Freezing of Gait and NexStride

Freezing of Gait is a debilitating occurrence associated with a number of neurological conditions. Here, Anatomical Concepts explain more about its impact, and how the latest innovations in rehab tech can assist

Freezing of gait (FOG) is a common motor disorder in Parkinson’s disease (PD). It is characterised by sudden, unanticipated interruptions in gait, lasting from seconds to minutes, in which people feel that their feet are stuck to the floor and unable to move forward despite trying hard.

FOG episodes can occur in other neurological diseases too. The phenomenon is particularly debilitating and often requires physical support from another person to get unstuck and start walking again.

Treatment strategies developed for managing gait disorders and freezing include medications, deep brain stimulation (DBS), physical therapy interventions and external visual cues.

The classic presentation of gait freezing is sudden and dramatic stops and starts while walking, but some patients describe that they feel like their feet are glued to the floor with an inability to take the next step.

These episodes often occur when crossing doorways, turning around, or approaching an obstacle. The severity is very variable from person to person with some experiencing only occasional episodes and rarely, some individuals will experience almost continuous FOG preventing useful ambulation.

Freezing of Gait obviously impairs mobility but also increases the risk of, and causes, falls and significantly reduces quality of life.

Gait disorders, including freezing, affect 60 to 80 per cent of PD patients, often presenting in the later stages of the disease.

Several factors can cause or worsen the freezing of gait, including fatigue, distraction, anxiety, stress, visual clutter, transitions from one walking surface to another, and narrow spaces. Patients who have freezing of gait also tend to experience more severe postural instability and other motor symptoms of the disease.

Studies have shown that more advanced PD patients who show primarily a freezing of gait phenotype tend to have less benefit from dopaminergic medication and have more potential side effects, including motor fluctuations.

Thus, there is a growing clinical focus on novel therapeutic interventions, not only for FOG but working on the significant non- dopaminergic pathology that exists in the primary progressive freezing gait syndrome.

Physical therapy, particularly a program that involves balance and gait training, is an essential non- pharmacological intervention to improve gait freezing and associated motor symptoms.

Standardised gait questionnaires and structured physical activity programmes have been used to assess patients’ motor and cognitive function, providing a baseline to evaluate this and guide clinical intervention.

Visual cues are known to be an effective method for improving freezing episodes.

The presence of sensory feedback may be useful for overcoming a “motor block” and promoting movement.

Various external visual cues, such as laser lines, stripes on the floor, or footstep rhythms, can be an effective way to overcome freezing, providing the patient with a predictable sequence to follow.

Additionally, tasks such as mental imaging and rhythmic audio cues can also effectively trigger gait initiation in PD patients.

Anatomical Concepts offers a neat product called NexStride that uses cueing technology to help overcome the freezing of gait.

The NexStride product combines both visual and rhythmic audio cues, and makes them adjustable and adaptable to different types of walking aids.

The device can be attached discreetly to any walking cane or frame with a laser line adjusted to a distance that suits the individual user. A metronome can also provide an audio cue with the volume control at your fingertips.

Fundamentally by using the visual and/or auditory cueing you are able to bypass the blocked neural pathway that is causing the freezing of gait.

The NexStride can effectively trigger gait initiation in many persons who have difficulty with FOG.

You can find out more or purchase the NexStride at https://www.anatomicalconcepts.com/nexstride or contact them for more information.