Coping With Freezing in Parkinson's Disease

Around half of people who have Parkinson's disease experience freezing—a temporary inability to move that occurs suddenly and without warning. Such episodes are short-lived, lasting from a few seconds to up to several minutes.

Parkinson's freezing can affect nearly any part of the body and disrupt nearly any activity—chewing for example, or writing. However, it most often occurs when someone is walking, causing them to feel as if their feet are glued to the ground even though the upper part of their body is still mobile. This sometimes is referred to as freezing of gait and can have repercussions ranging from a brief disruption in stride to an increased risk of falling that can lead to broken bones and other injuries.

The exact physiological cause of freezing in Parkinson's has yet to be determined. What is known is that it's often associated with lulls in the effectiveness of medication, particularly among people who have mid-to-late stage disease. There also are a number of common triggers of freezing while walking, such as changing direction, approaching a doorway, or navigating a crowded area. Although Parkinson's freezing can have a negative impact on a person's quality of life, there are simple and effective ways to manage it.

Causes

The exact cause of freezing is unknown, but researchers suspect it has to do with cognitive difficulties and the complex brain circuitry required for movement. Walking, for example, requires multiple connections between different parts of the brain, including:

• areas in the front of the brain that plan and initiate movement
• areas of the basal ganglia where the dopaminergic neurons that refine and control movement are found
• areas in the brainstem that modulate movement and wakefulness

In people with Parkinson's disease, the brain connection seems to get stuck—or short-circuit—at one or more places. The specific abnormalities that cause the problem may differ from person to person.

Common Triggers

Freezing is more common when a person is anxious, agitated, or simply having an “off” period. It can also be common when dopaminergic medication starts to wear off.

Although freezing episodes can happen at any time, they happen more often when you are first beginning to move. Freezing episodes are often triggered by the following:

• Walking through doorways
• Turning a corner
• Turning around
• Stepping from one type of surface to another, for example from tile to carpet
• Stopping or slowing down while walking
• Navigating a crowded or unfamiliar place

The unpredictability of freezing creates danger of falling. In addition, sometimes friends or family try to force you to move, which can cause you to lose your balance and fall.

Management

If you are struggling with freezing episodes talk to your healthcare provider. It can help to keep a symptom diary, noting times of day or specific actions that result in freezing. Your practitioner may be able to adjust your medications to help reduce episodes.

A physical therapist trained in Parkinson’s disease can also help you learn how to reduce your risk of falling. An occupational therapist can help you to lower the risk of falls in your home.

Tips to Get Moving Again

When you get stuck, these tricks from the National Parkinson Foundation can help:

• Be aware of freezing triggers and prepare strategies in advance.
• March with a straight leg. For example, swing the leg high and parallel to the ground with the knees straight.
• Shift the weight of your body from one leg to another.
• Listen to music and step with the rhythm.
• Hum, sing, or count.
• Imagine a line to step over or focus on a target on the floor to step on.
• Use a mobile laser device to create a line in front of you to step over.
• Turn by walking half a circle instead of by a pivot turn.

Support

Many people with Parkinson's disease become frustrated or embarrassed when freezing occurs. If you are a friend or family member of a person who is experiencing a freezing episode, you can help by being patient and not drawing attention to freezing episodes. Other things you can do:

• Remain calm. Do not rush or push the individual.
• Wait patiently for several seconds to see if the episode passes.
• If the person cannot move, try placing your foot perpendicular to the person and asking them to step over it.
• Help rock the person from side to side.
• Encourage the individual to try marching or counting.
• Ask the healthcare provider about physical therapy and/or occupational therapy.