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Freezing episode Parkinson's Disease

What Is Freezing In Parkinson’s

A freezing episode in Parkinson’s disease is a brief and sudden inability to initiate movement whether it be walking, speaking, or even the ability to open and close one’s eyes. The most common and debilitating form of freezing occurs when the individual is walking as it can be very dangerous and lead to a fall. Freezing episodes can be very scary and debilitating for those afflicted with Parkinson’s disease. Individuals may become so frightened after the first one occurs that they will be afraid to walk out of fear of having another episode.

In this article I will go into more detail about what freezing episodes are, briefly go over what Parkinson’s disease is, go over if you can prevent a freezing episode, and finally some tips to get out of a freezing episode. As a Physical Therapist who has worked with countless Parkinson’s disease clients I am sure you will find some value out of this article and hopefully will feel more prepared to tackle this scary phenomenon.

What is freezing?

A freezing episode occurs when an individual with Parkinson’s disease has difficulty initiating a movement or continuing a movement which they have already started such as walking. An example of a freezing episode is an individual who just woke up and is trying to get out of bed but is unable to initiate moving the legs to the side of the bed despite wanting to and the brain “telling” the legs to move. Another example would be someone who is using a walker and is going into a grocery store. As they get to the automatic sliding doors which open for them there are many people going in and out. With all this added distraction the individual freezes and suddenly can no longer walk and seems to be glued or stuck to the ground despite wanting to continue walking.

While it is unknown what ultimately causes freezing in Parkinson’s disease patients it may be due to longer term use of Carbidopa-Levodopa however can also occur in those who have never taken the medication. It also typically occurs in individuals as the disease progresses and is in the advanced stages. It is also impossible to predict who will have freezing episodes and who will not as some individuals will never have freezing episodes throughout their lifetime.

  • Freezing is an involuntary inability to initiate or continue a movement
  • Can feel as if the feet are glued or stuck to the ground
  • Can be a very frightening experience
  • Impossible to predict who will or won’t have freezing episodes
  • May be due to long term use of Carbidopa-Levodopa however the cause of Freezing is ultimately unknown

What is freezing in Parkinson’s video from the Parkinson’s foundation

What is Parkinson’s disease

Parkinson’s disease is a progressive neurological disorder characterized by difficulty initiating movement with the most noticeable trait being that of tremors in the hands. Parkinson’s disease may start with little to no disruption to one’s life with a small tremor in the hands possibly being the first warning sign. However as the disease progresses it can become a debilitating disease which may leave the individual wheelchair bound in the later stages.

Parkinson’s patients will often show little to no facial emotion or expression and may appear to be wearing a mask due to the lack of expression. They may also take a long amount of time to respond to questions. This can be unnerving to others who are interacting with the individual with Parkinson’s and may lead them to believe that they are unable to understand or are not following the conversation. This is not true for all but those in the more advanced stages of the disease process and they are able to hear and understand you without difficulty they simply are unable to form facial expressions and due to a lack of motor control and difficulty initiating speech it takes them longer to respond.

  • Progressive neurological disorder
  • A tremor in the hands is a common first sign
  • A mask like appearance is a common symptom
  • A slow or delayed speech is a common sign as the disease progresses

Here is an excellent overview video from The Michael J. Fox Foundation for Parkinson’s Research YouTube channel

Common symptoms

Parkinson's Disease symptoms
  • Tremor: Often the hallmark sign of Parkinson’s and the most noticeable symptom is a tremor of the hands or fingers. Some individuals may have a characteristic rolling of the fingers back and forth as if rolling a pill
  • Mask-like appearance: Those with Parkinson’s may exhibit little to no facial expressions and it may appear as if they are wearing a mask
  • Taking longer to respond to questions: Due to the disruption in motor control, it may take quite a bit longer for those with Parkinson’s to respond to questions
  • Poor fine motor control: As the disease progresses fine motor control tasks such as writing, using feeding utensils, buttoning a shirt, and tying your shoelaces may become progressively difficult and at a certain point you may require assistance to have these done for you
  • Rigidity: Another hallmark sign of Parkinson’s disease is rigidity or stiffness in your muscles. The muscles may become so stiff that they limit your range of motion and impact your ability to perform functional mobility such as walking or transfers
  • Freezing Episodes: The main topic of this article- Freezing episodes are characterized by an a temporary and sudden inability to initiate movement. Most often occurs when walking through doorways or when there is a change in the environment such as something on the floor in the walking path
  • Impaired Balance: Falls become more common as Parkinson’s progresses due to motor control changes. Your mind may be telling your body to perform a movement however the body will have difficulty following that command which can lead to falls and poor balance. A common occurrence with Parkinson’s is leaning back when standing up and when in a standing position. This can be very scary as the individual could fall backwards leading to injury

causes

The loss of dopamine producing neurons in the brain is the underlying cause of the motor control symptoms and related disorders caused by Parkinson’s. The exact cause is not known however genetic factors have been linked to some individuals having an increased risk for the disease.

  • Genetic factors: Certain gene variations increases the risk of developing Parkinson’s
  • Environmental factors: Certain toxins in the environment are linked to a higher risk of developing Parkinson’s
  • Mostly affects older individuals over the age of 60
  • Men more likely to develop

Medications and treatment for Parkinson’s

The main cause of the symptoms in Parkinson’s disease is the loss of dopamine producing neurons in the brain. The most commonly used medication and subsequently treatment for Parkinson’s disease is Carbidopa-Levodopa which is a drug which converts to dopamine after it has entered the brain. It mainly serves as a substitute for dopamine as those afflicted with the disease will be unable to produce dopamine. Many physicians will try to hold off using medication as a treatment until the disease has progressed to the point where it is affecting functional mobility and having a negative effect on quality of life. The reason for this is once you start taking the medication you may be on it for the rest of your life and the body will begin to develop a tolerance for the drug which will then necessitate taking more and more of the drug and eventually it will become less effective even at high doses.

Deep brain stimulation: Deep brain stimulation or DBS for short is a surgical procedure during which electrodes are implanted into the brain. A generator will be implanted into the body typically near the collarbone which will send electrical pulses to the brain which can help to decrease Parkinson’s disease symptoms. Deep brain stimulators are particularly effective for those who suffer from dyskinesia such as involuntary movements. Deep brain stimulators can not prevent the progression of Parkinson’s disease. The choice to have a deep brain stimulator surgery is an important discussion to be had with your physician as there are risks involved due to the invasive nature of the surgery.

Can I prevent freezing?

It is impossible to prevent freezing altogether however there are some tips to make the likelihood of having a freezing episode less common. Freezing episodes will occur more frequently when there is a change in the environment or an increase in activity or external factors. Common examples are that freezing episodes will occur more when walking on a path which is free and clear from any obstacles and then there will be an unexpected obstacle or object in the way. An example would be someone walking on a clear side-walk and then there is a branch from a tree which has fallen and is in the path of the Parkinson’s client. This can be enough to cause the brain to go haywire and go into a freezing episode. As might be expected freezing episodes can occur more often when you are at a place which has a lot of extra activity going on such as trying to go to the store at a popular time such as 5:30 pm which is after work and people may be trying to pick something up prior to heading home for the evening.

It will help if you are with a care-giver who is able to see the path ahead and remove any of these foreign objects prior to you getting there so that the freezing episode never has the chance to occur. Another tip would be to plan your trips and outings at off-peak times such as going to the store during the middle of the day when most people will be at work which will mean there will be less opportunity for distractions and high instances of activity.

U-step walker: The U-step walker is specifically designed for those with neurological conditions and is especially geared towards those with Parkinson’s disease. This walker is prescribed often by Physical Therapists and physicians as it has a unique hand brake system which is unlike most traditional walkers. With most traditional walkers the hand brakes are applied when you wish to turn the brakes on and step. With the U-step walker you will use the hand brakes when walking and if you wish to stop you simply release the pressure of the hand brakes and the walker will stop as the brakes are applied. This is particularly effective in helping to prevent a freezing episode as it allows you to stay in a continuous motion with the hand brakes being used and then if a freezing episode does occur you simply release the hand brakes and the walker will stop.

  • Freezing is impossible to prevent
  • If possible always have a care-giver with you to help remove any obstacles or foreign objects which may be blocking your walking path
  • Try to plan your trips and outings so they are not at peak times of the day

how do i get out of a freezing episode?

One of the scariest things for someone with Parkinson’s disease is to be calmly going about their day and then all of a sudden their feet feel stuck to the ground and they do not know how to get unstuck or start walking again. Their mind will start racing with thoughts of if they will fall or the embarrassment of being in this situation. While it is not easy to do, there are some ways to get out of a freezing episode however it will take some practice.

  1. Visualize an object in front of you- One of the easiest methods to perform is to visualize there is an object in front of your foot such as a pencil and then step over that object you imagined. This is a good one to use when you are by yourself. If you have someone with you they can even place something down in front of you- again such as a pencil or small stick if you are outside and have you step over it.
  2. Use a laser pointer- Laser pointers are cheap and you can buy one at the dollar store. Simply carry it in your pocket and if you have a freezing episode shine the light where you want to step and then step on that point. This should be enough to kick you out of the freezing episode.
  3. March in place- This is one of my client’s favorite to use at it does not require any external devices and can be done quickly. Simply march your feet up and down a few times and then continue with the step.
  4. Carry a metronome- This is a very effective method however requires you to wear or carry a metronome. Turn the device on and try to step to the devices beat.
  5. Sing or hum a song- One of the common themes on this list is you are doing something to distract your brain from the original activity you were doing and then going back to that activity. This is no different. Try to sing or hum a song- this requires activation from different areas of the brain than the ones used in motor control. Then go back to walking or performing whatever activity you were trying and you should be able to complete that motion.
  6. Touch your head- For some individuals simply touching the head is enough to get out of a freezing episode.

Most important piece of advice: My most important piece of advice I give my clients is don’t try and fight the freezing episode. If you are trying to walk and all of a sudden you freeze when of the worst things you can do is get tense and try with all your might to try and take that step. The mind needs to reset. Try your best to calm yourself, take a deep breath, and then do something else other than whatever movement you were trying to do. If you were trying to walk and you freeze- hum a song, or raises your arms up overhead. If you are trying to move your legs to get out of bed and you freeze, try bring your knees up to your chest or raises your arms up towards the ceiling. Then go back to the movement you were trying to do. The more you try and fight it the less effective you will be in getting out of the freeze.

How to get out of freezing episode- 3 tips from Bob and Brad

Disclaimer

Although I am a Doctor of Physical Therapy by profession, I am not your personal Physical Therapist nor am I a medical doctor. All content and information on this website is for informational purposes only, does not constitute medical advice and does not establish any kind of patient-client relationship by your use of this website. A patient-client relationship with you is only formed after we have expressly entered into a written agreement with you that you have signed, including our terms to represent you in a specific manner. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information. Always consult a professional in the area for your particular needs and circumstances prior to making any professional, legal, medical and financial or tax related decisions.


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