– Freezing of Gait (FOG)

Unfortunately, freezing is all too common, and it leads to a higher risk of falling. Freezing of gait (FOG) is defined as an episodic inability to generate effective stepping and is reported as one of the most disabling and distressing parkinsonian symptoms. (Albert C Lo, 2010)

When walking, your entire body has forward momentum. When FOG occurs, the feet suddenly stop moving, but your center of mass or upper body still has momentum. If you are not able to quickly decrease momentum of the center of mass, it will keep moving, passing over the feet and creating an imbalance. This can lead to a fall and potential injury.

Once you are moving, the trick is to stay moving. How can we accomplish this? Here are a few intervention ideas:

Intention with every step / Mindful movement: As children, once we have learned to walk, walking becomes more of an unconscious activity. Our brains have established more than enough neural firing patterns, allowing us to move without having to think about it most of the time.

When our ability to walk becomes compromised, we need to start thinking about walking in order to reduce the risk of falling. Some people naturally start focusing on movement while others do not think about it at all.

Mindful movement can be extremely helpful to improve gait. As described in the wonderful Norman Doidge book, The Brain’s Way of Healing, there is a science to conscious movement.

When exercising mindful movement, you are consciously paying attention to every step or movement, including every part of each movement.

There is a logical reason why conscious walking works. It is rooted in the anatomy and function of the substantia nigra (the area of the brain where loss of dopamine is most profound) and the basal ganglia of which it is a part. (Norman Doidge, 2016)

In PD, the compromised autonomic function of the basal ganglia along with a diminished presence of dopamine will cause gait and movement issues.

Conscious or mindful movement helps to bypass the basal ganglia and fire up other areas of the brain. Basically, during mindful movement, the substantia nigra and basal ganglia are outsourcing to other areas such as the cerebellum, to create neural firing patterns that will improve whatever task we are working on, in this case – gait.

Targets: The use of targets such as agility dots, pieces of tape, or other visual stimulus evenly spaced on the floor (including over thresholds, surface changes, and through doorways) will help to reduce FOG events

Music and rhythm: walking to the beat of a song or metronome can help to minimize FOG episodes

SPECIAL NOTE: when a patient first practices mindful movement, they are likely using all of their conscious thought processes to execute improved movement. It may take several sessions or weeks before they can handle the addition of any type of cognitive training. However, as new neural firing pathways develop and become more solidified, the need for the patient to concentrate on movement will diminish. At this point in time, cognitive training can be added . Mindful movement is a form of retraining the brain. It takes time and it takes a different amount of time for each person. Be patient and enjoy watching their progress.

Targets: The use of targets such as agility dots, pieces of tape, or other visual stimulus evenly spaced on the floor (including over thresholds, surface changes, and through doorways) will help to reduce FOG events

Music and rhythm: walking to the beat of a song or metronome can help to minimize FOG episodes.

Once again, you’ll see a couple of videos demonstrating the use of targets below. Targets tend to keep people moving more fluidly and reduce the number of freezing episodes.

Let’s take another look at this video with our friend, Cliff again. When he comes to the end of the agility dots, he nearly freezes. When he starts back using the dots, he moves very well. Targets are a game changer for many people.

Our friend, Cliff in Denver, April, 2018

We will soon be adding more videos using targets, music, and rhythm to demonstrate methods the diminish FOG episodes.