Gait and Balance Problems

Parkinson’s disease is a neurodegenerative disorder characterized by progressive damage to dopamine-producing nerve cells in a specific region of the brain. Dopamine is a neurotransmitter, or cell signaling molecule, that relays information between nerve cells and muscles. One of the most debilitating effects of Parkinson’s disease is the loss of coordination and control in body movements, which in many cases leads to severe walking disabilities.

About gait and balance

Gait can be described simply as a person’s manner of walking. Most people have a distinctive style of walking. In normal circumstances when people walk, their stance is upright and the center of gravity of the body is positioned in a manner that helps them coordinate their movement. As people walk, they swing their arms on the side, which also helps coordinate their motion.

Because of the body’s inability to coordinate movement in Parkinson’s disease, it becomes progressively more difficult for people to maintain proper posture and coordination during walking. Most Parkinson’s patients experience a range of walking difficulties, resulting in distinctive gait and balance problems.

Gait symptoms

Gait problems may not occur in every patient and their severity and characteristics vary from one patient to another. Gait and balance problems are more common during the more advanced stages of Parkinson’s disease.

Although gait symptoms can vary among patients, there are some common characteristic movements that are frequently observed. These include a tendency to lean or stoop forward while walking, dragging and shuffling of feet, and a decreased arm swing.

In many cases, the head is in a drooping position and the length of the stride is dramatically reduced. Postural disturbances in the knees and hips can tend to worsen these problems. Stiffness in the knees and hips also exacerbates gait problems by causing so-called festination — a walking condition where the patient involuntarily takes multiple short strides in quick succession but fails to coordinate balance and speed during the motion. This can often result in falls.

In general, gait problems lead to slowness and stiffness in movement. Difficulty turning and abrupt trembling in knees and joints are also commonly observed. Balance problems can make it difficult for the patient to change position and get up from a chair or a bed.

Freezing of gait (FOG) is observed in many cases. The condition renders the patient unable to initiate movement from a certain position; the patient remains “glued” in a particular spot for a significant period of time.

Management of gait and balance problems

Gait problems are mostly unresponsive to Parkinson’s medication. However, physiotherapy and occupational therapy can be useful in the management of gait problems. Physiotherapists can help develop specific exercise plans focusing on breaking down the walking motion into small, discrete steps that are consciously executed by the patient following verbal and non-verbal cues.

Some physiotherapists can devise special cues to facilitate movement and manage the freezing of gait symptoms. These can include asking the patient to step over imaginary lines and using rhythmic music as a cue to initiate movement. 

The use of mobility aids and assistive devices can also alleviate some gait problems. It is important to consult with a physiotherapist and occupational therapist to determine which devices are best for the patient. It is important to consult with a neurologist who can refer the patient to a qualified physiotherapist.


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