Walking strategies with Parkinson’s disease

Walking with Parkinson’s disease (PD), the challenges and the strategies employed to compensate for difficulties, to help contextualise the scientific knowledge base. Walking was invariably performed as an integral part of a purposeful activity within a specific context, termed walking ‘plus’, with challenges encountered by people with PD in three main areas: Undertaking tasks; negotiating environments; and making transitions to walking. The two key strategies to compensate for difficulties experienced were monitoring through the use of concentration, and correcting through generating rhythm and size of steps. Carers supported monitoring and correcting.

Problems like imbalance, shuffling, falling, staggering and freezing. Of the participants, 35 per cent found that their walking difficulties affected their ability to perform their usual daily activities and 52 per cent had one or more falls in the past year. The survey explained the seven main categories of compensation strategies. Each category was explained and participants were asked if they were aware of it if they’d ever used it, and if so, how it worked for them in a variety of contexts.

 

The majority of people who tried it said it had a positive effect. For example, 76 per cent said changing the balance requirement made a positive impact, while 74 per cent said altering their mental state did. However, researchers also discovered that strategies worked differently according to the context in which the person used them. Internal cueing, for example, seemed highly effective during gait initiation, with a 73 per cent success rate. Only 47 per cent found that tactic useful when trying to stop walking. Similarly, visualizing the movements had an 83 per cent success rate when people used it walking outdoors. It only had a 55 per cent success rate when people used it to navigate a narrow space.

People with PD need to constantly assess and drive their walking performance. Attentional resources, which can themselves be compromised in PD, were used to accomplish what is normally a largely automatic activity. Personal accounts support scientific hypotheses. Rehabilitation interventions and measurements in PD need to reflect both the physical and psychosocial context of everyday walking.

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We need to go a step further and teach people about all the available compensation strategies, for example through a dedicated online educational platform. This may help each person with Parkinson’s find the strategy that works best for them. This qualitative study was designed to explore the personal experience of everyday walking with Parkinson’s disease (PD), the challenges and the strategies employed to compensate for difficulties, to help contextualise the scientific knowledge base.

The majority of respondents who tried each method believed it had a favourable impact. Changing the balancing criterion, for example, had a favourable influence on 76% of respondents, while changing their emotional state had a positive impact on 74%. Researchers discovered that techniques operated differently depending on the environment in which they were deployed. Internal cueing appeared to be extremely effective during gait beginning, with a success rate of 73%.

Parkinson’s commonly use walking compensation strategies, but are not aware of all seven strategies. For example, 17 per cent of the people had never heard of any of these strategies, and 23 per cent had never tried any of them. Only 4% were aware of all seven categories of compensation strategies. A limitation of the study is that people reported their own gait disability, which was not confirmed by an independent neurological examination.

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