Elastic Priming of Gait: An Effective Patient‐Created Strategy for Freezing of Gait

Abstract

Freezing of gait (FOG) is a common symptom in Parkinson's disease (PD) and is a significant cause of falls, disability, and reduced quality of life. 1 Unfortunately, FOG is poorly understood pathophysiologically and remains difficult to treat. Beyond optimizing dopaminergic medications and considering surgical therapy, rehabilitation strategies are a mainstay of management. Behavioral strategies, such as using sensory cues or shifting weight to initiate gait, help reduce FOG. In addition, patients often develop their own compensatory strategies. 2 An 81-year-old right-hand-dominant male was assessed in clinic for PD. His symptoms began 7 years ago with the development of right-sided rest tremor in the hand, right-sided bradykinesia and rigidity, micrographia, and a slow, shuffling gait. Treatment with levodopa substantially improved his parkinsonism. 3 years after symptom onset, he developed FOG during gait initiation and turning. This was not dopamine responsive and progressed with increasing frequency and duration. Additional triggers included narrow spaces, doorways, navigating obstacles and crowds, and ambulating under time constraints. Physiotherapy strategies helped him avoid falls. However, to maintain safety during walking, he began using a 4-wheel walker at home and for short distances, which was not associated with improvement in FOG, and an electric scooter for long distances. His other motor symptoms continued to be well-managed with levodopa and non-motor symptoms were non-contributory.At 81 years of age, he created his own strategy to address FOG while performing upper extremity exercises with resistance bands. He decided to secure resistance bands (TheraBand, Akron, OH) under the soles of his feet individually or simultaneously and hold them at the level of the handles of his 4-wheel walker, such that the bands were mildly stretched superiorly and anteriorly (Video 1 and Video 2). He did not actively pull on the bands and passive elasticity helped facilitate gait initiation and maintenance. With the use of