As adults, our normal walking gait sees us bend one knee and lift our foot, then swing our lower leg forward, with the foot flexed and raised upwards, so it clears the ground. Then, we use the other leg to propel us forward, by raising our heel off the ground and pushing using the ball of our foot, as our toes flex.
When we walk, we unconsciously swing our arms to balance us and, unless we’re injured in some way, can usually walk at a speed that feels natural, without worrying unduly about falling.
What is Parkinsonian Gait?
In contrast to normal adult gait, Parkinsonian Gait — also called Parkinson’s Walk — is characterized by very short, shuffling steps, in which the feet do not lift far from the floor. There is little to no flexion in the knee, ankle or foot, so the foot is placed flat on the ground, resulting in extremely short stride length.
The ability to bend the knee, flex the foot and roll onto the ball of the foot is critical to the ability to begin moving. Because Parkinsonian Gait lacks the knee and foot flexion of our normal movement, it’s often difficult for those who experience it to start walking. Uneven surfaces, slopes and steps can prove almost impossible to navigate and the inability to swing or turn the leg can make turning slow and awkward.
Instead of the body being upright, those with Parkinsonian Gait often lean slightly forward with a hunched posture. To avoid overbalancing, it’s common to see rapid, short steps that seem to propel the individual forward. Reduced arm movement is often noticeable as well.
What Causes Parkinsonian Gait?
While the cause of Parkinson’s Disease itself is unknown, it is characterized by damage to the basal ganglia — a group of structures that sit in the base of the forebrain and top of the midbrain.
The basal ganglia is one of many stations in the communication circuit translating and moving neural impulses back and forth between the brain and the rest of the body.
The communication begins in the motor cortex — the part of the brain controlling voluntary movement — that creates a command, such as “move your legs.” This command moves to the basal ganglia, which produces dopamine — the brain chemical that facilitates the movement of messages between the brain and the body.
The dopamine opens up the pathways for the signal to travel down to the rest of your body.
As Parkinson’s progresses, the disease kills nerve cells in a subsection of the basal ganglia, called the substantia nigra, which produces dopamine. The pathways between the brain and the body rely on that steady supply of dopamine. As the levels of dopamine we’re producing drops, those pathways have trouble opening up.
Without those pathways, the brain has greater difficulty successfully sending impulses to the legs, arms, and other parts of the body involved with walking.
The body begins exhibiting symptoms such as inability to control the length and speed of steps, as well as decreased range of motion and sudden increases in pace (known as festination). These are the typical symptoms of the small, shuffling steps of Parkinsonian gait.
Why Does Parkinson’s Cause This Specific Gait Disorder?
As with many things related to Parkinson’s Disease, the precise causes of the Parkinsonian Gait walking pattern known aren’t yet fully understood, but researchers have found abnormalities in muscle function that may provide some answers.
Normal movement process sees muscles work in pairs to enable us to flex our joints. One set of muscles (you’ll see these called agonist muscles) contract to produce a movement, while the opposing muscle set (these are known as antagonist muscles) relaxes or extends to let that movement take place.
For example, our quadriceps — the muscles at the front of our thigh — contract to bend our knee, while the hamstrings lengthen to allow it to bend. The reverse then occurs to straighten the knee again.
It’s normal to have some degree of muscular co-activation, where the muscle pairs both contract at the same time, to support movement and provide stability for a joint. We use this frequently, especially when we are deliberately controlling movement, like gripping a pen and writing.
However, abnormal co-activation sees both the agonist and antagonist muscles contract at the same time, to a degree that does not allow the joint to flex much, if at all. While one set of muscles is contracting, for example to let us bend our knee, the opposing muscles are also contracting, holding the leg stiff.
This is important, because researchers have found that this abnormal muscle activity happens more frequently in people with Parkinson’s Disease. While the agonist muscles are contracting to try to create movement, the antagonist muscles should be extending. Instead, they are contracting, working against the muscles they should be supporting, and holding the joints rigid and inflexible.
It’s believed that this overactive and involuntary contraction of antagonist muscles is responsible for this peculiar walking pattern in individuals with Parkinson’s. Given the significant evidence that the basal ganglia and cerebellum also play a vital role in muscle co-activation, it seems likely that the same damage to the basal ganglia that goes along with Parkinson’s itself, is also directly in play here.
Abnormal muscle co-activation may also be responsible for the poor balance that people in the later stages of Parkinson’s often experience, where it’s difficult to maintain a steady and upright posture.
In particular, it may explain why these problems with balance tend to result in leaning or falling backwards. The antagonist muscles lie at the back of the legs. When they contract — without the opposing contraction from the front of the legs — the center of balance is shifted backwards, making it difficult to stay upright.
How Does Parkinson’s Walk Interact with Other Parkinson’s Symptoms?
Two other symptoms associated with Parkinson’s Disease can make walking, and moving in general, even more difficult, especially as the disease progresses.
Slow movement — referred to using the Greek term Bradykinesia — is another of the symptoms used to diagnose Parkinson’s. In addition to generally sluggish movement, including a decreased blink rate, and reduced facial expression, those with Bradykinesia find the fine motor control required for writing, or doing up buttons, challenging.
Additionally, those with Parkinsonian Gait often experience freezing episodes — called Freezing of Gait — during which they feel as if their feet are stuck in cement, so they’re unable to lift them from the ground.
Parkinson’s freezing can make walking especially risky, as it significantly increases the likelihood of falling. As a result, many with Parkinsonian Gait simply limit their movement as much as possible to avoid injury.
Rewiring the Basal Ganglia to Support Movement
Movement supports and assists our most basic bodily functions, from our circulation to our digestive system. It also allows us independence and quality of life, so retaining the ability to move to the greatest extent possible is absolutely vital to our wellbeing.
The brain is a remarkable organ, and as anyone who has ever worked to regulate or control their emotions will know, it can be tricked, distracted, or simply taught to think in a different way.
Decades of research have shown that audio or visual cues can be successfully used to improve movement for people with Parkinson’s. These cues allow the brain to find alternative ways to transmit instructions to the body, bypassing damaged neural pathways and creating new ones.
Physiotherapists often provide their clients with verbal cues, or visual aids laid out on the ground, to encourage movement. Advice often includes doing something rhythmical, such as counting out loud, to help the body and the brain to reconnect.
How Can This Help You?
NexStride combines the most effective visual and audio cues into an advanced neurological aid that attaches to walking frames, canes, and walking poles. You can activate these cues whenever needed — either independently or together — and they can allow you to take longer steps, increase your walking speed, break freezes when they occur, and avoid freezing episodes altogether.
NexStride is uniquely effective because you can configure the cues for you specifically — your stride length, your walking pace, the situations in which you have a tendency to freeze, or to slow down.
As a result, you’re far less prone to falls, lowering the injury risk that comes with losing your balance and falling.
The increased confidence and sense of well being that comes with improving Parkinsonian Gait is matched with the physical benefits of improving muscle tone, flexibility and bone density, which allows your body to stay healthier, for longer.
Looking for more information?
The Parkinson’s Foundation offers information on therapies and approaches to managing Parkinson’s and is an excellent resource for tips and medical-based options.