Freezing is a symptom of Parkinson's disease that causes sudden and temporary inability to initiate movement or continue walking, which increases the risk of falls and injuries. The freezing episodes can be managed by recognizing them, using techniques such as STOP-THINK-PLAN-DO and cueing strategies, modifying the home environment, and engaging in multimodal balance training. Effective management requires regular assessment and collaboration with healthcare professionals.
Freezing is a classic symptom of Parkinson's disease that affects an estimated 50-70% of patients at some point during the disease course. It is characterized by a sudden and temporary inability to initiate movement or continue walking resulting in the risk of falls and injuries.
Freezing episodes are often triggered by several factors, such as stress, fatigue, anxiety, medication wearing off, and complex environments. They can occur at any time of day but are most common during the morning when the medication effect is low and in narrow spaces, such as doorways, hallways, and elevators.
Freezing can be best described as a "short circuit episode" in which the brain has difficulty processing multiple stimuli. To manage freezing episodes, it is important to recognize, manage, and prevent freezing episodes using a range of strategies and tools.
Here's a quick guide to help you better manage freezing:
Recognizing freezing episodes:
The first step in managing freezing is to recognize when it occurs and what triggers it.
Keep a diary or log of your freezing episodes, including the time, location, duration, and circumstances.
You can also use wearable devices, such as the Apple smartwatch which detects mobility/steps and falls and provides feedback to the user and medical team.
Managing freezing episodes:
Once you recognize freezing episodes, you can start using various techniques to manage them. Here are a few approaches to overcome the freezing episodes.
STOP-THINK-PLAN-DO: this approach involves stopping when you feel stuck, thinking about what you need to do next, planning your movements, and doing them deliberately and confidently.
STEP STRATEGIES: involve taking exaggerated or alternating steps to initiate movement and maintain momentum.
BREATHING - ROCKING - CUEING:
Breathing: Practice deep breathing and standing upright while navigating new environments and tight spaces.
Rocking: Focus on rocking forwards and back while standing, shifting your weight sideways, and swinging your arms.
Cueing: Use various cues, such as:
Rhythmic Auditory (counting, singing, or using metronome beats).
Visual (using tape on the floor, attaching a soccer ball, and kicking to ball to get moving).
Sensory (using laser lights on the cane, walker, or tap-fit shoes), to help your brain process multiple stimuli and trigger movement
As you are using different cues, do remember to focus on the heel strike while initiating the walking. Also, try another movement and if you can’t move forward, try stepping sideways and then going forward.
Home Safety Modifications
Make your home environment more conducive to mobility and safety by creating a landing strip with LED lights for improving safety while walking from bed to bathroom, opening doors sideways, removing clutter, and using assistive devices as needed.
Multimodal balance training
In addition to these techniques, it's crucial to get a comprehensive assessment from a Neuro PT and appropriate recommendations to engage in home exercises and/or community Parkinson-specific programs.
Multimodal balance training can include a combination of exercises, such as Tai Chi, and PWR! Moves, boxing, yoga, or dance, which target various aspects of mobility and balance.
Managing Parkinson's disease and freezing is an ongoing and evolving process that requires a multidisciplinary and collaborative approach. Therefore, it's important to seek the right education and comprehensive training to improve your functional mobility, safety, and quality of life.
Everyone has their own unique characteristics and will respond differently to various prompts and strategies. To effectively manage and improve your level of functionality, it's recommended that you regularly assess your progress, communicate effectively, and collaborate with your Movement Disorder Specialist & Neuro PT.
If you require assistance in finding new strategies to enhance your mobility in and out of the home, don't hesitate to contact us for a complimentary consultation or email firstname.lastname@example.org. We are eager to learn about your personal approaches and techniques. Feel free to download the Freezing of Gait Guide here.
Freezing of Gait Workbook
Download our easy-to-use FOG workbook to track your freezing episodes.
"Repetitive practice in various environments and gradual progression with your balance training is the key to conquer your freezing."