Acknowledgement
Our thanks to Dr W Farid Abdo1for his help in reviewing this article.
Unfortunately, problems with gait, posture and balance do not tend to respond as well to medications as other common motor symptoms, such as tremor, rigidity and bradykinesia. Furthermore, in the latter stages of Parkinson’s, higher doses of medication for conditions such as dyskinesia and orthostatic hypotention (decreased blood pressure on standing) can sometimes increase problems with gait.
Nevertheless, there are lots of things you can do to help yourself (see How can I help myself? ) and there are also experienced professionals who can offer very useful advice.
Each case will be different and it is hard to generalise but your doctor will normally be your first contact and they may refer you to one or more of the professionals listed below. Referrals will largely depend on the country in which you live, the resources available, and your individual needs.
A physiotherapist will be able to advise you on the best ways to improve your walk and balance according to your specific needs. For example, they can suggest suitable exercises to help you with improving or maintaining good posture. Normally, the flexor muscles that open joints and the extensor muscles that close joints are balanced so that we hold an upright posture, but in Parkinson’s this balance becomes disrupted and the flexors tend to overpower the extensors. This leads to the stooped Parkinsonian posture. By strengthening the extensors and extending the flexors the equilibrium can be improved, resulting in a more upright posture.
Physiotherapists can also help with gait training by breaking down the sequence of walking so that you focus on each individual component and consciously carry out each movement in any sequence. They can advise on the use of various cueing strategies to help reduce freezing and the fear of falls, and the safe use of mobility aids such as walking sticks. They can also help you to improve your mobility in general and will work with you to identify problems you experience in everyday activities, such as transfers, advising on strategies and exercises to help overcome these.
It is important to be aware that if you book an appointment with a physiotherapist directly yourself you may have to pay for consultations.
An occupational therapist will be able to advise on suitable walking aids and how to use them when Parkinson’s is more advanced or when other techniques are no longer sufficient. It is important that any aid, eg walking frame or stick, is the correct height for each individual, and is used correctly so that balance and safety are not compromised.
An occupational therapist can also advise on the appropriate positioning on the ground of visual cues to help overcome freezing, and on various metronomes and other auditory devices that help with keeping an even pace when walking.
A podiatrist (foot doctor, specialising in problems with the feet, ankles and lower extremities) will be able to advise on the best footwear to help your walking, especially on the height of heels and the material of shoe soles.
In some countries there may be PDNS or nurses who specialise in neurology who can help, in which case your doctor may refer you to them as they will also have considerable experience in dealing with gait problems.
Clear adult gait patterns do not manifest themselves until we are around 3 years old.
The way we stand or sit. Postural problems, especially a tendency to stoop forwards, are common features of Parkinson’s.
Those affecting movement, e.g. tremor, rigidity, bradykinesia and freezing.
Rhythmic shaking of part of the body. It is one of the main symptoms of Parkinson's disease, although it is not experienced by everyone.
Stiffness of the limbs, joints or body that make movement and bending difficult.
Bradykinesia describes the slow execution of movement and impaired ability to adjust the body's position.
The word bradykinesia is derived from the Greek roots: bradys(slow) and kinesis(movement).
Involuntary movements that tend to occur in people who have had Parkinson's disease for some years as a side effect of long-term use of Parkinson's medication.
Health profession that treats people of all ages who have physical problems that occur as a result of injury, illness or ageing. Methods they use include exercise, heat treatments, manipulation and hydrotherapy.
See section on Physiotherapy.
Health profession that helps people of all ages who are disabled, ill or aged to remain independent and lead fulfilling lives at home, in work and through leisure pursuits. The methods they use include specific activities and equipment.
See section on Occupational Therapy.
The care and treatment of the feet (also called chiropody).
A podiatrist (or chiropodist) deals with the assessment, diagnosis and treatment of the lower limb.
A symptom of advanced Parkinson's disease where the person becomes ‘glued’ to the spot for a few seconds or minutes before being able to walk.
See section on Freezing.
The process of providing cues, prompts, hints, and other meaningful information, direction, or instruction to aid a person who is experiencing difficulties.
See also Coping Strategies.
