The Factors that Induce or Overcome Freezing of Gait in Parkinson’s Disease

Rahman, Shibley; Griffin, Harry J.; Quinn, Niall; Jahanshahi, Marjan

doi:10.1155/2008/456298

Cited by 138 publications

(148 citation statements)

References 45 publications

(69 reference statements)

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“…Our results indicate that similar activities are avoided by PD patients and that confidence decreases with increasing task complexity, but that situations with large numbers of people e.g., crowds, social events and public transport, are also avoided as shown in previous PD samples [18]. Previous work by our group has shown that such situations trigger freezing in a large percentage of patients [48]. Therefore, such situations may be avoided because they increase the likelihood of falling through freezing.…”

Section: Discussionsupporting

confidence: 71%

On the Nature of Fear of Falling in Parkinson’s Disease

Rahman

Griffin

Quinn

et al. 2011

Behavioural Neurology

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112

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Abstract. In the elderly, fear of falling (FoF) can lead to activity restriction and affect quality of life (QoL). Our aim was to identify the characteristics of FoF in Parkinson's disease and assess its impact on QoL. We assessed FoF in 130 patients with Parkinson's disease (PD) on scales measuring perceived self-efficacy in performing a range of activities (FES), perceived consequences of falling (CoF), and activity avoidance (SAFFE). A significant difference was found in FoF between PD patients who had previously fallen and those who had not and between frequent and infrequent fallers. Patient-rated disability significantly influenced FoF. Difficulty in rising from a chair, difficulty turning, start hesitation, festination, loss of balance, and shuffling were the specific mobility problems which were associated with greater FoF in PD. Disability was the main predictor of FoF, additionally depression predicted perceived consequences of falling, while anxiety predicted activity avoidance. The FoF measures explained 65% of the variance of QoL in PD, highlighting the clinical importance of FoF. These results have implications for the clinical management of FoF in PD.

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Section: Discussionsupporting

confidence: 71%

On the Nature of Fear of Falling in Parkinson’s Disease

Rahman

Griffin

Quinn

et al. 2011

Behavioural Neurology

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112

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“…Interestingly, a goal-directed deficit may concur with a separate literature that highlights a shift from internal to external control in PD (van Spaendonck, Berger, Horstink, Borm, & Cools, 1995;Brown & Marsden, 1988;Cools, van den Bercken, Horstink, van Spaendonck, & Berger, 1984). Observations that PD patients have no problem initiating actions when presented with an unambiguous external stimulus (e.g., Rahman, Griffin, Quinn, & Jahanshahi, 2008;Praamstra, Stegeman, Cools, & Horstink, 1998) suggest that if anything remains intact in PD, it is the ability to act on direct S→R associations. Difficulties with the internal generation of actions and cognitive plans as well as enhanced cue-reliance and stimulus-driven behavior are more in line with a goal-directed impairment.…”

Section: Discussionsupporting

confidence: 66%

Habitual versus Goal-directed Action Control in Parkinson Disease

Wit

Barker

Dickinson

et al. 2011

Journal of Cognitive Neuroscience

106

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Abstract■ This study presents the first direct investigation of the hypothesis that dopamine depletion of the dorsal striatum in mild Parkinson disease leads to impaired stimulus-response habit formation, thereby rendering behavior slow and effortful. However, using an instrumental conflict task, we show that patients are able to rely on direct stimulus-response associations when a goal-directed strategy causes response conflict, suggesting that habit formation is not impaired. If anything our results suggest a disease severity-dependent deficit in goaldirected behavior. These results are discussed in the context of Parkinson disease and the neurobiology of habitual and goaldirected behavior. ■

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“…FoG is elicited by specific situations or triggers: turning, gait ignition (start hesitation), approaching a destination, constrictions in visual input, e.g., doorways, and stressful, rushed situations such as hearing a knock at the door [14,15,42,51]. In more advanced PD FoG may occur in open spaces in the absence of any obvious trigger.…”

Section: External Influences On Gait In Pdmentioning

confidence: 99%

The effect of real and virtual visual cues on walking in Parkinson’s disease

et al. 2011

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Patients with Parkinson's disease (PwPD) have a slow, shuffling gait, marked by sporadic freezing of gait (FoG) during which effective stepping ceases temporarily. As these gait problems are not commonly improved by medical and surgical treatments, alternative approaches to manage these problems have been adopted. The aim of this study was to evaluate the effect of real and virtual visual cues on walking in PD. We assessed 26 mid-stage PwPD, on and off medication, on a laboratory-based walking task which simulated real world challenges by incorporating FoG triggers and using appropriate placebo conditions. Cueing interventions were presented via virtual reality glasses (VRG rhythmic, visual flow and static placebo cues), and as transverse lines (TL) on the walkway. Objective measures of gait (task completion time; velocity, cadence, stride length; FoG frequency) and self-rated fear of falling (FoF) were recorded. Cueing intervention affected task completion time only off medication. Whereas placebo VRG cues provided no improvement in walking, visual flow VRG cues marginally reduced the task completion time. TL on the floor elicited more substantial improvements in gait with reduced cadence, increased stride length and reduced FoG frequency. VRG rhythmic cueing impaired overall walking. Notably, a final no-intervention condition yielded quicker task completion, greater walking velocity, increased stride length and less frequent FoG. Although the VRG produced modest improvements only in the visual flow condition, their flexibility is an advantage. These results endorse the use of TL and justify further testing and customisation of VRG cues for individual PwPD.

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The Factors that Induce or Overcome Freezing of Gait in Parkinson’s Disease

Cited by 138 publications

References 45 publications

On the Nature of Fear of Falling in Parkinson’s Disease

On the Nature of Fear of Falling in Parkinson’s Disease

Habitual versus Goal-directed Action Control in Parkinson Disease

The effect of real and virtual visual cues on walking in Parkinson’s disease

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