“Like your feet are glued to the ground.”
That’s how many of the approximately 30% to 67% of people with Parkinson’s disease describe the “freezing” symptoms they often experience—the occasional inability to initiate or maintain even simple motion such as walking, chewing or hand movements.
These sudden, freezing episodes often prevent the individual from even walking, making them feel as if they’re frozen in place, lasting for several seconds or even a few minutes.
“When you combine the slowness of movement and rigidity of muscles, you get freezing episodes,” explains Morris “Rick” Casano Beato, PT, DPT, GCS, NCS, a University of Central Florida physical therapist. “The part of the brain that controls the automatic movement isn’t connecting efficiently with the portion that controls the muscles.”
That’s why freezing typically develops in the mid- to late stages of the disease. And while a short lapse in movement might appear to a minor inconvenience, it represents much more. In fact, freezing episodes increase the risk of broken bones and other injuries from falling. Plus, that fear of falling often prompts older adults to limit social engagements and physical activity.
“The secondary impairment of inactivity causes your heart and lungs to become deconditioned,” explains Beato. “So, now you’re at higher risk for developing pneumonia and heart disease.”
Because pneumonia is the leading cause of death among people with Parkinson’s, preserving mobility is especially important for not only quality of life but also longer survival.
What can caregivers do to reduce the freezing symptoms?
If you notice the onset or an increase in freezing, the first step is to identify triggers and make simple modifications:
1. Make sure to maximize medical intervention
Keep a log of the dosage and timing of medications and the day and time of freezing episodes and share it with health care providers. Sometimes, medical issues that can increase freezing include:
- A medication interaction
- A lull in medication efficacy between doses
- The need for a different prescription
- Absorption issues (such as eating protein within an hour of ingesting a commonly prescribed medicine)
2. Be patient and budget extra time for activities
Social interaction and activity are essential to preserving quality of life. However, keeping a tight time schedule only adds stress to a visit or an outing—especially when freezing and other symptoms occur.
“People who have Parkinson’s disease already know they’re slowing down their family members,” said Jennifer Prescott, RN, MSN, CDP, founder of Texas-based Blue Water Homecare & Hospice. “It’s frustrating to them.”
If freezing does occur, remain calm, remind the patient to do the same, and use the techniques below to move past the episode.
3. Recognize where freezing is most likely to occur (and be prepared)
Freezing is likely to occur when a person with Parkinson’s:
- Steps through a doorway or into an elevator
- Encounters a pathway that narrows
- Makes a turn
- Experiences a change in floor texture, pattern or color
- Takes a step on or off a curb
- Stops suddenly (such as to avoid a person or an object)
- Is in a very crowded place
- Enters a new environment in which the unfamiliarity triggers anxiety about falling
How can caregivers help in the moment?
Our experts have found these mind-over-muscle strategies help patients release the freeze, regain movement and minimize frustration.
1. Avoid fighting the freeze
If freezing occurs, a person’s first instinct might be to exert effort to force the body into motion. However, “That usually makes the freezing worse,” Beato said. “It’s better to stop what you’re doing, change the movement and do something else.”
While advanced Parkinson’s disease impairs muscle movement, “the silver lining is the other portion of the brain can be used,” he explained. “It allows you to move in response to an external visual or an auditory stimulus—a sound or a sight.”
Sometimes, regaining movement is as simple as the caregiver stabilizing the patient to prevent a fall and providing a voice (sound) cue. For example, you could say, “Mom, we’re going to step forward after the count of three. Let’s count together. One, two, three…step.”
3. Change direction or focus
You can amp up the potential of the counting technique by adding a change in direction. For example, if the freezing occurs as your dad walks forward, you can instruct him to step sideways to the left on the count of three. If that releases the freeze, you can then move forward together.
Taking a step backward can be a risky move for someone whose balance may be tentative. If your dad tends to freeze at the corner of two hallways, you might guide him into a half-circle rather than a pivot turn. Likewise, if he freezes while counting money or scrolling through cell phone contacts, he can stop and redirect by trying to reach for a nearby object.
4. March (or hip-hop) to the beat of your own drummer
Both experts encourage patients to keep a song in their hearts and on their cell phone apps.
“One of the best exercises we use in physical therapy is walking on a patterned surface with a metronome,” said Beato. “You can base your steps off the beat of the music and target your next step to a line or pattern change in the floor.”
Download a metronome or even a Parkinson’s music therapy app. Or, your loved one can just sing, hum, waltz, march, be-bop or hip-hop and take a step on any downbeat (that isn’t too fast).
5. Work on target practice
To help patients identify a target for their next step, some walkers now have laser pointers.
“It creates a line in front of you and prompts your brain to step forward,” says Prescott.
Prescott recommended placing colored tape at intervals of 12 to 18 inches in areas of the home that trigger freezing.
“Those visual cues actually can help your brain to initiate movement forward,” she said.
If freezing happens away from home, pick a point in the path – a line in the crosswalk, a grout line in the tile – and ask your mom to aim her next step there. If there’s no obvious target, just improvise and place a pen, phone or even tissue on the ground for a visual cue.
6. Make a large gesture
If external cues fail to release the freezing gait, try hand movement. If that gesture releases the freeze, count out loud as you step forward to help keep the momentum going. Conversely, if your mom experiences freezing in her hand, she might try moving her leg to release her fingers.
Thriving with Parkinson’s
While they’re not foolproof, these techniques have been proven to release the freezing that commonly occurs with advanced Parkinson’s. Besides their potential to relieve the inconvenience of immobility, these strategies help patients retain a sense of control and confidence, which contributes to their physical and mental welfare.
“There’s a huge emotional and psychological component to the success of living with a degenerative disease,” said Prescott, who also serves as the vice president of outreach and support groups for the Capital Area Parkinson’s Society.
While there’s no cure for the disease, she said many patients still find the key to maintain their quality of life.
“They exercise regularly, work on their mental health and receive tremendous support from their family,” she says. “Not only do they live with Parkinson’s, they truly thrive.”
Study: Top techniques for ‘un-freezing’
Research recently published in the Journal of Neurology analyzed 46 previous studies to evaluate 11 commonly used techniques by patients with mild-to-moderate Parkinson’s to recover from a freezing episode. The study found the top techniques that demonstrated immediate real-life benefits for freezing gait symptoms:
- Gait training on a treadmill
- General exercises (such as stretching and resistance training)
- Conventional physical therapy
- Obstacle training
- Action observation training (intently watching an action and practicing that movement)