'Recoupling' the attentional and motor control of preparatory postural adjustments to overcome freezing of gait in Parkinson's.
Amy Maslivec, Anna Fielding, Mark Wilson and 2 others
PMID 33129334WHAT IT FOUND
In people with Parkinson's, freezing attempts failed when the sideways weight shift was too small.
Training a specific verbal or analogy cue to increase this shift helped nearly all participants initiate a step successfully, with no difference between the two cue types.
Key findings
01Unsuccessful attempts to start walking from a freeze were associated with a significantly smaller sideways weight shift than successful attempts.
02Using a verbal or analogy strategy to increase the sideways weight shift reduced failed step initiations from a freeze from roughly half of attempts to near zero.
03There was no significant difference in success rates or weight shift amplitude between the verbal instruction and the analogy instruction conditions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted in a highly controlled laboratory environment using a stepping-in-place task and virtual reality, which may not fully reflect the complexity of real-world walking. Only 17 participants actually froze during the experiment, limiting the statistical power for comparisons between successful and unsuccessful attempts from a freeze. The Baseline condition was always performed first, which could introduce learning or fatigue effects, although the authors argue this was necessary to prevent strategy carry-over. The study did not categorize freezing subtypes, so it is unclear if these strategies work for all types of freezing (e.g., akinesia vs. tremor). Follow-up was immediate; the study did not assess whether these improvements persisted in daily life or over time.
Declared interests
The paper is supported by non-U.S. government funding. The authors declare no competing interests.
The easy way to misread this
Do not assume that these strategies will work outside the lab or for all freezing subtypes. The study used a specific stepping-in-place task with virtual reality to induce freezing, and only a subset of participants actually froze. The immediate success rates may not translate to long-term daily life management without further training and adaptation.