Summary: A large survey identifies seven compensation strategies that can help people with Parkinson’s disease manage walking and mobility problems, but many patients are unaware of these options.
Source: AAN
Many people with Parkinson’s disease experience difficulty walking, yet a new large survey shows that several effective compensation strategies remain unfamiliar to a substantial number of patients.
The research was published online on September 8, 2021, in the journal Neurology.
The study also found that the effectiveness of different compensation strategies varies depending on the situation—such as whether a person is indoors or outdoors, initiating gait or trying to stop, or under time pressure.
“We know people with Parkinson’s often invent creative ‘detours’ to cope with walking problems so they can stay mobile and independent,” said study author Anouk Tosserams, MD, of the Radboud University Medical Centre in Nijmegen, the Netherlands. “For example, people may walk to a steady beat, mimic another person’s gait, or count in their head. What we discovered is that most people are not taught the full range of available strategies. When they learn about more options, they often find methods that fit their needs and daily situations better.”
For this study, researchers surveyed 4,324 people with Parkinson’s who reported disabling gait impairments, such as imbalance, shuffling, falling, staggering and freezing of gait. Among respondents, 35% said walking difficulties interfered with their normal daily activities and 52% reported having one or more falls in the previous year.
The survey described seven main categories of compensation strategies and asked participants whether they were aware of each category, whether they had tried it, and how effective it had been across different real-world contexts. The seven categories were:
- Internal cueing: using an internal rhythm or counting in the head to guide steps.
- External cueing: using an outside rhythm, such as a metronome, to pace walking.
- Changing the balance requirement: altering turns or posture, for example by taking wider turns, to make walking easier.
- Altering mental state: using techniques such as relaxation or focused attention to change how walking feels.
- Action observation and motor imagery: watching another person walk or mentally rehearsing walking movements.
- Adopting a new walking pattern: deliberately changing gait mechanics, such as taking larger steps, hopping or walking backward.
- Other leg-based strategies: using alternative leg movements such as bicycling or crawling to maintain mobility.
Researchers found that while many people with Parkinson’s already use one or more compensation strategies, awareness of the full set of options was low. Seventeen percent of respondents reported they had never heard of any of the strategies described, and 23% said they had never tried any. Only 4% of participants were aware of all seven categories; on average, a person knew about three strategies.
Among the strategies (not including walking aids and alternative ambulatory activities), external cueing—such as walking to the beat of a metronome—was the most widely known, recognized by 47% of respondents. Internal cueing was known by 45%, while action observation and motor imagery was the least familiar, known by just 14%.
When people tried the strategies, most reported a benefit. For example, 76% of those who used techniques that changed balance requirements reported a positive effect, and 74% who altered their mental state reported improvements.
The survey highlighted how context influences success. Internal cueing showed high effectiveness for gait initiation, with a 73% reported success rate, but only 47% found it helpful when trying to stop walking. Similarly, visualizing movements had an 83% success rate outdoors, yet its success dropped to 55% when used to navigate narrow spaces.
“Our findings indicate that a ‘one-size-fits-all’ approach is unlikely to succeed because different situations call for different strategies and individual patients respond differently,” Tosserams said. “A practical next step is to educate people with Parkinson’s about the full range of compensation strategies—perhaps through a focused online educational platform—so each person can identify which techniques work best for their unique needs.”
A limitation of the study is that respondents self-reported their gait problems rather than undergoing an independent neurological assessment to confirm severity or diagnosis.
Funding: The study was supported by the Netherlands Organization for Health and Research Development.
About this Parkinson’s disease research news
Author: Amira Almujahid
Source: AAN
Contact: Amira Almujahid – AAN
Image: The image is in the public domain
Original Research: The findings will appear in Neurology