Wednesday, October 3, 2018

Parkinson's And Freezing

Help, i’m stuck. My feet feel like they are glued to the floor and I can’t move. The ability to move smoothly and without thinking is the result of a complex interaction between the brain, the body, and ones environment. When healthy we take for granted the ability to get up, stand, walk, and sit without thinking. Parkinson’s alters brain circuit function that enables semi automatic movement. Hesitation to start walking is an initial symptom of freezing. Neuroscientists refer to this as “start hesitation” and ”gait initiation failure” which develops into “freezing gait”. Scientific jargon defines it as a “set switching” or a “visuo-motor response” motor control disorder that involves “amplitude generation” (inability to maintain effective speed of movement) and “rhythm generation” (a disordered timing of movement cycles). You can move again when this “motor block” is overcome. Enough terminology.
Short and to the point. Freezing is the temporary inability to move. It usually occurs in the feet but may happen in any part of the body including speech. No-one knows the cause. No-one knows the cure. All the rest is what to do when it happens. 
What triggers freezing and when does it happen? Freezing may happen when a PWP is having an “off” period and is due for their next medication dose. It most often happens when initiating movement and is triggered by activities that involve switching between motor actions like going through doorways, turning a corner, turning around in tight spaces, stepping over things, or going from one type of surface to another. Darkness (install night lights) and stress (the PD nemesis) can also trigger freezing. The thing to do is to be aware of the situations in which it is most likely to occur and try to relax through them. It will pass. Be aware that many of the same things that trigger freezing can also cause loss of balance.
What to do when you freeze. The most important thing is to not fight it. Try to relax. It will usually only last for a few seconds to a minute. Forcing frozen feet to move could lead to falling. Be careful, know what your triggers are. If your foot is frozen, try swinging your arms and then try your foot again. Try rolling your foot up starting with the toes then arch and heel until the foot comes off the ground. Try moving your foot in a different direction, to the side or back instead of forward. Lifting my leg straight up works for me. Rock, shift your body from side to side. Some people count to three. Some imagine stepping over a line. Humming a song and moving to the beat can help. DBS doesn’t help but researchers are looking for new DBS brain targets to prevent freezing. Again, don’t force it. Falling is worse than freezing for a few seconds.
As with all PD problems, tell your doctor. He may adjust your meds or refer you to a physical therapist for help. Feet get moving, don’t fail me now.