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.
