What is Parkinsonian gait?
Parkinsonian gait is a defining feature of Parkinson’s disease, especially in later stages. It’s often considered to have a more negative impact on quality of life than other Parkinson’s symptoms. People with Parkinsonian gait usually take small, shuffling steps. They might have difficulty picking up their feet.
Parkinsonian gait changes can be episodic or continuous. Episodic changes, such as freezing of gait, can come on suddenly and randomly. Continuous changes are changes in your gait that happen all the time while walking, such as walking more slowly than expected.
What does it look like?
Parkinsonian gait is one of several motor symptoms that are the hallmarks of Parkinson’s disease, including slowness of movement and tremors. Motor symptoms in Parkinson’s disease come from a lack of control over movements and difficulty initiating muscle movements.
The exact features of Parkinsonian gait can differ from person to person, but there are some very common features that most people have. These include:
- taking small, shuffling steps
- moving more slowly than expected for your age
- festinating, or when your strides become quicker and shorter than normal, which can make it look like you’re hurrying
- taking jerky steps
- moving your arms less when walking
- falling frequently
- freezing of gait
People with Parkinson’s disease can sometimes lose the ability to pick up their feet, which makes them “stuck” in place. Freezing of gait can be triggered by environmental factors, such as walking through a narrow doorway, changing directions, or walking through a crowd. It can also be triggered by emotions, especially anxiety or feeling rushed.
Freezing of gait can happen anytime. However, it often occurs when you stand up. You might find that you’re unable to pick up your feet and start moving.
What are the causes?
In Parkinson’s disease, nerve cells in a part of the brain called the basal ganglia start to die and produce less of a neurotransmitter called dopamine. The basal ganglia use dopamine to form connections between neurons. This means when there’s less dopamine, there are fewer connections.
The basal ganglia are responsible for making sure your body movements are smooth. When there aren’t as many connections in this area of the brain, it can’t do that job as well. This leads to Parkinsonian gait and the other movement symptoms of Parkinson’s disease.
There’s some evidence that anxiety can cause freezing of gait, or make it worse in people with Parkinson’s disease. Anxiety is also a common symptom of Parkinson’s disease. However, more research into this area is needed.
Levodopa (L-dopa) and other medications that help the brain produce dopamine or use it more effectively can help treat Parkinsonian gait. These medications are the main treatment for all symptoms of Parkinson’s disease. L-dopa is often combined with a medication called carbidopa. This medication keeps the body from breaking down L-dopa before it reaches the brain.
Deep brain stimulation has also shown some positive effects on Parkinsonian gait for people whose symptoms don’t improve with L-dopa. In deep brain stimulation, small wires are placed in the parts of the brain that control movement. The wires are connected to a device that delivers continuous electrical pulses to the brain, like a pacemaker does for the heart.
While medications and deep brain stimulation can help treat gait issues in Parkinson’s disease, they tend to not be as effective for these symptoms as they are for other Parkinson’s symptoms. For example, long-term treatment with L-dopa and other similar medications can increase the risk of freezing of gait. This is because the effects of the drugs can start fluctuating throughout the day if you take them for a long time. If this happens, you might experience freezing of gait at times when the medication is having less of an effect.
Exercises to improve gait
Physical therapy, along with other exercises to help you practice walking “strategies,” can help reduce Parkinsonian gait. Some of these exercises can be done at home. Consult a physical therapist to help you figure out which exercises will be the most beneficial for you. Potential exercises include:
Metronome or music cues
Walking to the beat of a metronome or music may reduce shuffling, improve walking speed, and reduce freezing of gait. Try it for half an hour at a time, a few times a week.
Before you start walking, visualize yourself taking long strides and “rehearse” walking in your head. This can help you focus your attention on walking. It also activates parts of your brain besides the basal ganglia, which some studies show can help you compensate for low levels of dopamine.
This set of exercises helps align your posture and increase your stability and coordination.
Improving flexibility and range of motion
Improving your flexibility can help you improve your balance and gait, as well as reduce rigidity. Try these exercises:
- Sit in a chair and bend your upper body at the waist to your right and left.
- Get on all fours and turn your upper body to the right and left. Lift your arm on the side you’re turning to as you turn.
Also work on lower-body strength training. Strength training can help you improve your balance, walk further distances, and potentially increase your walking speed. Some exercises to try include:
- Leg presses. While sitting down, push a weight away from your body using your legs.
- Squats. Start in an upright position with your legs slightly wider than hip distance. Bend your knees while pushing your glute muscles back, so that your knees don’t come over your toes. You can hold onto something if necessary. You don’t have to go down more than a few inches.
- Exercise bike. If you have access to a recumbent exercise bike (a stationary bike with a back for you to lean on while your legs are straight in front of you), using the bike can help strengthen your legs.
- Repeatedly sit in and rise out of a chair. Repeating the motions of sitting down and rising helps strengthen your leg and core muscles. It also helps you practice a functional activity.
What’s the outlook?
Parkinsonian gait is a major symptom in people with Parkinson’s disease. A combination of medication, strength exercises, and mental strategies may help improve mobility.
There’s no known cure for Parkinsonian gait. In most people, Parkinsonian gait will continue to progress. Talk to your doctor about your options for managing your symptoms.