A Walk on the Wild Side: Parkinson's

Gait problems with Parkinson's disease.

I wanted to share some reflections and views on this, so this is not medical instruction to treat illness.

Here’s a video from Stanford Medicine with some explicit examples of gait disturbances. What we see may not manifest as clearly as these examples.

Take for example, the Parkinson's demonstration above, which is quite developed.

With less advanced Parkinson's, perhaps in an older person, I may see the tendency to smaller stride length with less walking speed, I might see some degree of postural stoop, maybe some less arm swing, but the flexed limbs, freezing and characteristic tremor that people associate with PD may be completely absent.

Sometimes out-of-nowhere more dramatic and unpredictable things might arise from time to time, for example the person suddenly walking on the spot, not being able to propel themselves forward. Turning may or may not be an issue at that stage.

All of this will vary on an individual level. How doctors are managing medication— and the person’s own fluctuations towards effects of the medication can also influence the situation.

Years ago I stumbled upon the curious fact that these walking disturbances in clients with PD responded extremely well to me just giving verbal cues to correct them, sometimes with me giving some visual examples as well.

What seemed like intractably small steps and reduced gait speed would just disappear with some spoken prompts. No one told me this, I had no specific education on this and I had been thrown into a new situation working with clients with PD and was still learning what I could.

As it turned out there is quite a bit of research and a fairly good understanding on this effect.

And in fact these cues can be developed far further, becoming rhythmic, or visual guides on the ground.

But even just irregular verbal cues can have a profound effect on some people.

Now, we have to be careful of being satisfied with that because that’s in the session with these external cues, and this effect may not necessarily persist outside of it. So people with PD may generate their own cues:

For a paper published in the September 2021 issue of Neurology, Dr. Tosserams and her co-investigator Jorik Nonnekes, MD, PhD, surveyed 4,324 adults with Parkinson's disease who reported disabling gait impairments to find out how much they knew about and used various compensation strategies. The researchers grouped the strategies into seven categories: internal cues (such as walking to an imagined beat), external cues (walking to the beat of a metronome or using a laser pointer to create a target on the ground), making wider turns, incorporating relaxation techniques to reduce stress, watching other people walk and mimicking their movements, adopting new walking patterns (such as raising the knees high or walking backward), and using the legs in other ways (such as riding a bicycle). Mason's walking poles are an external cue, while Grill's reciting of “ready, set, go” would be an internal cue.

In training it’s a good idea to combine external cues alongside a more goal-oriented approach, to foster intentionality. This inentionality is a big deal in Parkinson’s.

So walking isn’t just walking, instead we’ll set some tasks up that walking forms a part of with goals and we’ll get much more aggressive about intentions of movement and giving it deliberate rather than assumed qualities to facilitate these goals.

A powerful tool here, and with the walking itself, is with exaggerated movements and gestures. These are useful and even in isolation are sometimes used as a way of helping with walking where autopilot isn’t working.

There's many unusual movements and sequences—almost dramatic pieces of performance, that would be unthinkably strange in other exercise contexts, but make enormous sense and have a lot of value in PD.

All of these can be incorporated into a PD routine, seeking to exert conscious motor control, moving away from the physical tendencies the illness is pulling the person towards.

As a (once) aspiring actor (I never really quit godammnit) I've always been interested in the application of drama and performance type work into my training with my clients where it's appropriate or likely helpful (it's not always). It's also client-personality dependent. I can see a bit of potential overlap.

Just as it is for everyone else, strength training offers advantages as part of an exercise programme.

As this article from Parkinson’s Foundation points out,

There is no “exercise prescription” that is right for every person with PD. The type of exercise you do depends on your symptoms and challenges.

I’ll leave the topic of balance with Parkinson’s for now, because I wanted to touch more on the usual gait disturbances.

If you’re looking someone experienced to work with in London, from Central to far West you can contact me here.

If you have PD: 2 questions:

What physical activity do you enjoy doing most ?

And is there a particular thing have you done with a trainer or physiotherapist or in some class-based environment that you feel has been an effective tool for you with walking issues ?

Or maybe you want to: