Parkinson’s Disease and Freezing of Gate – FOG

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What is “Freezing of Gait” and how do I manage it?

Freezing of gait might be described like this:

· “I feel that my feet are glued to the floor”

· “It’s as if I am stuck in mud and cannot get my leg to move”

· “My mind knows to move, but legs just aren’t listening”.

(Experiencing FOG? Contact The Park for a personal 1:1 assessment and discover how we can assist you.)

Freezing of gait, or FOG, is a brief inability to initiate a step and is associated with an alternating flexion/extension of the knees, referred to as knee-trembling. It may occur when one is initiating gait – start hesitation, or when negotiating a turn in the middle of gait – turn hesitation, or when passing through narrow passages or walking around obstacles. It is typically exacerbated by stress or by being distracted.

FOG is thought to be due to a loss of postural reflexes; the anticipatory postural adjustment that precedes taking a step refers to the ability to shift your centre of mass over the stance leg, allowing the freed limb to move forward. It is thought that people who freeze, use multiple anticipatory postural adjustments (the trembling) in an attempt to match this reflex with the motor planning (the muscles coordinating the movement), required for movement.

It may also be that visual perception impacts how you move in your environment. Walking is in fact a complex combination of

· postural adjustments – that ability to shift your centre of mass,

· vestibular orientation – the sensory system that contributes to balance and spatial orientation,

· visual processing – the brain’s ability to make sense of what the eyes see, and

· motor coordination (sequencing of movement).

So, taking time to adjust to your environment is important to prevent freezing of gait.

Ways to minimise Freezing

1. Footwear is important. Choosing footwear that is closed in and fits your foot properly is key to improving your proprioception, that sense of where you are. Your feet should not slip in your shoe, and it should mould to the surface you are walking on. ‘Barely there’ shoes are becoming increasingly more popular for Parkinson’s because you can feel the ground better, giving your brain more information to weight shift and balance. These shoes have a slim sole and are more flexible than traditional sports shoes/trainers.

2. Be intentional. Pick a target to walk to which is especially helpful if you freeze when you enter a room or have a change of walking surface. Keep your eyes on a target in the distance, walking to this target reducing the distractions of everything around you. Walk with intention and count your steps as you go, focusing your brain to put one foot in front of the other.

3. Create visual cues. If there is an area in your home where you typically freeze, tape a series of lines to step over. These visual cues help direct the motor plan so that you simply step from one to the next. This is of course more limiting when you are out and about, but there are several products on the market now that provide this visual cue by way of a laser light or an actual step over target and this can take the stress out of negotiating new places.

4. Posture. Try to stand up straight and look ahead rather than at your toes. When you look down, your centre of mass shifts towards your toes and this can set you off balance. The result is a quick shuffle forward or an exaggerated anticipatory postural response setting off the trembling and exacerbating FOG.

5. Keep your feet wide. Have you noticed how close your feet are together when you walk, this is because your postural reflexes are impacted by Parkinson’s however, this only leads to an increased inability to shift your centre of mass efficiently? This is especially true when you are turning, so keep your feet wide apart. Imagine a balloon between your feet that you don’t want to pop. It is also helpful to exaggerate your turns by lifting your feet high in a marching action. Combine this marching with a count, 1, 2, 3, 4 to coordinate your turn successfully.

6. Let go of that stress. Anxiety and stress exacerbate FOG, so try to avoid shopping at the busiest times and time your trips with your medication. Before you start walking, deliberately loosen off your arms, hands, head, and trunk. Stomp your feet a couple of times to increase your sensory awareness and then breath in deeply and as you exhale, take BIG bold step forward.

7. Identify what triggers your freezing. No one person with Parkinson’s is alike and people have different triggers for freezing. Working with a physiotherapist can help you to identify what triggers your freezing then work specifically on rewiring your brain for change.

I am Frozen How do I get Unstuck?

I love the “5 S” method for getting unstuck by Sarah King (Invigorate Physical therapy and wellness) in Austin Texas.

1. STOP

2. STAND TALL

3. SHAKE IT OFF

4. SHIFT YOUR WEIGHT

5. STEP

If you get stuck, try this method.

STOP just where you are and do not fight it. Let your body just relax.

STAND TALL, whether you are standing or sitting in a chair, straighten up and let your weight shift back onto your centre of mass.

SHAKE IT OFF, take a second just to shake off your hands, arms, head and jaw so that your muscles relax and can recalibrate.

SHIFT YOUR WEIGHT, then shift your weight back and forth or side to side between your two feet or from one buttock and the other.

STEP or SHOOT forward with one big/high step, or a sudden thrust out of the chair.

The Parkinson’s Centre Google Reviews

Mike SmithMike Smith
23:02 14 Feb 24
I am thoroughly satisfied with the care and attention I receive as a Parkinson sufferer from the professional staff at The Park. They provide programs in a clean, modern facility with the latest knowledge and equipment. If you have been recently diagnosed with PD or have a more advanced condition, I can recommend The Park as the place to go to receive the best in individual or group physiotherapy.
Sue RussellSue Russell
06:13 14 Feb 24
I really enjoy my physio at the new Centre. Barbara and Rory have done a great job so far. I'm sure the future extensions will give usmore opportunities to improve our mobility and mental health.I am very happy that Barbara and Tina continue to offer Parkinson'speople the support needed.
John & Libby EdwardsJohn & Libby Edwards
00:37 14 Feb 24
I thoroughly enjoy my exercise classes at The Park. I feel safe, secure, welcome and supported. The gym is spacious and has excellent facilities. The equipment has been specifically designed, is brand new and satisfying to use. The Park is people orientated. There is a genuine sense of community fostered in classes. For me, The Park is a happy, welcoming place where I am encouraged to expand my boundaries. John Edwards
Susie ThomasSusie Thomas
00:35 14 Feb 24
Barb runs an amazing program, and has such passion for improving the lives of people with Parkinson’s (and their carers). We’ve been coming to Barb’s classes for a couple of years and we love it. It’s the highlight of our week. My husband loves coming here, and so do I. If I could give 100 gold stars I would.
Leanne WolfeLeanne Wolfe
22:23 10 Feb 24
Well equipped gym. Easy parking. Experienced Parkinsons related Pysio therapists. Newly opened. Friendly front desk gentleman. Highly recommended
Helen HallHelen Hall
02:58 05 Feb 24
I have attended class programs for two years and find the staff very professional, supportive and caring for the individuals and their journey. Programs suit all level of Parkinson's Disease within each class as well across the client cohort.A wide range of equipment provides challenges for every level. Cognitive maintenance is a constant element of the classes - often causing much fun!The premises are spotlessly clean - and air-conditioned. The location is easily accessed from the Bruce Highway and ample parking is available.The classes typically have developed into friendly support groups.
Margie DoyleMargie Doyle
00:58 05 Feb 24
I cannot speak highly enough of The Park - Parkinson's Centre. Barb is professional, friendly and caring as is Tina and Rory. I always feel very welcome and comfortable with all the great people in the class. I leave the class feeling motivated to keep exercising and to always try my best. The exercise room is spacious and I have everything I need to make the most out of my sessions. Good location and heaps of parking
AnonAnon
00:03 05 Feb 24
The Park is an amazing facility with professional and friendly staff who focus on each individual client. As the name suggests The Park tailors for people with Parkinson’s. The new premises are modern and welcoming and the staff greet everyone by name. The staff are extremely caring and you feel very valued as a member of The Park Everything is scrupulously clean and hygienic. The clients often undertake regular group sessions so people get to know one other well without any expectations of more involvement than they are comfortable with. The equipment is innovative and fun to use and a lot of items used can easily be obtained cheaply for home practice which is a great bonus. The new premises are easy to access, with ample parking and the proximity of the Super IGA and excellent coffee shop are an added attraction . I highly recommend The Park to anyone with Parkinsons.
GRAHAM WHITEGRAHAM WHITE
07:38 04 Feb 24
The Park is an excellent facility for people with Parkinsons disease.It is very accessible, with ample parking, and a has a very welcoming atmosphere on arrival. The programs are always varied, interesting, and topical.Barbs, Rory and staff are always very positive and obviously care and committed to their clients.I wish them all the very best for the future.
Megan MooreMegan Moore
00:49 04 Feb 24
Recent visits to The Park. We were met and welcomed in by the Receptionist and felt we were not just a number. We were made to feel special.The Park location is great just off the highway. The equipment in the Gym is unique. Barb has put alot of knowledge and time into being able to assist and help not only Parkinson’s but people with brain disease.The premises are well designed and clean and fresh. The best thing of all for me is there is a well equipped Disability Toilet. Overall a very impressive experience.
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