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Movement Disorders
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Movement Disorders
Article . 2011 . Peer-reviewed
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Doorway‐provoked freezing of gait in Parkinson's disease

Authors: Dorothy Cowie; Patricia Limousin; Amy Peters; Marwan Hariz; Brian L. Day;

Doorway‐provoked freezing of gait in Parkinson's disease

Abstract

AbstractFreezing of gait in Parkinson's disease can be difficult to study in the laboratory. Here we investigate the use of a variable‐width doorway to provoke freeze behavior together with new objective methods to measure it. With this approach we compare the effects of anti‐parkinsonian treatments (medications and deep‐brain stimulation of the subthalamic nucleus) on freezing and other gait impairments. Ten “freezers” and 10 control participants were studied. Whole‐body kinematics were measured while participants walked at preferred speed in each of 4 doorway conditions (no door present, door width at 100%, 125%, and 150% of shoulder width) and in 4 treatment states (offmeds/offstim, offmeds/onstim, onmeds/offstim, onmeds/onstim). With no doorway, the Parkinson's group showed characteristic gait disturbances including slow speed, short steps, and variable step timing. Treatments improved these disturbances. The Parkinson's group slowed further at doorways by an amount inversely proportional to door width, suggesting a visuomotor dysfunction. This was not improved by either treatment alone. Finally, freeze‐like events were successfully provoked near the doorway and their prevalence significantly increased in narrower doorways. These were defined clinically and by 2 objective criteria that correlated well with clinical ratings. The risk of freeze‐like events was reduced by medication but not by deep‐brain stimulation. Freeze behavior can be provoked in a replicable experimental setting using the variable‐width doorway paradigm, and measured objectively using 2 definitions introduced here. The differential effects of medication and deep‐brain stimulation on the gait disturbances highlight the complexity of Parkinsonian gait disorders and their management. © 2011 Movement Disorder Society

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Keywords

Male, Analysis of Variance, Parkinson Disease, Walking, Middle Aged, Severity of Illness Index, Biomechanical Phenomena, Space Perception, Humans, Female, Freezing Reaction, Cataleptic, Gait Disorders, Neurologic, Size Perception, Aged

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    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
94
Top 1%
Top 10%
Top 10%
bronze