How can I help myself?

If you experience frequent freezing your doctor may suggest that you keep a medication or ‘wearing off ’ diary to help establish what might be causing these episodes. Alternatively, he or she may advise a short stay in hospital so that this can be monitored. By keeping a diary you can record the timing, duration and frequency of freezing episodes, as well as the timing and dosage of each medication, which can help your doctor in adjusting medication to try to overcome freezing problems. For a sample diary and information on keeping one see www.epda.eu.com/patientGuide/diary.

Freezing can happen at any time so it is important to take great care when out near roads or when swimming, for example. So if you are prone to freezing make sure you have someone with you at such times.

If you experience freezing you are significantly more likely to fall. Parkinson’s also tends to affect posture and poor posture may lead to impaired balance and falls, so try to improve your posture and balance so as to minimise the risks.

The risk of freezing is also increased by anxiety and if you do freeze and fall you may become even more anxious so it becomes a vicious circle. It is therefore important to try to find or develop strategies to help you overcome freezing as you will then feel more confident in dealing with it and feel calmer when it occurs.

Strategies or tricks to deal with freezing are very individual and what works for one person may not work for another. Furthermore, something that works now may become less effective over time. It is therefore important to adopt a ‘trial and error’ approach and see what works for you. And if something does work but then becomes less effective try to explore other options.

Freezing in public places may cause you embarrassment but social activities are important to quality of life and overall well-being. So it is important to try to devise strategies to prevent or overcome freezing so that such activities can continue.

There are a number of strategies to help towards preventing and overcoming freezing and a physiotherapist will be able to help you with strategies that address your specific problems in daily life. Some are outlined below:

Cueing

• Visual, auditory or rhythmical cues may be helpful in overcoming freezing. These can be used to help you to concentrate so that it is easier to keep your feet moving at a steady, even pace. Such cues give information about the length and number of steps you take and they use a part of the brain which is not affected by Parkinson’s. A physiotherapist will be able to help you with cues to overcome any difficulties you may have.
• Visual cues such as lines on the ground or on steps can be useful as they prompt you to step over them if freezing is a problem, particularly in doorways. A tape, or several lines of tape, across a doorway to step over can help you focus on getting through the doorway. It is important that the tape is in a contrasting colour to the colour of the flooring but any kind of tape may be used, for example electrical, masking tape or coloured gift tape. Remember that it may get worn and scuffed so may need to be replaced from time to time.
• A physiotherapist or occupational therapist will be able to advise on the best space between lines but as a general rule strips of approximately 40 to 60 cm length should be stuck approximately 35 to 50 cm apart through a doorway if the flooring pattern is the same on both sides. If the pattern is different on both sides then a single strip across the join should suffice. If you need to negotiate a corner, similar length strips should radiate out like a rays of the sun picture. It is not important to step either on or off the tape – it is entirely up to you as the tape is simply a visual cue about where to place your feet. Some people also find it helpful to look through a doorway, or to focus on a point beyond, rather than looking directly at the doorway itself.
  
  Patterned carpets and the cracks between tiles or paving stones can also help to focus your attention on the quality of your walking and to keep the step size regular, or you may consciously use the pattern to step on the lines and keep an even stride. Look out for any rugs or mats which seem to cause you to freeze, such as patterned bathmats, and move them out of your normal path to see if this helps.
  
  If you do freeze and someone is with you they can help by putting their foot in front of yours for you to carefully step over (raising your foot so you do not trip) and start walking again.
  
  Some people also find it useful to use a small torch or laser pointer to project onto the floor ahead of them. This acts as a visual cue to walk ahead and meet the pool of light on the floor.
• Rhythmical or auditory cues such as a steady beat from a metronome or suitable music can also help. The rhythm should be a comfortable pace, the beat prompting you to lift your feet and step. You may also find it helpful to say, either silently or aloud, a phrase such as ‘one, two, three, step’, ‘one, two, one, two’, or ‘left, right, left, right’ which when said in a firm, rhythmical tone can be used as a cue to move the feet and walk forwards. The speed of the beat can be varied according to where you are, for example you will probably walk faster outside and slower in your home.
  
  You may find it helpful to ‘chant’ such phrases when approaching a spot which you often freeze at. The rhythm, if started early, may prevent freezing, or it may prevent the shorter, more shuffling pace that often occurs just before a freezing episode.
  
  A physiotherapist or occupational therapist may be able to advise on mini metronomes or similar devices that can be clipped onto clothing so can be taken with you anywhere.
• Attentional strategies where you rehearse certain movements in your mind and carry the sequence or beat in your head can also be helpful. For example you may find that focussing on putting your heel down firmly on the ground as your foot makes contact will help you to step evenly, or imagining a line to step over might help you to negotiate narrow entrances. Attentional strategies do require concentration however and can be difficult if there are external distractions.

The weight shift method may be used to overcome freezing, that is gently shifting your weight onto the other leg rather than trying to move forward. This may help to break the over-activity that can occur in your leg muscles when freezing and may allow you to then continue moving forward. You may also find it helpful to step or stamp your feet from side to side, especially if freezing when opening doors is a problem for you. This may help you maintain a stepping movement until the door is open and passable.

‘Start hesitation’ , or difficulty in starting an action, may be overcome by imagining or replaying in your mind the detailed sequences of an action, making sure that you complete the sequence without any problem in your mind. Only when you have done this should you try to start the movement, for example getting out of a chair: imagine moving to the front of the seat with your feet close together and slightly tucked under the chair, with your hand ready to push down and take your body’s weight so you can rise to a standing position. Once you have run this sequence through in your mind you can count down to the sequence, ‘three, two, one’ and then follow the actions you have run through. This technique is sometimes known as mental rehearsal and is often used by musicians or athletes to improve their performance. It works because the imagined sequences use the same part of the brain as the actual movements, so the ‘rehearsal’ prepares the brain for the ‘performance’.

If you find that you freeze in busy places such as shops or public places you may find it helpful to stop safely to one side for a moment and plan the next part of your route section by section to your destination. By looking ahead for obstacles such as people or trolleys, and by observing quieter routes, you will make your journey much easier and will therefore reduce the likelihood of freezing. You can then repeat this strategy of ‘pause, look, plan, proceed’ for the next stretch of your route and as often as necessary.

 

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