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October 18, 2021 – Walking problems are common and worrying for people with Parkinson’s disease, but a new study of more than 4,000 people with Parkinson’s disease and mobility problems found seven “workarounds” that can help.
“Compensation strategies are” tricks “that people use [Parkinson’s] used to overcome their walking difficulties, ”say researchers Dr. Anouk Toserams and Dr. Eorik Nonnekes, both from Radbud University Medical Center in the Netherlands.
Parkinson’s often causes movement problems, such as imbalance, stirring, falling, staggering, and freezing.
“We found that these strategies are used frequently, but patients’ awareness of the full range of available strategies is quite limited,” they say.
A personalized approach to rehabilitation and patient education is important, the authors say.
Dr. Rebecca Gilbert, vice president and chief research officer of the American Parkinson’s Disease Association, says the study should help doctors and patients.
Although many of the proposals are already in use, the study, which goes into greater detail, should make practices more “systematic,” said Gilbert, an associate professor of neurology at Bellevue Hospital in New York.
Creative solutions
Tosserams and Nonnekes explain that their research is “inspired by the creativity of people with [Parkinson’s] who have devised a wide variety of strategies to overcome walking difficulties. “
Improving the ability to go through this type of non-invasive strategy is essential, they say, because drugs and surgeries are often not successful enough.
In their daily practice, the authors say that “they notice that different strategies seem to have different effects on walking, depending on the person using the strategy and the context in which the strategy is used.”
An online study was sent to more than 8,000 participants (over the age of 18) with Parkinson’s disease who have difficulty walking. Of these, 4,324 responded and were included in the analysis.
Participants were attracted by the Fox Insight cohort, a study led by the Michael J. Fox Foundation, and by ParkinsonNEXT.
The study is divided into three parts: The first includes information on gender, age, time after diagnosis, ability to walk and history of falls in the last year.
The second part of the study asked participants how familiar they were with seven strategies:
- External cues (for example, walking to the beat of a metronome, wearing vibrating socks, or going through lines)
- Internal arrangement (eg using self-guidance or mental math)
- Changing balance requirements (eg moving the weight in place before stepping, making wider turns or using walking aids)
- Change in mental status (eg breathing exercises or other approaches to reduce anxiety or fear of falling)
- Observation of action and motor images (imitating someone else walking or visualizing the desired movement)
- Adapt to a new walking pattern (eg scissors, knee lift, jumping, running or walking backwards)
- Other forms of using the legs to move forward (eg cycling, skateboarding or crawling)
The third part of the study focuses on the interest of participants to learn more about these strategies.
The context matters
One-fifth of respondents have never tried any form of compensation strategy, but most have tried at least one. The most commonly tested strategy was to adapt to a new walking pattern.
Overall, nearly 65% of respondents continued to use at least one strategy in their daily lives, most often when walking outdoors or in time pressure situations. The most widely used category was the change in the balance requirement, followed by internal signals and a change in mental state. Interestingly, the external arrangement was used the least (only 55%).
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