Why lines on the ground break freezes.

It is commonly known that visual cues like lines on the ground help break freezing episodes for pwp.  It also thought that perhaps the reason for this is that visual cues like lines causes the brain to by pass the faulty regions of the brain and causes the brain to use an alternative route to break the freeze. I don’t think  this is the case ,  looking some of the video footages on youtube where pwp use a laser pointer or a line on drawn I have noticed that what happens is really a change in the way pwp take a step.

According to my reasoning a  person freezes because the person cannot  push  their foot off the ground. However when they come across a line on the ground they change the way they take a step. Instead of pushing their foot off the ground, they lift their foot off the ground to step over the line. A pwp does not appear to have problems lifting their foot off the ground,   that’s why stepping over a line helps break the freeze.   It a change in the way they take a step.

The Moon Walk

The Moon walk is more of dance move than and actual type of walk. It is an illusion created to look like you are trying to walk forward but you are being pulled backwards. The overall effect is of one gliding backwards while walking forward.  It was popularised by Michael Jackson.

Technique (Wikipedia)
"An illusion is involved in creating the appearance of the dancer gliding backwards. Initially, the front foot is held flat on the ground, while the back foot is in a tiptoe position. The flat front foot remains on the ground but is slid lightly and smoothly backward past the tip-toe back foot. What is now the front foot is lowered flat, while the back foot is raised into the tiptoe position. These steps are repeated over and over creating the illusion that the dancer is being pulled backwards by an unseen force while trying to walk forward. Variations of this move allow the moon walking to also appear to glide forwards, sideways, and even in a circle."

When adapted this move can be very useful and helpful  for pwp who have freezing of gait. People with freezing of gait have massive difficulties stepping backwards. The tendency is to lose their balance and fall backwards. For people having problems with FOG I do not recommend stepping  backwards  because it can be very dangerous. But if for any reason at all you need to step backwards this method may help.

How it works.
Slide your foot backwards instead of stepping backwards. This way both your feet are always in contact with the ground thus minimising the chances of losing your balance. If you are trying this remember to keep safe.

The Tai Chi Step.

This step  which I call the tai chi  step is another useful way to move forward. Often used in martial arts this is a very stable way of moving your feet forward.

1. rest your body weight on one foot and keeping balance on ths foot
2. using your knee to lift the other foot , gently glide your foot forward in a semicircular arc.

The movement is done slowly and evenly , and balance is always maintained. The trick is in resting your entire weight in one foot. This frees up the other foot to do almost anything. e.g. glide forward, kick etc.

 

How my brain thinks about walking.

I have made some observations and realised that one of the main contributions to Freezing of Gait (apart from the lack of dopamine) has to do with how the mind thinks about walking. I have observed that my  brain seems to operate on two modes. The first mode which I will refer to as the “normal” mode. In this mode,  the brain uses a pathway which is a combination of voluntary and involuntary to signal the feet. The mind is on normal mode when we are relaxed and calm.

The second mode is a “flight mode”, where the brain completely relies on the involuntary part to control leg movements.  The mind goes into this mode whenever we sense danger or panic or reacting to situation which requires quick response.  It is usually a seamless transition  but because Pwp do not have involuntary control of their feet, problems occur. When it goes into this mode, the mind completely loses it’s connection with the feet  and therefore freezing occurs. What happens is I lose the feelings of my legs. That is why I freeze when I see a car coming, or when I hear a loud noise or when I crossing roads where cars are waiting for me to cross.  All these situations  cause me to panic and  my mind responds by switching into flight mode to get me out quickly. Instead of getting out quickly … I am unable to move.

Once the mind gets into flight mode it is quite hard to get it back into normal mode. I need to stop everything  I am doing and try to calm myself down. Take deep breaths and try to relax. Sometimes it takes a minute to calm down.

So it is better to prevent the mind from switching into flight mode than trying to calm myself down after it has gone into flight mode.  To prevent this from happening I do a number of things:

      a.       Try to keep calm at all times

      b.      Try not rush to get somewhere

      c.       Give myself plenty of time by planning ahead

      d.      If I feel a panic attack coming on, slow down my  walking instead of wanting to rush (it’s the opposite reaction so need to train myself to do this). Take deep breaths as I walk. Helps calm things down.

      e.      As long as I keep myself calm and relaxed I can walk anywhere without freezing.

The slow march.

I learnt this while I was at school as part of the school cadets band. It is an interesting march because it looks quite smart but it doesn't get you anywhere quickly. We mostly see it in a bridal procession during  a wedding but most people don't know how to do it correctly thinking that it is just a normal walk only done very slowly. It has a distinct motion to it and when done properly actually has a very nice feel to it.  The military bands perform this march with precision and accuracy making a thing of beauty.  It has two dinstinct steps :

Walking on air : Solution for Freezing of Gait

Changing the way we think about walking.

The solution is to simplify the way we think about walking. Instead of using our feet as springs and having to push them off the ground,  just swing or slide them forward to take a step. This removes the need to push off the ground.

To try this, just stand normally with your feet slightly apart.  To take your first step, just slide one foot gently outward.Then shift your weight onto the front foot and slide the other foot out. So instead of pushing your foot off the ground , it is just a gentle slide forward.

It is like the slow bridal march in a wedding procession. 

It will feel like walking on air or like gliding accross the floor. It will feel like a lot less effort but not a natural way to walk.  

What really happens when we walk?

How we normally walk.

We use our feet as springs by pushing them down to push them off the ground. When we walk we feel the ground pushing back on our feet. This is the feedback we look for and rely on when we take steps consciously. It’s the feedback of  the ground pushing back on our feet that provides the spring in our step.

When we walk we don't actually lift our feet up instead we push them off the ground so it does not really help to tell someone who has freezing to lift their feet higher when they walk unless they change the way they think about walking. The first instinct is to push our feet down so that we can take a step. This is where the problem starts.

What causes freezing and shuffling?

When freezing of gait happens, PWP often say that it feels like their feet are glued to the ground. This is a good description of fog. It is the pushing down on the foot that is affected most by Parkinson's Disease. I  cannot feel my feet. So when I want to walk, my mind is unconsciously telling  my feet to push down on the ground to take a step. Experientially I am just taking a step, but what really is happening, I am pushing my feet down on the ground but it is so weak that it is not enough to push off the ground. So the feet feels like they are glued to the ground. 

Similarly, shuffling occurs  when the ability to push off has been significantly reduced and is not enough to clear the ground. So the steps we take are shorter because we aren’t able to push the feet off higher from the ground.

This ability to push the feet off the ground is also interrupted when some stimulus is present like a doorway appears, or interruptions or when a pwp has to multitask.    

This is key to understanding why  freezing occurs and why the solution works.