Parkinson’s disease (PD) is a degenerative disease that involves the central nervous system, and freezing of gait (FOG) is one of the common pathological gait patterns in Parkinson’s disease.
Freezing of gait (FOG) is one of the common pathological gait patterns in Parkinson’s disease. Studies have shown that approximately 7.1% of patients with early PD develop FOG, while the prevalence of FOG in patients with advanced PD is as high as 53%. Freezing gait has a great impact on patients’ lives, and in severe cases it can lead to falls causing fractures, loss of self-care and even death.
I. FOG subtype
FOG is a special kind of gait abnormality, patients often show that they cannot take the first step or suddenly cannot move forward again in the process of walking, patients feel as if their feet are stuck to the floor or sucked by the floor, it is difficult to lift their feet to take a step, and only after a few seconds or even minutes, patients can walk; some patients will be accompanied by a certain degree of leg tremors; it is most likely to occur when starting and turning. In the most severe cases, the phenomenon occurs any time the patient walks.
Studies have concluded that there are three subtypes of Parkinson’s frozen gait.
1, Leg tremor: alternating tremors in both legs (knee joints) to overcome walking block;
2.Dragging gait;
3, complete motor inability: limbs to trunk can not move, less common.
Second, drug treatment
The majority of patients have frozen gait in the “off” phase, and the duration of frozen gait in the “off” phase is significantly longer than that in the “on” phase, and levodopa can relieve it. Freezing gait in the “off” phase. When the freezing gait occurs only or mainly in the “off” phase, maintaining the patient in the “on” phase by adjusting the levodopa dose and changing the levodopa dosage form is currently the most conventional treatment method. Increasing the amount of dopamine agonists, adding catechol-oxygenation-methyltransferase inhibitors, monoamine oxidase inhibitors, and amantadine can also improve the “off” phase freezing gait.
It is very rare that freezing gait occurs only in the “on” state, and treatment is more difficult than in the “off” state.
Deep brain electrical stimulation therapy
Deep electrical stimulation of the nucleus accumbens (DBS) in Parkinson’s patients can improve frozen gait and motor fluctuations, and the therapeutic effect of bilateral DBS is better than unilateral stimulation. DBS seems to have little effect or even the opposite effect.
IV. Stabbing and bleeding therapy
According to Chinese medicine, wind and blood stasis are the main pathological factors of freezing gait in Parkinson’s disease, so treatment should focus on both “treating wind” and “treating blood”. As one of the characteristic therapies of TCM, bloodletting therapy has the function of opening the orifices, removing heat, activating blood stasis and unblocking the meridians. By treating the blood and bringing it to the surface, removing the stasis and creating new blood channels, the blood channels are opened, the qi and blood are regulated, and the yin and yang are balanced, which has the dual effect of treating wind and blood.
It is not necessary to stick to the classical route of meridian circulation, and all pathological ligaments with abnormal color and shape on the body surface can be pricked. Stasis ligaments are mostly distributed near the elbow fossa and popliteal fossa, more superficial in the extremities, and slightly deeper in the abdomen and back. If necessary, cupping therapy is needed to promote the blood stasis to come out. The amount of bleeding is based on the principle of “if the blood changes, it will stop”. At present, the mechanism of bloodletting treatment is still unknown, and further research is needed to make Chinese medicine treatment more effective and reliable.
V. Rehabilitation training
Rehabilitation training is an important adjunct to the treatment of Parkinson’s disease patients with frozen gait, especially for patients with frozen gait whose drug therapy is not effective. The rehabilitation training methods for frozen gait include sensory cue training, gait training, physical training, mechanical assisted exercise, etc.
1.Sensory cue training
Motor and sensory skills are a very effective way to overcome frozen gait. Sensory cue training refers to providing patients with rhythmic auditory, visual, tactile or mental stimulation through external or portable sensors to compensate for proprioceptive deficits, such as rhythmic music and metronome, to adjust the gait variability of Parkinson’s disease patients and reduce frozen gait. If stripes are drawn on the ground, the distance between the horizontal lines is the size of the patient’s normal walking pace, and the tester walks according to the prescribed pace size.
2.Gait training
Plate exercise training can improve the motor status and gait coordination of Parkinson’s patients, and can also reduce the number of frozen gait occurrences. By instructing patients to walk on the front, back and side of the plate, the patient’s starting speed, balance function and gait coordination can be targeted to strengthen training.
3.Physical training
Physical training methods include a variety of boxing, dance and equipment exercises, such as flat bicycle training, or simple limb stretching and relaxation exercises, and there are even training courses designed specifically for PD patients that require professional counseling by physical therapists.
4.Machine assisted exercise
Crutches, walkers and wheelchairs can be used to assist with exercise. Crutches can provide additional support to maintain the patient’s balance and are suitable for patients with milder conditions; walkers have a larger support area, but the patient’s gait speed cannot be improved; and wheelchairs with power are helpful for patients who are unable to walk in advanced stages. Choosing the right assistive device is very important for patients, because unsuitable devices not only do not help patients improve their mobility difficulties, but may also cause danger. Also, great care should be taken when selecting assistive devices for patients with cognitive impairment.
Summary
Since the pathophysiological mechanism of freezing gait is not clear, there is no good treatment available. When a patient with Parkinson’s disease develops a frozen gait, it is important to promptly adjust the treatment plan according to the patient’s condition and to combine it with rehabilitation therapy to improve the patient’s clinical symptoms and quality of life. Rehabilitation treatments such as sensory cue training, physical training and the application of assistive devices have promising applications in helping patients overcome frozen gait.