Gait is our manner or pattern of walking. When we walk our body is normally upright, neither leaning forwards nor backwards, with an even stride and arms swinging at the sides. When we hold ourselves in this upright position our centre of gravity is held so we should have good balance.
How might Parkinson's affect gait?
‘Parkinsonian gait’ is a distinctive, less steady walk that arises from changes in posture, slowness of movement (bradykinesia) and a shortened stride. This is characterised by some, but not necessarily all, of the following:
- a tendency to lean unnaturally forwards in a stooped position when walking and, in some cases, a tendency to lean backwards when standing
- the head dropped forwards, with shoulders down, hips and knees bent
- steps taken on the front of the feet
- feet dragging on the ground, resulting in shuffling steps
- a reduced length of stride
- a reduced arm swing, particularly on the side on which Parkinson’s is most noticeable.
If you develop this Parkinsonian gait you may experience some of the following problems:
- start hesitation - a hesitation in initiating movements such as walking
- difficulty making a turn due to slowness, stiffness or instability
- difficulty making transfers, e.g. getting out of a chair or bed
- freezing - a sudden inability to start or continue walking, as if glued to the spot
- postural instability (poor balance) which makes falls more likely
- festination - progressively shorter but accelerated steps forward, often in a shuffling manner or as if falling forwards, in an attempt to maintain the position of the feet beneath the forward moving trunk. This tends to occur in later in Parkinson’s.
Some features of Parkinsonian gait are likely to become more pronounced over time, particularly festination, stooped posture and freezing. Your range of movements may change over the years and you may become less active as a result, which can reduce muscle strength and reflexes. This in turn can lead to musculoskeletal changes that exacerbate poor posture and stooped stance and so increases the risk of falls.
If you become less mobile or feel unsteady it is easy to lose confidence because of a fear of falling. This may impact on your social activities and quality of life, so it is important to seek advice on how to improve gait.
Gait problems may also be related to medication becoming less effective over time, particularly if you experience ‘wearing off’. You should therefore talk with your doctor as he or she may be able to adjust your medication to alleviate some gait related difficulties.
Treating and managing gait problems
Unfortunately, problems with gait, posture and balance tend not to respond as well to medications as other common motor symptoms, such as tremor, rigidity and bradykinesia (slowness of movement). In addition, higher doses of medication over time to manage symptoms such as dyskinesia and orthostatic hypotension (decreased blood pressure on standing) can sometimes increase problems with gait.
Nevertheless, there are lots of things you can do to help yourself and there are also experienced professionals who can offer very useful advice. Each case will be different and it is hard to generalise but depending on where you live your doctor will normally be your first contact and they may refer you to one or more of the professionals listed below.
A physiotherapist will be able to advise on techniques and exercises to improve your gait, balance and posture according to your own individual needs. He or she can help by breaking down the sequence of walking so that you focus on each individual component and consciously carry out each movement. They can advise on the use of various cueing strategies (see Freezing) to help reduce freezing and the fear of falls, and the safe use of mobility aids such as walking sticks. They can also help you to improve your mobility in general and will work with you to identify problems you experience in everyday activities, such as getting out of a chair or bed, advising on strategies and exercises to help overcome these.
For more information see Physiotherapy.
An occupational therapist will be able to advise on suitable walking aids and how to use them if needed. It is important that any aid, e.g. walking frame or stick, is the correct height for you and that you use it correctly so that your balance and safety are not compromised.
An occupational therapist can also advise on the appropriate positioning on the ground of visual cues (see Freezing) to help overcome freezing, and on various metronomes and other auditory devices that can help you keep an even pace when walking.
For more information see Occupational therapy.
A podiatrist will be able to advise on the best footwear to help your walking, especially on the height of heels and the material of shoe soles.
For more information see Foot care.
Parkinson’s Disease Nurse Specialists (PDNS)
In some countries, there may be PDNS or nurses who specialise in neurology and have experience in dealing with gait problems. Your doctor will be able to advise on this.
How can I help myself?
As the effects of medication on gait improvement are limited it is important to look at how you can help yourself by adjusting the way you walk and using cues which can help. The following suggestions may help you:
- Look forward as you walk, not down at your feet.
- Focus on maintaining good, upright posture when walking.
- Increase awareness of your posture by standing against a wall with your head, shoulders, hips and heels all making contact with the wall.
- Lift your toes and place your heel firmly on the ground after each step - this will help you take longer steps.
- Practice taking long strides, keeping focussed on stride length so that it does not gradually shorten.
- Concentrate on swinging your arms at your side.
- Avoid walking and doing something else at the same time, e.g. talking.
- Avoid shoes with a high heel or a crepe sole as these may ‘catch’ on the ground.
- Use auditory, visual and cognitive cues (see Freezing): rhythmical counting can help keep your stride even; marking a line to step over can help initiate walking; imagining lines on the floor of a confined space can help prevent loss of balance or freezing.
- Seek advice on exercises to strengthen muscles that will help you maintain an upright posture.
- Do stretching exercises each day to improve mobility and reduce rigidity or stiffness.
- Try different techniques to reduce freezing.