by Sarah Dawson and Josefa Domingos 

Freezing in the home or in busy public places can be upsetting, embarrassing, or even frightening. The anxiety that comes with this symptom of Parkinson’s may make you feel tempted to avoid situations that are more likely to make you freeze – whether that’s crowded rooms, narrow walkways or something else. 

However, we understand that avoiding these situations is not always practical. It is important to know that freezing of gait does not have to stop you from enjoying your social life or the activities you love. There is lots you can do to prevent or overcome freezing. 

Physiotherapist (and President of Parkinson’s Europe) Josefa Domingos – who has spent decades specialising in physiotherapy for Parkinson’s – has approved the following advice. 

Here are our top tips to help with freezing with Parkinson’s: 

1. Stop, don’t force it

If you think you’re about to freeze, stop moving. This gives you time to think about your balance. Try to stay calm, take a deep breath and don’t rush. Think about your next movement and plan out how you’re going to carry it out before you actually move. 

2. Keep a diary

Understanding the triggers of freezing is a powerful way to help take back some control. Keep a diary to record the timing, location, activity being performed, duration and frequency of freezing episodes. Also note down the timing and dosage of each medication. This can help your doctor look at adjusting medication to try and overcome freezing problems. 

3. Optimise medications & manage ‘Off’ periods

Take medications on time to prevent motor fluctuations and improve ‘off’ freezing. Discuss with your doctor about adjusting Parkinson’s medication to reduce freezing. If freezing worsens, deep brain stimulation (DBS) may be an option to consider. 

4. Use visual cues to help when freezing with Parkinson’s

For some people with Parkinson’s, visual cues can be effective at managing freezing. Stick a line of tape across a threshold or on the edges of steps – this can act as a prompt to step over and reduce the risk of freezing. Patterned carpets or cracks between tiles can also act as visual clues. You may even find it useful to use a small torch or laser pointer to project onto the floor ahead as your cue. 

5. Follow the beat (auditory cues)

A steady beat, whether from counting out loud, a metronome or a piece of music, can help prompt you to lift your feet and step. Decide which foot you want to step forward with.   

Then, either silently or out loud, say ‘one, two, three, step’ or ‘left, right, left, right’ to cue the feet to walk. You may like to try closing your eyes to take the first step (as long as it’s safe), then open your eyes to continue.  

A trigger word, like ‘go’, ‘step’ or ‘march’ helps to restart your walking if you do freeze. There are mini metronomes, or similar, which can be clipped onto your clothing – a physiotherapist or occupational therapist should be able to suggest something suitable. 

6. Use your imagination (mental imagery)

Rehearse certain movements in your mind, focusing hard on the sequence. For example: 

• Concentrate on putting your heel down firmly on the ground as your foot makes contact 

• Imagine yourself walking smoothly before starting to move or 

• Mentally picture stepping over an object when freezing starts.  

This technique is called an attentional strategy, and it’s a valuable tool to help with freezing. Attentional strategies require concentration – thinking about moving and rehearsing a sequence uses the same part of your brain as when you actually move. 

7. The weight shift method for freezing with Parkinson’s

When you freeze, gently shift your weight onto the other leg, rather than trying to move forward. This technique will allow you to move forward on your other leg. Try gently rocking your head and shoulders from side to side to help achieve this weight shift. 

Other strategies may include taking a step sideways and then forward. Taking a small step back and then forward with the same foot might also be helpful. Try marching in place for a few steps before moving forward.  

Also try to avoid sudden direction changes – turn slowly and deliberately. Turn using a U-shape, rather than pivoting sharply. 

8. Touch

Using touch as a cue to unblock freezing can be helpful for some people. For example, lightly tap your leg to signal when to step, or have a caregiver touch your back when freezing occurs.  

Source: 

Original article published by Parkinson’s Europe