Gait Disturbances in Parkinson’s Disease

  • Nir Giladi
  • Jacov Balash
  • Jeffrey M. Hausdorff


Gait disturbances have recently been added as the fifth cardinal motor symptom of parkinsonism. This addition was made due to the unique phenomenology of gait disturbances (e.g., in the form of freezing and festination) and their importance in the clinical spectrum of parkinsonism. In his famous “Essay on Shaking Palsy”, James Parkinson first elegantly described how the parkinsonian patient is “irresistibly impelled to make much quicker and shorter steps, and thereby to adopt unwillingly a running pace...”. Gait disturbances, like decreased arm swing, slower speed, and shorter steps appear early in the course of Parkinson’s disease (PD), sometimes even as presenting symptoms. From the functional point of view, however, gait abnormalities are of clinical significance mainly in the advanced stages of the disease. With the current, modern treatment of PD, patients are able to maintain locomotion longer, but this is accompanied by motor response fluctuations and dyskinesias. “Off” state akinesia, severe lethargy, light headedness and dystonic postures of the legs or trunk and “on” state dyskinesias have created a new type of gait disturbance that was not seen prior to the levodopa era. Gait disturbances in PD exert profound effects on function and independence and haverecently been shown to be a major risk factor for institutionalization and death in patients with PD (Hely et al 1999).


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  1. Aziz TZ., Davies L., Stein J., France S., 1998, The role of descending basal ganglia connections to the brainsetm in parkinsonian akinesia, Br. J.. Neurosurg. 12, 245–249.PubMedCrossRefGoogle Scholar
  2. Blin, O., Ferrandez A. M, and Serratrice G., 1990, Quantitative analysis of gait in Parkinson patients: increased variability of stride length, J. Neurol.Sci. 98, 91–97.PubMedCrossRefGoogle Scholar
  3. Blin, O., Ferrandez A. M, Pailhous J., and Serratrice G., 1991, Dopa-sensitive and dopa-resistant gait parameters in Parkinson’s disease, J.Neurol.Sci. 103, 51–54.PubMedCrossRefGoogle Scholar
  4. Elble RJ, Cousins R, Leffler K, Hughes L., 1996. Gait initiation by patients with lower-half parkinsonism, Brain 119, 1705–1716.PubMedCrossRefGoogle Scholar
  5. Feve AP., Fenelon G., Wallays, C., et al. 1993, Axial motor disturbances after hypoxic lesions of the globus pallidus. Mov Disord., 8, 321–326.PubMedCrossRefGoogle Scholar
  6. Fukuyama H., Ouchi Y., Matsuzaki S., et al., 1997, Brain functional activity during gait in normal subjects: A SPECT study. Neurosci. lett. 228, 183–186.PubMedCrossRefGoogle Scholar
  7. Garcia-Rill E., 1986, The basal ganglia and the locomotor regions, Brain Research Reviews, 11, 47–63.CrossRefGoogle Scholar
  8. Giladi N., D. McMahon, S. Przedborski, E. Flaster, S. Guillroy, V. Kostic, S. Fahn, 1992, Motor blocks (“freezing”) in Parkinson’s disease, Neurology, 42, 333–339.PubMedCrossRefGoogle Scholar
  9. Giladi N., Treves T.A., Simon E.S., et al., 2001. Freezing of gait in patients with advanced Parkinson’s disease, J. Neural Transm., 108, 53–61.PubMedCrossRefGoogle Scholar
  10. Giladi N., McDermott M., Fahn S., Przedborski S., Jankovic J., Stern M., Tanner C., The Parkinson Study Group, 2001, Freezing of gait in Parkinson’s disease: Prospective assessment of the DATATOP cohort. Neurology, in press.Google Scholar
  11. Grasso R., Peppe A., Stratta F., et al., 1999, Basal ganglia and gait control: apomorphine administration and internal pallidum stimulation in Parkinson’s disease, Exp Brain Res. 126, 139–148.PubMedCrossRefGoogle Scholar
  12. Hanakawa T, Katsumi Y, Fukuyama H, et al., 1999, Enhanced lateral premotor activity during paradoxical gait in Parkinson’s disease, Brain 122(7), 1271–1282.PubMedCrossRefGoogle Scholar
  13. Haslinger B., Erhard P., Kämpfe N. et al., 2001, Event-related functional magnetic resonance imaging in Parkinson’s disease before and after levodopa, Brain 124 (3), 558–570.PubMedCrossRefGoogle Scholar
  14. Hausdorff JM, Lertratanakul A, Cudkowicz ME, Peterson AL, Kaliton D, Goldberger AL., 2000, Dynamic markers of altered gait rhythm in amyotrophic lateral sclerosis. J Applied Physiology. 88, 2045–2053.Google Scholar
  15. Hausdorff, J. M., M. E. Cudkowicz, R. Firtion, J. Y. Wei, and A. L. Goldberger, 1998, Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson’s disease and Huntington’s disease, Mov Disord. 13, 428–437.PubMedCrossRefGoogle Scholar
  16. Hely MA, Morris JG, Traficante R, Reid WG, O’sullivan DJ, Williamson PM, 2000, The Sydney multicentre study of Parkinson’s disease: progression and mortality at 10 years, J Neurol Neurosurg Psychiatry. 68 (2), 254–255.CrossRefGoogle Scholar
  17. Masdeu JC., Alampur U., Cavaliere R., Tavoulareas G., 1994, Astasia and gait failure with damage of the pontomesencephal ic locomotor region, Ann. Neurol. 35, 619–621.PubMedCrossRefGoogle Scholar
  18. Nutt J.G. Peculiar gait and balance synergies. AAN 51stAnnual Meeting, Toronto 1999, 2DS.003.Google Scholar
  19. Ouchi Y., Kanno T., Okada H., et al., 2001. Changes in dopamine availability in the nigrostrial and mesocortical dopaminergic systems by gait in Parkinson’s disease, Brain, 124. 784–792.PubMedCrossRefGoogle Scholar
  20. Pahapill PA. Lozano AM, 2000, The pedunculopontine nucleus and Parkinson’s disease, Brain, 123:1767–1783.PubMedCrossRefGoogle Scholar
  21. Rosin R., Topka H., 1997. Gait initiation in Parkinson’s disease, Mov Disord. 12 (5).682–690.CrossRefGoogle Scholar
  22. Trillet M., Croisile B., Tourniaire D., Schott B., 1990, Disorders of voluntary motor activity and lesions of caudate nuclei, Rev Neurol. 146 (5).338–344.PubMedGoogle Scholar
  23. Ueno E., 1989, Clinical and physiological study of apraxia of gait and frozen gait. Rinsho Shinkeigaku 29 (3),275–283.PubMedGoogle Scholar
  24. Villablance J.R, Marcus RJ., 1975, Effects of caudate nuclei removal in cats. Comparison with frontal cortex ablation. UCLA Forum Med Sci. 18, 273–311.PubMedGoogle Scholar
  25. Winn P.. 1998. Frontal syndrome as a consequence of lesions in the pedunculopontine tegmental nucleus: A short theoretical review, Brain Res Bull. 476, 551–563.CrossRefGoogle Scholar
  26. Yanagisawa N, Ueno E., Takami M., 1991. Frozen gait in Parkinson’s disease and vascular parkinsonism — A study with floor research forces and EMG. In: Neurobiological Basis of Human Locomotion. M. Shimamura, S. Grillner. V.S. Edgerton Ed., Japan Scientific Societies Press, Tokyo. pp. 291–304.Google Scholar
  27. Zijlstra W., Rutgers A.W.F., Van Weerden T.W., 1998, Voluntary and involuntary adaptation of gait in Parkinson’s disease. Gait and Posture, 7, 53–63.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic / Plenum Publishers, New York 2002

Authors and Affiliations

  • Nir Giladi
    • 1
  • Jacov Balash
    • 1
  • Jeffrey M. Hausdorff
    • 1
    • 2
  1. 1.Movement Disorders Unit, Department of NeurologyTel-Aviv Sourasky Medical CenterTel-AvivIsrael
  2. 2.Beth Israel Deaconess Medical CenterBostonUSA

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