Understanding Freezing of Gait in Parkinson’s Disease: Causes, Symptoms, and Solutions

Freezing of Gait (FOG) is a common yet complex motor symptom experienced by individuals with Parkinson’s Disease. In fact, freezing episodes not only disrupt mobility but also significantly increase the risk of falls and loss of confidence. Understanding the underlying causes and triggers of FOG can empower individuals and their caregivers to better manage these symptoms and improve overall quality of life.

In this blog, we’ll dive into the causes and symptoms of freezing of gait, including the brain’s role in motor control and the external factors that may worsen episodes. We’ll also explore practical strategies and solutions, such as targeted exercises, visual and auditory cues, and Parkinson ’s-specific therapies that can help overcome freezing.

What is the Freezing of Gait

Freezing of Gait (FOG) happens when individuals experience a sudden inability to move their feet forward while walking, often feeling as though their feet are glued to the floor. This can happen unexpectedly, particularly in challenging environments like narrow spaces or encountering obstacles. It can disrupt walking, increase the risk of falls, and significantly impact a person’s mobility and independence.

In addition, motor blocks can affect movements, including the upper limbs and speech. People may find it difficult to initiate or coordinate arm movement or speak clearly, further complicating daily activities. Targeted therapies, such as physical and speech therapy, are often necessary to manage these symptoms and improve quality of life.

When does Freezing of Gait occur

Freezing of Gait (FOG) often occurs during challenging movements, such as turning, initiating steps, or navigating narrow spaces like doorways. It can also be triggered by changes in flooring or other spatial constraints that disrupt movement coordination. These factors make it difficult for the brain to manage smooth gait transitions, leading to freezing episodes.

Stressful situations, distractions, and multitasking can also contribute to FOG by dividing attention away from walking, further impairing movement. Additionally, freezing may occur when dopamine medications wear off, leading to a temporary reduction in motor control. The brain’s deceased dopamine levels during this time can cause increased difficulty in movement and coordination.

Who gets Freezing of Gait

A recent study analyzed 35 studies of Freezing of Gait (FOG) in Parkinson’s Disease (PD) and found that the prevalence of FOG varies widely, from 14% to 55%. The overall prevalence of FOG in PD patients was 39.9%. The highest rates were found in patients with PD for 10 or more years (70.8%), followed by those with 5 to 10 years of disease (53.3%), and those with less than 5 years (22.4%).

This analysis highlights how common FOG is in Parkinson’s disease, especially as the disease progresses. It shows that the longer a person has PD, the more likely they are to experience FOG. This is why early identification and management of FOG are crucial for improving the quality of life for people with Parkinson’s.

Precursors to Freezing of Gait

Shuffling is a common precursor to freezing of gait in individuals with Parkinson’s. It is characterized by short step lengths, dragging of the feet, and decreased arm swing, which can make walking appear slow and unsteady. This can lead to further difficulties with mobility and coordination, eventually contributing to more significant gait problems.

Festination follows shuffling and involves a reduction in stride length, with the steps becoming progressively more rapid. Individuals may also develop a flexed posture, where the body leans forward, making it harder to control movement. This combination of symptoms can significantly impact mobility, increasing the likelihood of freezing episodes during walking.

What causes Freezing of Gait?

Freezing of Gait (FOG) is a phenomenon commonly seen in Parkinson’s disease but its exact cause remains unclear. It involves an individual’s inability to initiate or maintain normal walking patterns, often leading to episodes where the feet seem “glued” to the floor. While the exact mechanisms are still being studied, FOG is considered one of the more complex motor symptoms of Parkinson’s.

One potential cause of FOG is damage to the substantia nigra pars compacta, a region in the brain responsible for producing dopamine. Dopamine is crucial for smooth, purposeful movement, and its deficiency in Parkinson’s disease can lead to motor impairments like freezing. This disruption in dopamine production may contribute to motor coordination problems associated with FOG, though further research is necessary to fully understand its underlying mechanisms.

Assessing Freezing of Gait

The Characterizing Freezing of Gait (C-FOG) Questionnaire is a valuable tool designed to assess the freezing of gait (FOG) in individuals with Parkinson’s. This questionnaire helps identify the presence, frequency, and severity of FOG episodes by asking patients to reflect on their experiences with movement difficulties. It provides clinicians with a standardized way to evaluate how FOG affects daily functioning and mobility.

The C-FOG Questionnaire includes a series of questions that focus on specific instances of freezing, such as when it occurs during walking or in response to external triggers. It aids in monitoring changes over time, ensuring that healthcare providers can track the progression of symptoms and adjust treatment plans accordingly. The results can help tailor interventions aimed at reducing FOG and improving overall mobility and quality of life for those affected.

How to address/avoid Freezing of Gait

Freezing of gait (FOG) is a major cause of falls and disability in Parkinson's disease (PD). As FOG only partially improves in response to dopaminergic medication, physical therapy is an important element of its management.

1. Individualized Physical Therapy

It focuses on assessing and treating the specific triggers to overcome freezing, along with improving walking, balance, and overall function. Regular follow-up sessions help monitor progress and refine the approach to ensure continuous improvement.

Therapists provide personalized recommendations for safe and effective exercises aimed at reducing the impact of FOG. Emphasis is also placed on fall prevention, addressing any concerns related to safety and mobility. This comprehensive approach aims to enhance daily function and minimize the risk of falls.

a. Physical Therapy for FOG and Gait Impairments in Parkinson’s Disease

Visual and auditory cueing and treadmill training are effective interventions for FOG and gait impairments in PD patients (evidence level A- according to the European Federation of Neurological Societies). Tactile cues and other specific therapies targeting FOG are probably effective but need further studies.

b. Anti-Freeze Strategies

A systematic review of Physical Therapy for Freezing of Gait highlights the effectiveness of specific anti-freeze strategies, such as cueing techniques, weight shifting, and cognitive movement training, which can be integrated into therapy.

A checklist can be provided that can be sent to people with PD allowing them to rate the effectiveness of various strategies used to reduce freezing of gait.

c. How to Find a PD-Specialized PT in your area

Finding a Parkinson’s disease-specialized physical therapist (PT) can be crucial for managing symptoms and improving quality of life.

One way to locate a qualified therapist is through PWR! Moves, a specialized program dedicated to enhancing movement in individuals with PD.

You can also check http://www.pwr4life.org/pwr-workshops, for resources that will help connect you with trained therapists.

Additionally, many states offer direct access to physical therapy, meaning you can see a PT without needing a doctor’s prescription. This makes it easier to start therapy as soon as you identify a need, offering more flexibility in accessing treatment.

By seeking a PD-specialized PT through trusted programs like PWR! Moves, you can receive targeted care to address balance, mobility, and overall physical well-being.

d. Exercises

Parkinson’s disease (PD) causes a steady decline in movement and motor control, and there are still no treatments that effectively address both the physical and mental aspects of the disease. This decline can significantly impact patient’s lives and place a heavy burden on their caregivers. While care models that involve multiple healthcare professionals show promise, there is a need for better approaches that can address all the challenges of PD.

Neurohabilitation, which combines exercises for both movement and brain health, is a hopeful non-drug treatment for PD. However, more research is needed to understand how these therapies can work best in practice. This perspective discusses current evidence and offers ideas for improving rehabilitation strategies to help manage PD more effectively in the future.

Here at Rogue Physical Therapy and Wellness, we offer cardio exercises that can help improve both motor and cognitive function.

Located in Orange County, California, we offer exercise and wellness programs designed for people with Parkinson's, bridging the gap between insurance-based therapy and community exercise classes. We offer ongoing access to exercise through group classes and individual exercise sessions, which are not typically covered by insurance.

While our main focus is group classes via a monthly membership, we also provide personalized 1:1 sessions with a Parkinson’s specialist physical therapist, tailoring workout to your specific goals. This is ideal for those who have used up their insurance benefits but want continued, individualized support.

We also understand that attending in-person classes isn’t always possible, which can make achieving your fitness goals feel out of reach.

That’s why we created Rogue in Motion - an online exercise program designed to bring the same sense of community, support, and guidance to you, no matter where you are.

Whether you live in a remote area, face transportation challenges, or simply prefer the comfort of your home, we’ve got you covered!

Our high-quality, Parkinson-specific online exercise classes are available anytime and anywhere through our extensive video library.

From PWR! Moves and HIIT to cardio, boxing, and speech classes, we’ve created a supportive space where you can build strength, confidence, and community.

2. Physical + Cognitive Training

Freezing of Gait (FOG) is linked to executive dysfunction, which affects an individual’s ability to inhibit responses, divide attention, and switch focus, as well as impacts visuospatial abilities. These cognitive challenges are often intertwined with motor difficulties, meaning issues in movement are often intertwined with motor difficulties, meaning issues in movement are connected to problems in thinking and processing information. FOG, therefore, not only involves physical motor control but also cognitive control, complicating the management of mobility in individuals with Parkinson’s.

Research suggests that integrating cognitive training with mobility exercises may offer significant benefits for people experiencing FOG. This approach targets both motor and cognitive functions simultaneously, enhancing response inhibition, attention, and spatial awareness. By addressing the overlap between cognitive and motor impairments, these combined training methods may improve gait and overall movement in individuals affected by FOG.

3. Address Anxiety

In one of our self-care talks, we explored the importance of addressing anxiety as a key part of overall well-being. Anxiety can significantly impact daily life, especially for those managing Parkinson’s disease. We shared effective strategies for reducing its effects and emphasized the role of both mental and physical care in managing anxiety.

We recommended combining talk therapy, as supported by Psychologytoday.com, with movement-focused approaches to tackle anxiety more holistically. By adopting a team approach, individuals not only experience personal growth but also gain the support of a community, connecting with a network of resources and professionals.

4. Optimizing Dopamine Medications

Optimizing dopamine medications, particularly oral levodopa, has been proposed as an effective strategy to address freezing of gait (FOG) in Parkinson’s disease. A study involving 20 Parkinson’s patients examined their gait before and after a standardized levodopa doxe, focusing on the relationship between festination (hastened steps) and akinetic freezing.

The results showed that levodopa completely resolved festination and freezing in 20% of patients and significantly reduced FOG severity in most others, highlighting its potential impact on these gait challenges.

The study also found that patients with less severe symptoms before the dose experienced better outcomes after treatment, indicating a correlation between pre-dose and post-dose ratings. These findings reinforce the importance of optimizing levodopa dosage as part of managing episodic gait disorders in Parkinson’s disease.

Rogue in Motion Anti-Freeze Videos

Rogue in Motion has introduced a series of Anti-Freeze videos designed to address freezing of gait. These action observation videos focus on reducing episodes by helping individuals practice specific movements and build confidence in their ability to navigate daily activities. Each video includes targeted home exercises that empower users to take control of their mobility and improve their quality of life.

The series also promises additional content with practical strategies to prevent or overcome freezing during common triggering situations, such as turning or navigating crowded spaces. These resources aim to equip individuals with actionable tools to regain independence and ease of movement.

Together, the Anti-Freeze videos represent Rogue in Motion’s commitment to providing tailored, anti-Parkinson’s specific solutions to improve mobility and reduce the frustration of freezing episodes.

Conclusion

Freezing of Gait (FOG) can be one of the most frustrating and limiting symptoms of Parkinson’s disease, but it doesn’t have to define your journey. With tailored Parkinson’s exercise programs and Parkinson’s exercise classes, you can regain confidence in your movements and reduce the frequency of freezing episodes. These programs provide practical strategies, such as action observation, balance exercises, and cognitive training, to empower you to take control of your mobility from the comfort of home.

If you are in the Orange County, California area, you can check out our in-person classes here at Rogue Physical Therapy and Wellness. Or if there are no gyms near you, you can also try online classes like this one.

By incorporating Parkinson’s exercises at home or through specialized classes in-person, you can address the physical and cognitive challenges that contribute to FOG. With consistent practice and the right guidance, it’s possible to improve motor function, enhance mobility, and experience a higher quality of life.

Whether through exercise videos or expert-led therapies, the key is starting today - because every step forward counts.