Freezing of Gait in Parkinson's Disease

Its Pathophysiology and Pragmatic Approaches to Management

Research output: Contribution to journalReview ArticleOtherpeer-review

Abstract

Background
Freezing of gait (FOG) in Parkinson's disease (PD) is poorly understood; however, with the established understanding of basal ganglia function, its manifestations should be more easily interpretable. This review examines freezing of gait (FOG) from such a perspective.

Methods
A search of the MEDLINE and EMBASE databases from the year 2000 onward for review articles, focused on the pathophysiology of FOG, was used to determine current concepts. A previously established model of basal ganglia function was used to determine the concepts' validities. At the core of the model are deficits in motor set maintenance and timing cue production for automatic movement. It includes the shift between attention and automation to the predominant attention control of gait in PD.

Results
The difficulties of the found concepts to explain FOG stem from failure to characterize different FOG components, from the assumption that all components share a similar pathophysiology, from a failure to separate basic deficits from compensatory mechanisms, and from the assumption that cognitive deficits are the cause of FOG rather than representing an inadequate compensation to FOG. Pragmatic approaches to management use the attention shift, with the provision of visual information about correct amplitude of step to correct initiation deficits, and motor blocks during gait. It also emphasizes the need to prevent step length reduction on turns, environmental situations, and cognitive overload.

Conclusion
The concept of automatic deficits in set maintenance and cue production best describe FOG manifestations in PD and, with the use of attention, the concept also provides pragmatic strategies for management.
Original languageEnglish
Pages (from-to)290-297
Number of pages8
JournalMovement Disorders
Volume4
Issue number3
DOIs
Publication statusPublished - May 2017

Cite this

@article{2f293c266e3245d29406eb5f3ede46a4,
title = "Freezing of Gait in Parkinson's Disease: Its Pathophysiology and Pragmatic Approaches to Management",
abstract = "BackgroundFreezing of gait (FOG) in Parkinson's disease (PD) is poorly understood; however, with the established understanding of basal ganglia function, its manifestations should be more easily interpretable. This review examines freezing of gait (FOG) from such a perspective.MethodsA search of the MEDLINE and EMBASE databases from the year 2000 onward for review articles, focused on the pathophysiology of FOG, was used to determine current concepts. A previously established model of basal ganglia function was used to determine the concepts' validities. At the core of the model are deficits in motor set maintenance and timing cue production for automatic movement. It includes the shift between attention and automation to the predominant attention control of gait in PD.ResultsThe difficulties of the found concepts to explain FOG stem from failure to characterize different FOG components, from the assumption that all components share a similar pathophysiology, from a failure to separate basic deficits from compensatory mechanisms, and from the assumption that cognitive deficits are the cause of FOG rather than representing an inadequate compensation to FOG. Pragmatic approaches to management use the attention shift, with the provision of visual information about correct amplitude of step to correct initiation deficits, and motor blocks during gait. It also emphasizes the need to prevent step length reduction on turns, environmental situations, and cognitive overload.ConclusionThe concept of automatic deficits in set maintenance and cue production best describe FOG manifestations in PD and, with the use of attention, the concept also provides pragmatic strategies for management.",
author = "Robert Iansek and Mary Danoudis",
year = "2017",
month = "5",
doi = "10.1002/mdc3.12463",
language = "English",
volume = "4",
pages = "290--297",
journal = "Movement Disorders",
issn = "0885-3185",
publisher = "Wiley-Blackwell",
number = "3",

}

Freezing of Gait in Parkinson's Disease : Its Pathophysiology and Pragmatic Approaches to Management. / Iansek, Robert; Danoudis, Mary.

In: Movement Disorders, Vol. 4, No. 3, 05.2017, p. 290-297.

Research output: Contribution to journalReview ArticleOtherpeer-review

TY - JOUR

T1 - Freezing of Gait in Parkinson's Disease

T2 - Its Pathophysiology and Pragmatic Approaches to Management

AU - Iansek, Robert

AU - Danoudis, Mary

PY - 2017/5

Y1 - 2017/5

N2 - BackgroundFreezing of gait (FOG) in Parkinson's disease (PD) is poorly understood; however, with the established understanding of basal ganglia function, its manifestations should be more easily interpretable. This review examines freezing of gait (FOG) from such a perspective.MethodsA search of the MEDLINE and EMBASE databases from the year 2000 onward for review articles, focused on the pathophysiology of FOG, was used to determine current concepts. A previously established model of basal ganglia function was used to determine the concepts' validities. At the core of the model are deficits in motor set maintenance and timing cue production for automatic movement. It includes the shift between attention and automation to the predominant attention control of gait in PD.ResultsThe difficulties of the found concepts to explain FOG stem from failure to characterize different FOG components, from the assumption that all components share a similar pathophysiology, from a failure to separate basic deficits from compensatory mechanisms, and from the assumption that cognitive deficits are the cause of FOG rather than representing an inadequate compensation to FOG. Pragmatic approaches to management use the attention shift, with the provision of visual information about correct amplitude of step to correct initiation deficits, and motor blocks during gait. It also emphasizes the need to prevent step length reduction on turns, environmental situations, and cognitive overload.ConclusionThe concept of automatic deficits in set maintenance and cue production best describe FOG manifestations in PD and, with the use of attention, the concept also provides pragmatic strategies for management.

AB - BackgroundFreezing of gait (FOG) in Parkinson's disease (PD) is poorly understood; however, with the established understanding of basal ganglia function, its manifestations should be more easily interpretable. This review examines freezing of gait (FOG) from such a perspective.MethodsA search of the MEDLINE and EMBASE databases from the year 2000 onward for review articles, focused on the pathophysiology of FOG, was used to determine current concepts. A previously established model of basal ganglia function was used to determine the concepts' validities. At the core of the model are deficits in motor set maintenance and timing cue production for automatic movement. It includes the shift between attention and automation to the predominant attention control of gait in PD.ResultsThe difficulties of the found concepts to explain FOG stem from failure to characterize different FOG components, from the assumption that all components share a similar pathophysiology, from a failure to separate basic deficits from compensatory mechanisms, and from the assumption that cognitive deficits are the cause of FOG rather than representing an inadequate compensation to FOG. Pragmatic approaches to management use the attention shift, with the provision of visual information about correct amplitude of step to correct initiation deficits, and motor blocks during gait. It also emphasizes the need to prevent step length reduction on turns, environmental situations, and cognitive overload.ConclusionThe concept of automatic deficits in set maintenance and cue production best describe FOG manifestations in PD and, with the use of attention, the concept also provides pragmatic strategies for management.

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DO - 10.1002/mdc3.12463

M3 - Review Article

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SP - 290

EP - 297

JO - Movement Disorders

JF - Movement Disorders

SN - 0885-3185

IS - 3

ER -