**********
**********
Are you a Parkie who sometimes (maybe all the time?) has problems walking? Do you have more problems, say, walking on a busy street or moving around in your kitchen? Do you use any strategies to help you walk in some or all of these situations?
A recent research paper (Perception and Use of Compensation Strategies for Gait Impairment by Persons with Parkinson’s Disease) discusses the responses of over 4000 Parkies to interview questions about their experiences with gait issues. I’ll cut straight to the conclusions, then elaborate further below.
In the paper’s own wording:
“(1) Compensation strategies for gait impairments are commonly used by people with PD, but their awareness of the full spectrum of available strategies is limited; (2) The patient-rated efficacy of compensation strategies is high but varies depending on the context in which they are applied; and (3) Compensation strategies are useful for all types of patients with PD, but the efficacy of the different strategies vary per person.”
Now for some elaboration, beginning with text lifted directly from the article:
“Gait disturbances are common and are reckoned among the most disabling symptoms of Parkinson’s disease. They most often give rise to falls and fall-related injuries and decreased functional mobility, independence, and quality of life.”
Parkies adapt to these conditions in various ways. The study’s authors clumped the gait compensation strategies into seven broad categories, and interviewed Parkies individually to see if they were aware of these strategies and if they had used any of them themselves.
Here are the seven categories:
- External cueing. This entails picking up on some external rhythmic cues, such as listening to a metronome or wearing vibrating socks. (I’ve never heard of vibrating socks….Does anyone know about these?)
- Internal cueing. This happens when you focus your attention on some precise portion of your gait.
- Changing the balance requirements. Examples: using canes or other walking aids; shifting your weight from one leg to another; making wider turns than you would have in the past.
- Altering the mental state. This includes trying to be more alert and/or taking measures to limit anxiety, such as deep breathing exercises.
- Action observation and motor imagery. This includes watching how others walk and copying their movements.
- Adapting a new walking pattern. Examples: lifting your knees higher than usual; running; jumping; walking backward.
- Other forms of using your legs to move forward. Examples: skateboarding; crawling; cycling.
As I already mentioned, the researchers interviewed over 4000 Parkies one by one, explaining the seven categories and ascertaining whether each Parkie had known of that strategy and used it. They asked about the context of when the Parkie had used the strategy, and whether the strategy helped in that situation.
Some results:
About 35% of the Parkies said walking difficulties hampered their daily life. Over half of the group had fallen at least once during the previous year, with 385 cases needing medical attention. 16% of the group had never heard of any of the seven strategies, and 23% had never tried any strategy. Only 3% knew about all seven.
The overall highest success rate was when the Parkie changed the balance requirement by using a cane, walker, or similar device. On the other hand, the Parkies experienced the worst gait disturbance outcome when they had to dual-task, such as walking at the same time you’re talking with a friend.
From the paper’s concluding paragraph:
“The present findings support the application of compensation strategies for gait impairments in PD and emphasize that a one-size-fits-all approach to gait rehabilitation is inappropriate. Persons with PD should be – and wish to be – more thoroughly informed about the range of available strategies. The choice of compensation strategies should be tailored to the individual patient and to the contexts in which the strategies need to be applied.”
********
And now for a personal twist. I used to be seriously hindered when walking around my home. I had dozens of falls; they often followed an attack of festinating gait. My feet would start taking tiny, mincing steps while the upper half of my body still wanted to sally forth. Soon my feet would freeze completely but my upper body continued forward. If I couldn’t catch myself by grabbing hold of a table or desk or door frame, I’d crash to the floor.
I received physical therapy for this, and I’ve since invented a way to force myself to stride better, especially in the trouble spots around my house. I did this by attaching 5-pound weights to my ankles, then purposefully strolling around my home for a half hour or so, hitting the areas where my gait was often less-than-stellar: moseying around our small kitchen, entering and exiting the tiny powder room on our main floor, and making sharp turns when I reached the top of the stairs to the 2nd floor.
Here are the ankle weights:
**********
**********
You’ll see what I mean by watching these two videos. In the first one, I’m walking without the ankle weights. Note how many tiny steps I take just to turn 90 degrees. Up until now, that was my natural way of walking.
********
********
In the second video, I’m walking with the ankle weights. You’ll see a big difference in my stride. The more I do this particular exercise, the better my stride is when I take the weights off.
********
********
Our cat, Tako, makes a cameo appearance in both videos. When she’s hungry for dinner she’ll often run circles around my feet, a potential hazard.
