Combating Mobility Freezing Caused by Parkinson’s Disease

SAFE SUGGESTIONS

by J. Thomas Hutton, M.D., Ph.D.

Freezing is the name given to the temporary, involuntary inability to move that is fairly common among persons with advanced Parkinson’s disease. One’s feet may seem to stick to the floor or one may be unable to get up from a chair. The problem can occur at any time and some people are more prone to freezing episodes than others. Freezing is not responsive to any medication and requires behavioral retraining to initiate movement. The cause of this frustrating gait disturbance is unknown. Freezing creates a danger of falling because the beginning and end of a freezing episode are unpredictable. The unpredictability coupled with efforts by well-meaning companions to force the person to move may cause the person with Parkinson’s disease to lose balance and fall.

Frequently, the circumstances leading to a freezing episode may be anticipated, even though a particular circumstance may not cause a freezing episode every time it is encountered. Many situations encountered in day-to-day activities lead to freezing episodes. Some of the more common situations are:

        Walking in crowds
        Walking in narrow hallways
        Being in confined spaces such as elevators or restroom stalls
        Sudden obstructions
        Approaching a doorway
        Over-fatigue or stressful situations

One of the ways to move smoothly through the environment is to develop a motor program. A motor program is an anticipated strategy for movement in space. Before walking down a hallway, based on experience, the kind of movements to be made are anticipated. If correctly anticipated, the attention needed for this activity is reduced. If movements in space are preprogrammed, as each movement occurs the program can be continually referred to for accuracy and the need for small adjustments. This preprograming process makes movement through space less cognitively demanding. An obstacle or unpredictable situation, such as a crowd of people, may require that the anticipated motor program end or be altered significantly, or another program developed quickly. For example, passing through a door and then reaching a stairwell requires generating another motor program.

Because freezing often occurs in situations in which an ongoing program must be altered or several programs strung together, the best suggestion for a person with Parkinson’s disease is to consciously prepare for such situations. People should consider those situations that tend to cause freezing and, if possible, avoid those circumstances. Plan ahead and think about what to do to counteract freezing. There is no “official” way of getting started again and patients often develop their own unique methods of initiating movement.

Suggestions to combat “freezing”

        Stop trying to continue the activity.
        Call for help if necessary.
        Change direction: If you can’t move forward, move sideways or take a step backward.
        Use a sound or rhythm to stimulate movement.
        Think of or sing a tune and then move to the beat. Marches have good rhythm.
        Count silently or out loud and then move to the count: 1-2-3, 1-2-3.
       Visualize an object, then lift your foot and try to step over the imaginary object.
        Imagine floor tiles are stepping stones and try to step from one to another.
        Use a pocket flashlight to throw a pool of light in front of you; try stepping in the pool.
        If you use a cane, draw an imaginary line on the floor and try stepping over the line.
        Ask a companion to place a handkerchief or piece of paper on the floor; try to step over the object.
        If you tend to freeze in a specific place, such as a doorway, try to visualize beyond the obstacle. Once beyond the object, freezing will not likely occur.

From Preventing Falls, A Defensive Approach, by J. Thomas Hutton, M.D., Ph.D. Copyright © 2000 by Prometheus Books. Excerpted by arrangement with Prometheus Books. $18.95. Available in local bookstores or call 800-853-7545 or click here.