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Journal of Neurology

, Volume 261, Issue 9, pp 1763–1767 | Cite as

Short rapid steps to provoke freezing of gait in Parkinson’s disease

  • Jorik NonnekesEmail author
  • Arno M. Janssen
  • Senja H. G. Mensink
  • Lars B. Oude Nijhuis
  • Bastiaan R. Bloem
  • Anke H. Snijders
Original Communication

Abstract

Freezing of gait (FOG) is both common and debilitating in patients with Parkinson’s disease. Due to its episodic nature, it is a challenge to provoke FOG in clinical practice and in the research setting. Turning is most sensitive to provoke FOG, particularly when performed as rapidly as possible. Walking with short steps is an alternative approach to provoke FOG. Here, we assessed a modified version of this test, consisting of the instruction to make short steps as rapidly as possible. We evaluated what the diagnostic value of this new test is compared to rapid turning. 28 patients with Parkinson’s disease participated, who all had objective FOG. Patients performed the following tasks two times: (1) normal walking, (2) walking as rapidly as possible, (3) walking with short steps, (4) walking with short steps as rapidly as possible and (5) making full rapid turns in both directions. FOG was provoked in 20 subjects (71 %). The most effective test to provoke FOG was rapid full turns (64 % of subjects). FOG occurred more often when patients walked with rapid short steps (50 %) compared to walking with short steps at normal speed (18 %). The combination of ‘full rapid turns’ and ‘walking with short steps rapidly’ yielded the highest sensitivity of provoking FOG (0.71, CI 0.51–0.86). The most sensitive way to provoke FOG is by asking patients to make full rapid turns, but if negative, walking with short steps as rapidly as possible can identify further subjects with FOG.

Keywords

Parkinson’s disease Freezing of gait Gait 

Notes

Acknowledgments

This research was funded by a Radboud University Medical Centre Research Grant to J Nonnekes.

Conflicts of interest

The authors report no conflict of interest.

References

  1. 1.
    Bloem BR, Hausdorff JM, Visser JE, Giladi N (2004) Falls and freezing of gait in Parkinson’s disease: a review of two interconnected, episodic phenomena. Mov Disord 19:871–884CrossRefPubMedGoogle Scholar
  2. 2.
    Chee R, Murphy A, Danoudis M, Georgiou-Karistianis N, Iansek R (2009) Gait freezing in Parkinson’s disease and the stride length sequence effect interaction. Brain 132:2151–2160CrossRefPubMedGoogle Scholar
  3. 3.
    Giladi N, Hausdorff JM (2006) The role of mental function in the pathogenesis of freezing of gait in Parkinson’s disease. J Neurol Sci 248:173–176CrossRefPubMedGoogle Scholar
  4. 4.
    Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N, Movement Disorder Society URTF (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170CrossRefPubMedGoogle Scholar
  5. 5.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Lewis SJ, Barker RA (2009) A pathophysiological model of freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord 15:333–338CrossRefPubMedGoogle Scholar
  7. 7.
    LundinOlsson L, Nyberg L, Gustafson Y (1997) ‘‘Stops walking when talking’’ as a predictor of falls in elderly people. Lancet 349:617CrossRefGoogle Scholar
  8. 8.
    Moore ST, Yungher DA, Morris TR, Dilda V, MacDougall HG, Shine JM, Naismith SL, Lewis SJ (2013) Autonomous identification of freezing of gait in Parkinson’s disease from lower-body segmental accelerometry. J Neuroeng Rehabil 10:19PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Muller J, Seppi K, Stefanova N, Poewe W, Litvan I, Wenning GK (2002) Freezing of gait in postmortem-confirmed atypical parkinsonism. Mov Disord 17:1041–1045CrossRefPubMedGoogle Scholar
  10. 10.
    Nieuwboer A, De Weerdt W, Dom R, Lesaffre E (1998) A frequency and correlation analysis of motor deficits in Parkinson patients. Disabil Rehabil 20:142–150CrossRefPubMedGoogle Scholar
  11. 11.
    Nieuwboer A, Rochester L, Herman T, Vandenberghe W, Emil GE, Thomaes T, Giladi N (2009) Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson’s disease and their carers. Gait Posture 30:459–463CrossRefPubMedGoogle Scholar
  12. 12.
    Nonnekes J, Geurts ACH, Nijhuis LBO, van Geel K, Snijders AH, Bloem BR, Weerdesteyn V (2014) Reduced StartReact effect and freezing of gait in Parkinson’s disease: two of a kind? J Neurol 261:943–950CrossRefPubMedGoogle Scholar
  13. 13.
    Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A (2011) Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol 10:734–744CrossRefPubMedGoogle Scholar
  14. 14.
    Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A (2011) Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol 10:734–744CrossRefPubMedGoogle Scholar
  15. 15.
    Schaafsma JD, Balash Y, Gurevich T, Bartels AL, Hausdorff JM, Giladi N (2003) Characterization of freezing of gait subtypes and the response of each to levodopa in Parkinson’s disease. Eur J Neurol 10:391–398CrossRefPubMedGoogle Scholar
  16. 16.
    Schepens B, Stapley P, Drew T (2008) Neurons in the pontomedullary reticular formation signal posture and movement both as an integrated behavior and independently. J Neurophysiol 100:2235–2253CrossRefPubMedGoogle Scholar
  17. 17.
    Snijders AH, Haaxma CA, Hagen YJ, Munneke M, Bloem BR (2012) Freezer or non-freezer: clinical assessment of freezing of gait. Parkinsonism Relat Disord 18:149–154CrossRefPubMedGoogle Scholar
  18. 18.
    Snijders AH, Leunissen I, Bakker M, Overeem S, Helmich RC, Bloem BR, Toni I (2011) Gait-related cerebral alterations in patients with Parkinson’s disease with freezing of gait. Brain 134:59–72CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jorik Nonnekes
    • 1
    Email author
  • Arno M. Janssen
    • 2
  • Senja H. G. Mensink
    • 1
  • Lars B. Oude Nijhuis
    • 2
  • Bastiaan R. Bloem
    • 2
  • Anke H. Snijders
    • 2
  1. 1.Department of RehabilitationRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
  2. 2.Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands

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