in the dosage levels of carbidopa/levodopa and the dopamine levels in the bloodstream. During off times folks with PD have difficulty moving or other symptoms between doses. Freezing does tend to happen more often during those off times and they are also unpredictble. So the best thing to know is to be empowered with the knowledge to do something about those freezing episodes when they do happen. We will cover that shortly. Before we do it is important to note that freezing episodes do tend to happen or can happen when there is a noticeable change in surfaces; for example, if somebody is walking down a hallway and it is a tile floor and then it changes to carpet, or you go from a single monochromatic floor to a floor with a checkered pattern, or anything that may be off visually, that can trigger a freezing episode. It's transitions. And a lot of times in clinical practice, I've noted that turns while walking, approaching a chair to turn to sit in a chair, etc. can be times that will induce a freezing episode.
Now, if you are a care partner of a PwP, it is very important to remember is that trying to force somebody to move or take a step when they're having a freezing episode can be very dangerous as it can really increase their risk of having a fall. This is also why it's important also for you to know what to do as well as the person with Parkinson's.
But anyway, what to do about that when it happens. These are the best tips and cues that I am aware of or have seen success with in clinical practice:
March in place
So trying to just take high steps and stomp the feet in place, that can be very helpful in breaking out of a freezing episode. Even just shifting the weight from one leg to the other while in standing can do some good. Essentially, that's the same thing as marching in place, as you have to put weight on one leg and then the other.
Play music with a really good BEAT
Auditory cues can be very helpful. Trying to take a step or march to the rhythm can break you out of a freezing episode.
Step over an object
Taking a cane or a stick or some kind of object that's small enough to step over and physically stepping over it can be very helpful to break out of a freezing episode.
Visualize stepping over something
Even picturing taking steps in your mind's-eye, particularly stepping over an object can be just as effective as literally stepping over something.
Use an Assistive Device (If you need one)
I'm not saying you need to use an assisted device if you don't already have one, but if you are using a walker, you may consider getting a specialized walker, like a U-Step. Some of them have built-in lasers, and there's a company called Laser Cane that makes a cane that you can use to project a laser beam out in the form of a line on the floor so you can step over it. So it's kind of nifty, but obviously that would be if you really truly need a device. Generally speaking, folks that have really bad freezing episodes tend to be in more advanced stages of PD. So, somebody like that might be a better candidate for something like a U-Step walker just because of the stability of the device and it's built specifically for people with Parkinson's.
BREATHE and SLOW DOWN
Something just to keep in mind when experiencing a freezing episode is to take a deep breath and don't get in a hurry. Stress, anxiety, and trying to really rush can actually make the freezing episode worse and can actually increase your risk of falling due to the freezing.
Combining these all or some of these recommendations with BIG steps is very important. I'm certified in the LSVT BIG program for Parkinson's disease, and in that program we focus on high amplitude, meaning LARGE, high intensity movements. I often tell people if they're having a freezing episode while trying to turn while walking or trying to sit down to stomp the feet loud enough to actually hear a stomp. And if they're not hearing a stomp or feeling a stomp, they're not moving their feet big enough. Often that's enough of a cue to get their feet moving better so that they can complete that transition.
I'd love to know what your experiences have been with this, and whether you have Parkinson's or know somebody that does in your family or perhaps a loved one with PD. I'd also like to know what other tips that you've found to be helpful with freezing episodes that I may not know about.
Dr. Michael Hyland, DPT, CEEAA has been a physical therapist since 2012. He is a Certified Exercise Expert for the Aging Adult and an expert in Parkinson's Disease. He owns Hyland Physical Therapy and Wellness in Broken Arrow, OK