Understanding and Managing Freezing of Gait

Freezing of gait (FOG) is often described as one of the most stubborn aspects of the condition. It is a sudden, involuntary inability to move that makes you feel as though your feet are glued to the floor. While it primarily affects walking, it can also impact how you move your arms, how you change positions, and even the way you talk or think. For the 80 per cent of people with advanced Parkinson’s who experience this, the episodes can be brief or last upwards of thirty seconds, often appearing without warning and causing a great deal of anxiety about falling. How Freezing Looks and Feels A freezing episode can be a frightening experience. As Richie Rothenberg, a member of the Michael J. Fox Foundation patient council, describes it, the entire body can seem to "rebel," making it impossible to move in any direction. Physically, you might see someone trembling in place or moving their feet rapidly without actually gaining any ground. One of the greatest dangers is that while the feet are stuck, the upper body’s momentum may continue forward, which is a common cause of falls. It is also important for loved ones to know that urging or pushing someone during a freeze can actually increase the risk of an injury. Why the Brain "Freezes" Walking requires a complex series of signals from the brain, and in Parkinson’s, these messages can become blocked. Certain triggers are more likely to spark this "messaging mix-up." Research has found that turning around is the most common trigger, followed closely by walking through a doorway or trying to multitask. Other common triggers include navigating narrow spaces, stepping up or down, or simply feeling rushed and anxious. Changes in flooring or skipping a dose of medication can also play a major role. Richie Rothenberg finds that his freezes are more frequent when he is tired, stressed, or hasn't exercised that day. Medical Treatments and Dosing If you are experiencing freezing, your healthcare provider will likely start by looking at your medication schedule. They will want to know if you are freezing during "off times"—when your medication is wearing off—or during "on times" when it should be working best.Adjusting the dosage of carbidopa-levodopa is often the first step, as freezing is frequently linked to low dopamine levels. If this doesn't resolve the issue, other options include amantadine, droxidopa, or stimulants like atomoxetine. For rapid relief, a fast-acting medication called apomorphine is available as an injection or a film that dissolves under the tongue, though it can cause side effects like a dry mouth. For some, Deep Brain Stimulation (DBS) has shown promising results in managing these electrical brain messages more effectively. The Role of Physical and Occupational Therapy Specialised therapy is an essential tool for regaining mobility. Physical therapists work on strengthening the brain's pathways for walking and help you identify your specific triggers so you can avoid them. They often teach "cueing" techniques to break a freeze, such as: - Rhythmic Cues: Using a metronome to step to a beat or counting "one, two, three" before moving. - Visual Cues: Focusing on a laser pointer dot or stepping over a cane or a strip of tape on the floor. - Physical Movements: Marching in place, shifting your weight from side to side, or raising an arm to reset the brain's signals. Occupational therapists focus on independence and home safety. They might suggest adding more light to room transitions, removing throw rugs that cause trips, or applying bright tape to the floor in "danger zones" like the bathroom. They can also help you restructure your daily routine to avoid the stress of multitasking. Self-Management Strategies Beyond professional therapy, there are simple ways to manage a freeze when it happens. If you find yourself stuck, remember to pause, stand up straight, look ahead, and try to take one deliberate, big step. If the freeze is particularly stubborn, it is often best to find a place to sit down and let the episode pass. Learning what works for your body is a process, and your healthcare team is there to help you refine these strategies so you can stay safe and keep moving.