Walking with Parkinson's: Understanding Gait Freezing & How to Manage It
For most people, walking is something they don't think about. It is automatic. You stand up, put one foot in front of the other, and keep moving forward. Now imagine one moment you're walking normally, but the next, your feet feel as if they are glued to the floor.
The above scenario can become reality for people with Parkinson's disease. Parkinson's disease is a progressive neurological condition that affects movement. It can also cause cognitive changes, mood disturbances, and extreme fatigue.
One frustrating mobility problem that can develop is Parkinson’s freezing gait. It manifests as an inability to take a step forward. For someone with Parkinson’s, their brain tells their feet to move. But the feet remain still as if frozen.
Parkinson's freezing of gait can happen suddenly as someone is navigating a crowd, turning around, or just after standing up. It can be frightening, unpredictable, and frustrating. But there are strategies and Parkinson's disease treatments that can help improve mobility and cope.
The article below explains gait freezing and how mobility and cueing devices could be part of Parkinson's disease treatments.
To add expert perspective, this article includes insights from Sidney Collin, inventor of NexStride and Clinical VP – Technology Innovation at Drive Medical. Sidney has a background in biomedical engineering and computational neuroscience. Her work has focused on helping people with Parkinson’s disease and other neuro-ambulatory conditions use visual and auditory cueing strategies during everyday movement.
What Is Gait Freezing and Why Does It Happen in Parkinson's Disease?
Gait freezing is an abnormal walking pattern that involves a sudden, involuntary inability to move the feet forward. During an episode, someone may feel as if their feet are frozen or may take quick marching steps in place without moving forward.
“People sometimes assume freezing is caused by muscle weakness, or even that the person simply isn’t trying hard enough to move,” Collin says. “But freezing is a neurological symptom. Someone can know exactly where they want to go and be trying very hard to take the next step, yet temporarily feel as though their feet are ‘stuck’ to the floor.”
According to the Parkinson's Foundation, episodes can be triggered by:
- A delay in taking medication
- Multitasking
- Or walking through doorways
Collin adds that anxiety is another trigger that may not get discussed enough. For example, feeling rushed while crossing a road or pressured to move quickly can make freezing worse for some people.
These episodes only last a few seconds. However, they can have a significant impact. Gait freezing can increase the risk of falls, reduce overall activity, and decrease confidence when walking.
Parkinson's freezing gait is fairly common. According to an article in the journal Neuromodulation, up to 63% of people with idiopathic Parkinson's disease experience freezing gait. Doctors are not entirely clear why some people with Parkinson's develop freezing gait, and others do not.
Walking is a complex process that involves various parts of the brain, including:
- The front of the brain
- The basal ganglia
- And areas of the brain stem.
Research suggests that miscommunication can happen in the basal ganglia and frontal cortex, affecting the initiation, planning, and control of steps.
How Parkinson's Disease Affects Walking and Mobility Over Time
Parkinson’s disease can develop when nerve cells in part of the brain called the substantia nigra degenerate, leading to reduced production of the neurotransmitter dopamine.
Dopamine plays a role in coordinating controlled smooth movements. As dopamine decreases, communication between nerve cells in the brain and muscles does not work as well. Various muscles of the body are affected, including those in the arms, legs, and even the face.
As the condition progresses, motor symptoms commonly occur and can include muscle rigidity, slow movement, balance problems, tremors, and changes in walking patterns.
The speed of progression varies greatly. Generally, walking difficulties develop gradually. For instance, a person may start to notice subtle changes, such as moving more slowly. It's also common for someone with Parkinson's to no longer swing their arms naturally when walking.
As the disease progresses, common changes in walking include:
- Shuffling
- Slumped posture
- Slower walking speed
- Difficulty turning
- Poor balance
- Trouble stopping and starting movement
Because of these walking changes and the possibility of gait freezing, everyday activities and getting around can become more difficult. Even something as simple as walking through a narrow hallway can become challenging.
What Are Visual and Auditory Cues and How Do They Help with Gait Freezing?
Parkinson's disease self-care includes developing strategies to manage freezing gait, such as using visual and auditory cues. These cues or prompts can help reset the brain when there are problems initiating movement. This may help some people take the next step more smoothly.
Visual Cues
Visual cues may help an individual with Parkinson's by giving their brain a clear target to focus on. A visual cue also encourages more deliberate steps.
Collin explains that a laser cue can work because it gives the brain a specific goal. “The laser line is simply a clear goal to focus on,” she says. “You think about stepping over the green laser line and your movement switches from an automatic movement to a goal-oriented movement.”
Various visual cueing strategies may be helpful, including the following:
- Focusing on floor tiles as stepping targets
- Walking over colored tape
- Stepping over a laser line projected onto the floor
Certain visual cues attach directly to mobility aids convenient use and enhanced mobility. For instance, the NexStride Visual and Auditory Cueing Device uses both laser and sound to help improve mobility.
The device projects a laser line in front of the user to provide a stepping target when gait freezing occurs. It also includes an audible metronome which is used as a goal to walk to the beat of. This allows users and clinicians to explore whether visual cues, auditory cues, or a combination of both may be most helpful.
Auditory Cues
Auditory cues provide a steady rhythm that can help encourage smoother steps by synchronizing movements. Some people naturally match footsteps to the beat, which makes walking feel more fluid.
Collin’s early work with cueing began with music. One early user responded well to walking to favorite songs, which is a form of rhythmic auditory stimulation. The first prototype even included an MP3 player loaded with songs of his choice before the design evolved toward a simpler metronome that could work more practically for a wider range of users.
Although it may not completely eliminate freezing episodes, auditory cues may improve stride length, walking speed, and overall gait quality.
Examples of auditory cues include:
- Counting aloud, such as 1, 2, 3, and step
- Listening to rhythmic music
- Walking to the beat of a metronome
Because every person’s symptoms and walking patterns are different, cueing is not one-size-fits-all. “Some people almost exclusively use the laser, while others really respond to the metronome,” Collin says. “There really isn’t one cue that works best for everyone, which is why it is important to offer a variety of solutions.”
The Best Mobility Aids and Walking Devices for People with Parkinson's
It's helpful to consider mobility aids as a part of Parkinson's disease treatments instead of as a final resort. According to the Parkinson's Foundation, 38% of people with Parkinson's disease have a fall each year.
Changes in balance and walking can occur as Parkinson's progresses. This can make walking and activities, such as shopping, going out for dinner, and visiting friends, more challenging.
The right mobility device improves safety, increases confidence, and helps individuals remain active and independent. It's common for people with Parkinson's to also develop problems with balance. Depending on the person’s mobility level, they may start with one aid and move on to something else as more support is needed.
Below are options.
Canes and Walking Poles
A cane may be beneficial for someone in the early stages of Parkinson's disease with mild instability. A cane can provide additional support and help improve balance on uneven surfaces, allowing continued mobility.
Walking poles may be another option for people with Parkinson's who want light support while staying active. Also known as Nordic walking poles, they are used in pairs to engage the arms and legs in a rhythmic walking pattern. According to the Parkinson’s Foundation, pole walking may help users walk faster, more upright, and more steadily. For people with Parkinson’s, this rhythm may help encourage:
- A more upright posture
- Longer strides
- Improved arm swing
- A steadier walking pace
Walking poles may be best suited for people who can safely coordinate both arms and legs while walking. They should be used with guidance from a physical therapist or healthcare provider, especially for anyone with balance concerns, freezing episodes, or a history of falls.
Rollator walkers
Rollator walkers are another option after a cane is not enough and balance problems are progressing. A rollator walker usually has four wheels, hand brakes, and a built-in seat.
Drive Medical Rollators have ultra-light options with three or four wheels, including an upright model. Walkers can help someone with Parkinson's maintain their mobility and stay active.
Walkers
A standard walker may be the next step up from a cane for individuals who have significant balance problems. Drive Medical Walkers offer additional support while walking and include two-wheeled, upright, and folding models.
Specialized Parkinson's disease walkers
Among the best walkers for seniors with balance problems may be models specifically designed for people with Parkinson's disease. These walkers may have features including:
- Reverse braking
- Laser cueing systems
- Enhanced stability
- Audible metronomes for auditory cueing
How to Use Cueing Devices in Physical Therapy and Daily Life
Cueing devices are helpful tools that may benefit individuals with Parkinson's disease by helping them cope with gait freezing. But cueing devices may not be recommended for every person with Parkinson's disease.
When recommended, cueing devices may include:
- Smartphone apps providing auditory cues
- Laser cueing devices
- Specialized Parkinson's disease walkers
- Metronomes
There's no one exact strategy that works for everyone with Parkinson's to improve walking and mobility. It's best to have an evaluation from a physical therapist. They can determine what cueing devices would be most effective for an individual. A therapist can also teach someone with Parkinson's and their caregiver how to use cueing devices in everyday activities.
Collin says physical therapists often use cueing creatively in the clinic, including during gait initiation, turning, step length practice, and obstacle navigation. Devices may be attached to gait belts, treadmills, walkers, canes, or other mobility aids as part of supervised therapy.
Physical therapists will implement cueing devices differently for different patients. For example, possible uses for a cueing device in daily life include:
- Walking in distracting environments
- Making quick turns
- Walking through hallways, doorways, or narrow spaces
- During gait training
- Walking in a new environment
The main value of cueing devices is that they can make visual or auditory strategies available during everyday activities, not only during physical therapy sessions. “What’s different about home use is that the cue becomes available when the person actually needs it in daily life,” Collin says.
One early example has stayed with Collin: a user who struggled with a long, narrow hallway between his bedroom and kitchen. Narrow spaces had become such a significant trigger that he sometimes crawled through the hallway rather than walk. After using NexStride, Collin says, he was able to use the visual cue to navigate that hallway on his feet again.
Tips for Caregivers Supporting Someone with Parkinson's and Walking Difficulties
There are several things caregivers and family members can do to improve walking with Parkinson's disease, including the following:
Stay calm
Provide clear, simple instructions and remain calm if a freezing episode occurs. Your first instinct may be to help pull someone forward, but that increases the risk of a fall. Remaining calm and giving clear instructions may help decrease anxiety in someone experiencing freezing gait.
Collin says caregivers should avoid rushing the person through the episode. “The most common mistake I see is caregivers saying ‘hurry up’ or ‘come on’ or ‘just keep walking,’” she says. “This can actually make the freezing worse.” Instead, she recommends pausing, encouraging a deep breath, and helping the person focus on a clear goal, such as a laser line, visual target, or steady rhythm.
Encourage safe exercise
It is common for a caregiver to ask, “Does walking help Parkinson's disease?” and the answer is yes. If someone has mobility issues, it may seem safer to limit exercise. However, exercise is one of the core components of a Parkinson's disease self-care program.
Regular exercise can include balance exercises, walking, and Parkinson 's-specific classes such as Rocksteady Boxing. It's essential to ensure the exercises are physician-approved before participating.
Remove tripping hazards
Check for possible tripping hazards such as steps without handrails, poor lighting, and clutter. Options to make a home safer include:
- Improving lighting in hallways
- Using non-slip mats in the kitchen and bathroom
- And installing grab bars in the bathtub.
Monitor progression
Consider keeping a simple log of when symptoms occur and whether the symptom is new. Report any changes, symptoms, or disease progression to the healthcare team. As a caregiver, you don't have to be in it alone. Your healthcare team can provide information on the latest Parkinson's disease treatments, mobility aids, and support services.
Take care of yourself
As a caregiver, it's easy to overlook your own needs. Supporting someone with Parkinson's disease can be exhausting.
Make it a priority to maintain your own health and well-being by:
- Getting enough rest
- Exercising regularly
- Taking breaks
- And staying connected with others.
Caregiver burnout is a real thing. Taking care of yourself is not selfish. It lets you be the best support person for your loved one.
FAQ
What causes gait freezing in Parkinson's disease?
Changes in the brain due to Parkinson's disease can interfere with the signals that control movements such as walking. When an individual is in a situation that demands extra concentration, such as carrying something or having a conversation while walking, it can increase the risk of gait freezing. This is likely because the brain's ability to coordinate movement becomes overwhelmed.
Does walking help slow the progression of Parkinson's disease?
As reported by Yale Medicine, exercise, such as walking, may help slow disease progression. Regular exercise improves balance, flexibility, and muscle strength.
What is the best walking aid for someone with Parkinson's disease?
There is no one best walking aid for everyone. Selecting the most appropriate aid depends on a person's symptoms, mobility level, and overall balance. It is helpful to have a physical therapist or healthcare provider evaluate your gait and recommend a mobility aid that meets your individual needs. For people who just need a little support, a cane or walking pole for balance may be sufficient for added stability.
How do visual and auditory cues help people with Parkinson's walk better?
Auditory and visual cues provide the brain with a rhythm or external target to follow. This may help bypass part of the impaired motor pathway implicated in gait freezing. These external prompts may help some people overcome freezing gait and improve their stride.
Can a cueing device be used alongside physical therapy for Parkinson's?
Yes, physical therapists often use cueing devices when treating freezing of gait in people with Parkinson’s disease. It's also common for therapists to teach caregivers how to implement cueing devices during daily activities.
How do I know if a cueing device could help me or my loved one?
Collin recommends discussing cueing devices with a physical therapist or healthcare provider because every person’s gait, symptoms, and mobility needs are different. A therapist may use visual targets, such as lines on the floor, or rhythmic auditory cues, such as a metronome, during gait training. If someone responds well to those kinds of external cues, that may be a helpful sign that portable cueing strategies are worth exploring further.
Expert Contributor
Sidney Collin is the inventor of NexStride and Clinical VP – Technology Innovation at Drive Medical. She started the company while studying biomedical engineering at Cal Poly and later launched and scaled NexStride to help people with mobility impairments improve walking and reduce fall risk. Sidney has an academic research background in computational neuroscience, with research published in the Journal of Clinical Neurophysiology. She is also involved in the Parkinson’s community and serves on the board of the Capital Area Parkinson’s Society in Austin, Texas, as well as the Industry Advisory Board for the Cal Poly Biomedical Engineering Department.
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