Have you ever felt like your feet are super glued to the floor? Or felt like your feet kept taking a studer step. Those are both common signs of freezing. Freezing is a brief, episodic absence or decrease of forward movement of the feet despite the intention to walk.
About 26% of those with mild PD and 80% with more significant PD experience freezing episodes. When your feet are stuck to the ground, your trunk is still moving forward, which can result in a fall. Freezing is the most common reason for falls in those with PD. For some people, this can be really frustrating and possibly embarrassing while for others freezing can be a major concern and lead to injury. This is why it is so important to understand freezing.
You may be wondering why does freezing happen?
Typical walking uses a complex system of communication to activate numerous muscle groups to be able to move, keep your balance, and stand tall. The brain uses different communication pathways (circuits) and feedback to produce movement and make adjustments as needed. From childhood on we learn to walk without having to put a significant conscious effort into how we are performing this task.
With Parkinson's disease the circuits that help to make walking automatic are impacted. This can lead to decrease in step length, walking speed, posture, and arm swing (common symptoms at initial diagnosis). Parkinson's can make it harder to move big, move with rhythm, and do 2 things at once (dual tasking)
The exact reason why people "freeze" is not known but these episodes can occur during "off" times of medication, times of stress and when trying to do 2 or more things at once. Another thought is that freezing is related to a mismatch between your motor system and your perception system. Body awareness and visual navigation (depth perception, contrast, ocular misalignment with 1/3 of people with PD have double vision) can be impacted by PD.
Freezing is often triggered by specific activities or circumstances which require shifting between movements. This can be when standing from a chair having a brief hesitation (start hesitation) which can be seen even in early PD. Each person is unique and what triggers freezing can be really specific. Here are some common triggers of freezing
Environmental and Emotional triggers:
Gait initiation (“start hesitation”)
Doorways
Narrow passages
Turning or changing directions
Obstacles in the path
Elevators
Busy crowds
Multi-tasking / distractions
Being rushed
Being startled (“startle hesitation”)
Stress and Anxiety
Stay tuned for next week where we will go over strategies on how to thaw a freeze!