The typical Parkinson’s gait develops over time as a result of the features of Parkinson’s disease such as bradykinesia (slowness of movement), loss of postural reflexes, and rigidity (increased tone). The gait of a person is his manner of walking and normally, a person will walk upright, with steady steps and even strides, and arms swinging by his sides. The distinctive gait of a person with Parkinson’s disease comprises of features such as stooped posture, slowness to start walking, short shuffling steps and a tendency to run with reduced arm swing. Levodopa is particularly helpful in improving Parkinson’s gait by helping to reduce bradykinesia and rigidity.
Features of Parkinson’s Gait
Parkinson’s gait develops gradually and a person may have all or some of the following features :
- Difficulty or slowness to start walking as a result of developing bradykinesia.
- Shortened stride.
- Bending forwards while walking, with rapid, small, shuffling steps and a tendency to run (festination). Festination may only develop at later stages of the disease and becomes more pronounced as the disease progresses.
- Stiff, flexed posture is due to rigidity or increased muscular tone.
- Tendency to stoop and lean forward while walking.
- Difficulty in maintaining balance on turning is due to impaired postural righting reflexes.
- Reduced arm swing while walking, especially on the side where Parkinson’s is more pronounced.
- Tendency to fall, due to poor balance, may develop at a later stage of Parkinson’s disease.
- Freezing – inability to move or start walking or stopping in mid-step, as if frozen on the spot (‘statue’).
Refer to the Youtube video for a better understanding of the typical presentation of a Parkinson’s gait.
Management of Gait Problems in Parkinson’s Disease
Certain problems with gait such as festination and freezing may worsen as the disease progresses. To help a person with Parkinson’s disease with gait problems, drug therapy is only one aspect of the management.
- Initial treatment with levodopa shows dramatic improvement in gait, along with other symptoms of Parkinson’s disease, by improving rigidity and bradykinesia. With long term treatment, however, the effect tends to wear off and there may be fluctuations in response to the drug, resulting in the “on-off” phenomenon. This may be corrected with dose adjustments with smaller, more frequent doses or by using slow-release preparations. Subcutaneous injections of apomorphine may help during the “off” phase of treatment with levodopa.
- Levodopa continues to be the mainstay of treatment in Parkinson’s disease and other drugs such as amantadine, COMT (catechol-O-methy transferase) inhibitors, ropinirole or pramipexole may help with gait problems, but to a lesser degree.
- A physiotherapist can help with advice on improving posture and balance and suggest relevant exercises.
- Breaking down the sequence of walking and carrying out each sequence consciously may help in walking steadily.
- Use of certain cues while walking may help prevent falls or freezing.
- Use of correct walking aids such as walking sticks or walking frame may help in the later stages.
- Wearing of correct footwear may help in walking and preventing falls.
Each person has individual symptoms in the presentation of Parkinson’s disease and correct management aims at addressing those individual problems effectively.