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How to improve walking in people with Parkinson’s disease

October 18, 2021 – Walking problems are common and troublesome for people with Parkinson’s disease, but a new study of more than 4,000 people with Parkinson’s and mobility problems has found seven “solutions” that can help.

Compensation strategies are ‘tricks’ used by persons [Parkinson’s] used to overcome their walking problems, ”say researchers Anouk Tosserams, MD, and Jorik Nonnekes, MD, both from Radboud University Medical Center in the Netherlands.

Parkinson’s often causes movement problems, such as imbalance, shuffling, falling, staggering and freezing.

“We have found that these strategies are widely used, but that patients’ awareness of the full range of available strategies is rather limited,” they say.

According to the authors, a personal approach to rehabilitation and patient education is important.

Rebecca Gilbert, MD, vice president and chief scientific officer of the American Parkinson’s Disease Association, says the study should help doctors and patients.

While many of the suggestions are already in use, the study, which goes into more detail, should make the practices more ‘systematic’, ‘says Gilbert, associate professor of neurology at the Bellevue Hospital Center in New York.

Creative solutions

Tosserams and Nonnekes explain that their research “was inspired by the creativity of people with [Parkinson’s] who have come up with a wide range of strategies to overcome their running problems. ”

Improving the ability to go through these types of non-invasive strategies is essential, according to them, as medicine and surgery are often not successful enough.

In their daily practice, the authors say that they “noticed that different strategies have different consequences for walking, depending on the person using the strategy and the context in which the strategy is used.”

An online survey was sent to more than 8,000 participants (18 years or older) with Parkinson’s having difficulty walking. Of these, 4,324 responded and were included in the analysis.

Participants were drawn from the Fox Insight cohort, a study led by the Michael J Fox Foundation, and from ParkinsonNEXT.

The survey is divided into three parts: the first contains information about gender, age, time since diagnosis, walking ability and history of falls during the past year.

The second part of the survey asked the participants how familiar they are with seven strategies:

  • External directions (for example, walking to the beat of a metronome, pulling vibrating socks or walking across lines)
  • Internal directions (for example, by using self-education or mental mathematics)
  • Change the balance requirements (for example to move weight in place before walking, taking wider turns or using walking aids)
  • Changing the state of mind (for example, breathing exercises or other approaches to limiting anxiety or fear of falling)
  • Action observation and motor images (imitation of someone else walking or visualizing the desired movement)
  • Adjusting a new walking pattern (for example, scissors, kneeling, jumping, running or walking backwards)
  • Other forms of using the legs to move forward (for example cycling, skateboarding or crawling)

The third part of the survey focuses on the interest of the participants to learn more about these strategies.


A fifth of respondents have never tried any form of compensation strategies, but most have tried at least one. The strategy most tried is to adapt to a new step pattern.

In general, nearly 65% ​​of respondents still use at least one strategy in daily life — mostly when walking outdoors or in time-stressful situations. The category most used was to change the balance requirement, followed by internal directions and changing the state of mind. Interestingly, external cues were the least used (only 55%).

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