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, the tendency to lean backwards when standing
• the head bending forwards, with shoulders down, hips and knees bent
• steps taken on the front of the feet
• the feet dragging on the ground resulting in shuffling steps
• a reduced length of stride
• decreased arm swing, particularly on the side on which Parkinson’s is most noticeable.

As a result of these, a number of gait problems may be encountered such as:

• slowness
• start-hesitation - a hesitation in initiating movements such as walking
• difficulty in making a turn due to slowness, stiffness and instability
• difficulty in making transfers, eg 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 the latter stages of Parkinson’s.

Some features of Parkinsonian gait are likely to become more pronounced over time, particularly festination, stooped posture and freezing. A person’s range of movements may change over the years and reduced general activity can cause muscle strength to deteriorate and decreased balance reflexes. This in turn can lead to musculoskeletal changes that can exacerbate poor posture and stooped stance and increase the risk of falls.

Any decrease in mobility and stability may result in a loss of confidence and a fear of falling. This can impact heavily on social activities and quality of life, so it is important to seek advice and adopt techniques to improve gait. Not only can this lead to a better quality of life, but it can also bring with it a sense of control and self-esteem.

Gait problems may also be related to a decrease in the effectiveness of medication for motor symptoms, and walking can become more difficult, particularly during the ‘wearing off ’ period. Reviewing levels of medication and adjusting accordingly can sometimes help to alleviate some related gait problems.

 

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