Frauke E. Schroeteler

A new rating instrument to assess festination and freezing gait in Parkinsonian patients

Festination and freezing of gait (FOG) are sudden episodic inabilities to initiate or sustain locomotion mostly experienced during the later stages of Parkinsons disease (PD) or other higher‐level gait disorders. The aim of this study was to develop a clinical rating instrument for short‐interval rating of festination and FOG. Foot movements of 33 patients were video taped and rated during 12 episodes in a standardized course on a four‐level interval scale according to severity. Motor blocks were provoked in four situations and by three levels of dual‐tasking (tasks). Addition of the item scores produced a FOG score. The assessment requires less than 15 min. The inter‐rater and re‐test reliability of the FOG score is high (Kendall κ = 0.85–0.92, P < 0.0001). Variability of the item scale due to situations and tasks can be attributed to unidimensional group factors (Cronbachs α 0.84 and 0.94). Group comparisons and a logistic regression model show significant effects for both situations and tasks on the item scale (Friedman test: “situation”: P < 0.0001, “task”: P < 0.0001). Six patients with PD have significantly different scores during mobile (practical ON; 6.2 ± 3.9) and immobile (practical OFF; 15.8 ± 4.6) medication states (P < 0.05). The FOG score correlates with the 10 m number of steps (ρ = 0.58; P = 0.001) and with the self‐evaluation of FOG (ρ = 0.51; P < 0.01). Our results encourage the further use of the FOG score to evaluate festination and FOG.

Randomized cross-over trial to investigate the efficacy of a two-week physiotherapy programme with repetitive exercises of cueing to reduce the severity of freezing of gait in patients with Parkinson’s disease:

Objective: To investigate the efficacy of a two-week programme of repetitive exercise with cueing and movement strategies upon freezing of gait in people with Parkinson’s disease. Design: Randomized cross-over trial. Setting: Specialist clinic for Parkinson’s disease. Subjects: A total of 22 patients with Parkinson’s disease and freezing while other symptoms had favorably responded to dopaminergic treatment. Intervention: Patients were randomized into a four-week cross-over trial, and received either treatment (Group 1) or no treatment (Group 2) during Period 1, and switched during Period 2. Treatment consisted of a two-week programme during which the patients exercised cueing, and movement strategies together with a physiotherapist. Main measure: The primary outcome measure was a freezing score assessed from blinded and random ratings of video recordings. The secondary outcome measure was a patient-reported freezing questionnaire. Mean differences between the treatment periods (treatment arms) were evaluated for treatment (period) effects. Sums of treatment periods were evaluated for carry-over effects. Results: The programme led to a significant treatment effect in the freezing score of 3.0 improvement (95% confidence interval 0.9–5.0; p < 0.01). No carry-over or period effects were detected. The questionnaire revealed a period effect, so groups were compared after Period 1, where a significant difference was found (15.0 vs. 11.7; p < 0.05). Conclusions: The two-week physiotherapy programme reduced the severity of freezing in patients with Parkinson’s disease.

[Freezing of gait : phenomenology, pathophysiology, and therapeutic approaches].

Freezing of gait (FOG) is a common disturbance in Parkinsons disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.ZusammenfassungFreezing während des Gehens ist beim idiopathischem Parkinson-Syndrom und anderen zentralen Gangstörungen häufig. Bei den meisten Patienten tritt es im späteren Verlauf der Erkrankung auf. Vor dem Beginn der Therapie mit Levodopa kann es aber auch das frühe Krankheitsbild prägen. Freezing beim Gehen besitzt eine eigene spezifische Pathophysiologie und ist nicht der Bradykinese zuzuordnen. Es kommt sowohl während On- als auch während Off-Phasen vor. Es reduziert die Mobilität, beeinträchtigt Aktivitäten im täglichen Leben und ist eine bedeutende Ursache für Stürze. On-Freezing lässt sich durch Pharmakotherapie und tiefe Hirnstimulation nur unzureichend beeinflussen. Der Einsatz externer Schrittmacher kann Freezing und Festination hingegen wirkungsvoll reduzieren. Schrittmacher können akustisch, visuell, taktil oder mental dargeboten werden. Der vorliegende Artikel diskutiert die zu Verfügung stehenden pharmakologischen und physiotherapeutischen Therapieoptionen.AbstractFreezing of gait (FOG) is a common disturbance in Parkinson’s disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.

Freezing während des Gehens

Freezing of gait (FOG) is a common disturbance in Parkinsons disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.ZusammenfassungFreezing während des Gehens ist beim idiopathischem Parkinson-Syndrom und anderen zentralen Gangstörungen häufig. Bei den meisten Patienten tritt es im späteren Verlauf der Erkrankung auf. Vor dem Beginn der Therapie mit Levodopa kann es aber auch das frühe Krankheitsbild prägen. Freezing beim Gehen besitzt eine eigene spezifische Pathophysiologie und ist nicht der Bradykinese zuzuordnen. Es kommt sowohl während On- als auch während Off-Phasen vor. Es reduziert die Mobilität, beeinträchtigt Aktivitäten im täglichen Leben und ist eine bedeutende Ursache für Stürze. On-Freezing lässt sich durch Pharmakotherapie und tiefe Hirnstimulation nur unzureichend beeinflussen. Der Einsatz externer Schrittmacher kann Freezing und Festination hingegen wirkungsvoll reduzieren. Schrittmacher können akustisch, visuell, taktil oder mental dargeboten werden. Der vorliegende Artikel diskutiert die zu Verfügung stehenden pharmakologischen und physiotherapeutischen Therapieoptionen.AbstractFreezing of gait (FOG) is a common disturbance in Parkinson’s disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.

Gleichgewicht und Gehen verbessern sich durch Tai Chi Chuan

Tai Chi Chuan steigert wirksam Gleichgewichtsleistungen und balanceabhängige Gangparameter. Neben einer aktivierenden Physiotherapie eingesetzt, erweitert Tai Chi Chuan die Palette der Trainingsoptionen bei Parkinson. Gleichgewicht und Gehfähigkeit können in frühen Stadien verbessert werden und die Sturzinzidenz sinkt, wie neuere Studien belegen.

Freezing während des Gehens@@@Freezing of gait: Phänomen, Pathophysiologie, Therapie@@@Phenomenology, pathophysiology, and therapeutic approaches

Freezing of gait (FOG) is a common disturbance in Parkinsons disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.ZusammenfassungFreezing während des Gehens ist beim idiopathischem Parkinson-Syndrom und anderen zentralen Gangstörungen häufig. Bei den meisten Patienten tritt es im späteren Verlauf der Erkrankung auf. Vor dem Beginn der Therapie mit Levodopa kann es aber auch das frühe Krankheitsbild prägen. Freezing beim Gehen besitzt eine eigene spezifische Pathophysiologie und ist nicht der Bradykinese zuzuordnen. Es kommt sowohl während On- als auch während Off-Phasen vor. Es reduziert die Mobilität, beeinträchtigt Aktivitäten im täglichen Leben und ist eine bedeutende Ursache für Stürze. On-Freezing lässt sich durch Pharmakotherapie und tiefe Hirnstimulation nur unzureichend beeinflussen. Der Einsatz externer Schrittmacher kann Freezing und Festination hingegen wirkungsvoll reduzieren. Schrittmacher können akustisch, visuell, taktil oder mental dargeboten werden. Der vorliegende Artikel diskutiert die zu Verfügung stehenden pharmakologischen und physiotherapeutischen Therapieoptionen.AbstractFreezing of gait (FOG) is a common disturbance in Parkinson’s disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.

Freezing während des GehensFreezing of gait

Freezing of gait (FOG) is a common disturbance in Parkinsons disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.ZusammenfassungFreezing während des Gehens ist beim idiopathischem Parkinson-Syndrom und anderen zentralen Gangstörungen häufig. Bei den meisten Patienten tritt es im späteren Verlauf der Erkrankung auf. Vor dem Beginn der Therapie mit Levodopa kann es aber auch das frühe Krankheitsbild prägen. Freezing beim Gehen besitzt eine eigene spezifische Pathophysiologie und ist nicht der Bradykinese zuzuordnen. Es kommt sowohl während On- als auch während Off-Phasen vor. Es reduziert die Mobilität, beeinträchtigt Aktivitäten im täglichen Leben und ist eine bedeutende Ursache für Stürze. On-Freezing lässt sich durch Pharmakotherapie und tiefe Hirnstimulation nur unzureichend beeinflussen. Der Einsatz externer Schrittmacher kann Freezing und Festination hingegen wirkungsvoll reduzieren. Schrittmacher können akustisch, visuell, taktil oder mental dargeboten werden. Der vorliegende Artikel diskutiert die zu Verfügung stehenden pharmakologischen und physiotherapeutischen Therapieoptionen.AbstractFreezing of gait (FOG) is a common disturbance in Parkinson’s disease (PD) and other higher-level gait disorders. It appears most often during the later stages of PD but is seen also during the initial phases before oral substitution of levodopa has started. The disorder has its own pathophysiology and differs from bradykinesia. It can occur both on and off medication. It interferes with activities of daily life, reduces mobility, and is an important risk factor for falling. While patients with FOG during medication do not reliably respond to pharmacotherapy or deep brain stimulation, external cues have been demonstrated that influence FOG effectively. They are applied as auditory, visual, tactile, or mental cues. This article discusses available pharmacological and physiotherapeutic approaches to the treatment of FOG.