Freezing of Gait in Parkinson's Disease: Its Pathophysiology and Pragmatic Approaches to Management

Iansek, Robert; Danoudis, Mary

doi:10.1002/mdc3.12463

Cited by 35 publications

(34 citation statements)

References 49 publications

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“…The phenomenon of gradual step to step reduction is termed sequence effect (SE), which may attribute to the inability of basal ganglia (BG) to provide timing cues and is believed to cause FOG in PD patients (11,12). Based on the defects of BG function and gait-control system, the concept of dual requirement of background step length reduction (manifestation of gait hypokinesia) and presence of SE can explain most of the freezing phenomenon in PD (13). Chee et al reported that FOG episodes were induced more frequently through voluntarily diminishing step length if a significant SE was co-existent in the PD patient (14).…”

Section: Introductionmentioning

confidence: 99%

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Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

et al. 2020

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Background: The sequence effect (SE), referring to step-to-step reduction in amplitude, is considered to lead to freezing of gait (FOG) in Parkinson's disease (PD). Visual cues may alleviate SE and help reduce freezing episodes. FOG patients show significant SE prior to turning or toward a doorway, but the SE toward a destination has not been clearly studied. Objectives: To examine the SE when approaching a destination in PD patients with FOG, and to further explore the effects of different types of visual cues on destination SE. Methods: Thirty-five PD patients were divided into a freezing (PD+FOG, n = 15) group and a non-freezing (PD-FOG, n = 20) group. Walking trials were tested under three conditions, including without cues (no-cue condition), with wearable laser lights (laser condition), and with transverse strips placed on the floor (strip condition). Kinematic data was recorded by a portable Inertial Measurement Unit (IMU) system. The destination SE and some key gait parameters were evaluated. Results: The PD+FOG group showed greater destination SE in the no-cue and laser conditions when compared to the PD-FOG group. There were no significant differences in the strip condition when comparing destination SE of the two groups. The destination SE was alleviated only by using the transverse strips on the floor. In contrast, transverse strips and wearable laser lights could increase the step length. Conclusions: The significant destination SE may explain why FOG patients are prone to freezing when heading toward their destination. Visual cues using transverse strips on the floor may be a more effective strategy for FOG rehabilitation in PD patients.

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Section: Introductionmentioning

confidence: 99%

“…Chee et al reported that FOG episodes were induced more frequently through voluntarily diminishing step length if a significant SE was co-existent in the PD patient (14). Particularly, motor blocks will not occur in the absence of SE during walking (13).…”

Section: Introductionmentioning

confidence: 99%

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

et al. 2020

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“…They observed this phenomenon only in the older (> 70 years) group but not in the middle-aged group. It is unclear whether this phenomenon is a physiological characteristic of healthy aging or a pathological symptom of subtle diseases, such as those accompanied by gait freezing [24]. Second, the phenomenon of extended error correction time has not been reported in earlier studies with driving simulators, due probably to the function unique to PS-PVT that requires switching between parallel and cross modes every 2 min.…”

Section: Discussionmentioning

confidence: 97%

Effects of aging on foot pedal responses to visual stimuli

Yuda

Yoshida

Kaneko

et al. 2020

J Physiol Anthropol

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Background: Car accidents due to unexpected forward or backward runaway by older drivers are a serious social problem. Although the cause of these accidents is often attributed to stepping on the accelerator instead of the brake, it is difficult to induce such pedal application errors systematically with usual drive simulators. We developed a simple personal computer system that induces the pedal errors, and investigate the effects of age on the error behaviors. Methods: The system consisted of a laptop computer and a three-pedal foot mouse. It measured response time, accuracy, and flexibility of pedal operation to visual stimuli. The system displayed two open circles on the computer display, lighting one of the circles in a random order and interval. Subjects were instructed to press the foot pedal with their right foot as quickly as possible when the circle was lit; the ipsilateral pedal to the lit circle in a parallel mode and the contralateral pedal in a cross mode. When the correct pedal was pressed, the light went off immediately, but when the wrong pedal was pressed, the buzzer sounded and the light remained on until the correct pedal was pressed. During a 6-min trial, the mode was switched between parallel and cross every 2 min. During the cross mode, a cross mark appears on the display. The pedal responses were evaluated in 52 subjects divided into young (20-29 years), middle-aged (30-64 years), and older (65-84 years) groups. Additionally, the repeatability of the pedal response characteristic indicators was examined in 14 subjects who performed this test twice. Results: The mean response time was 95 ms (17%) longer in the older group than in the young group. More characteristically, however, the older group showed 2.1 times more frequent pedal errors, fell into long hesitations (response freezing > 3 s) 16 times more often, and took 1.8 times longer period to correct the wrong pedal than the young groups. The indicators of pedal response characteristics showed within-individual repeatability to the extent that can identify the age-dependent changes. Conclusions: Hesitations and extended error correction time can be associated with increased crash risk due to unexpected runaway by older drivers. The system we have developed may help to uncover and evaluate physiological characteristics related to crash risk in the elderly population.

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“…It was suggested that the impaired BG function in PD leads to abnormalities of motor set and motor cues and in consequence the initiation deficits and reduced step length. Such mechanism may be responsible for incidents of gait blocking [48]. So, NW can be considered as the kind of cueing in which upper limb movements are the source of external information enabling the normalization of speed and amplitude of leg movements while walking.…”

Section: Discussionmentioning

confidence: 99%

The Therapeutic Effect of Nordic Walking on Freezing of Gait in Parkinson’s Disease: A Pilot Study

Wróblewska

Gajos

Smyczyńska

et al. 2019

Parkinson's Disease

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Introduction. The effectiveness of the currently utilized therapies for FoG is limited. Several studies demonstrated a beneficial impact of Nordic walking (NW) on several gait parameters in Parkinson’s disease, but only one paper reported reduction of freezing. Research Question. In the present study, the question is whether NW is an effective therapeutic intervention in FoG. Methods. Twenty PD subjects trained NW for 12 weeks, with a frequency of twice per week. Each session lasted about 60 minutes. Twenty patients in the control group did not use any form of physiotherapy (no-intervention group). Freezing of Gait Questionnaire (FOGQ), the Timed Up and Go (TUG) test, and the Provocative Test for Freezing and Motor Blocks (PTFMB) were performed at baseline, immediately after the end of NW program, and three months later. Results. The results of FOGQ, TUG, and total PTFMB revealed significant improvement after completing the exercise program, and this effect persisted at follow-up. The results of the PTFMB subtests showed a different effect of NW on particular subtypes of FoG. Start hesitation, sudden transient blocks that interrupt gait, and blocks on turning improved considerably, while motor blocks, when walking through narrow space and on reaching the target, did not respond to NW training. Significance. The results show, for the first time, that FoG during turning and step initiation, two most common forms of this gait disorder, has been significantly reduced by NW training. Different responses of particular subtypes of FoG to NW probably reflect their different pathophysiologies. Conclusions. The present study showed that NW training had a beneficial effect on FOG in PD and that the achieved improvement is long-lasting. Future research should clarify whether the observed improvement limited to FoG triggered by only some circumstances reflects different pathomechanisms of FoG subtypes.

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Freezing of Gait in Parkinson's Disease: Its Pathophysiology and Pragmatic Approaches to Management

Cited by 35 publications

References 49 publications

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

Effects of aging on foot pedal responses to visual stimuli

The Therapeutic Effect of Nordic Walking on Freezing of Gait in Parkinson’s Disease: A Pilot Study

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