Gait and Balance Challenges in Parkinson’s Disease

Parkinson’s disease (PD) affects millions of people worldwide, bringing with it a range of motor and non-motor symptoms that can impact daily life. One of the most noticeable and challenging motor symptoms is Parkinsonian gait—an abnormal walking pattern caused by the disease. 

At Plexus, we focus on providing holistic care that includes targeted physiotherapy and advanced rehabilitation techniques, designed to help patients overcome these difficulties and reclaim their mobility.

In this blog, we explore the nature of gait and balance problems in Parkinson’s, how they develop, and the wide range of available treatment approaches, particularly the comprehensive rehabilitation services offered at Plexus.

What is Parkinsonian Gait?

Parkinsonian gait refers to the distinct walking pattern commonly seen in individuals with Parkinson’s disease. This gait disturbance is characterized by a series of abnormal movements that make it difficult to walk naturally. Parkinson’s disease primarily affects the basal ganglia, the part of the brain responsible for controlling movement. When these structures don’t function properly due to the loss of dopamine-producing cells, patients develop motor symptoms like tremors, rigidity, and, in this case, gait disturbances.

What Does Parkinsonian Gait Look Like?

Gait disturbances in Parkinson’s disease are well-known and commonly experienced. Parkinson’s disease gait is marked by several key characteristics:

• Shuffling Walk: Many Parkinson’s patients take short, shuffling steps. This is primarily caused by muscle rigidity and the inability to fully extend the legs while walking.
• Freezing of Gait: Patients often experience episodes where their feet feel “stuck,” making it difficult to initiate or continue walking.
• Stooped Posture: Parkinson’s posture and gait are interconnected, with many patients adopting a stooped or forward-leaning posture, which disrupts their balance.
• Reduced Arm Swing: One of the hallmarks of Parkinson’s gait is a reduction in arm swing, contributing to a stiffened, unnatural walking pattern.
• Festinating Gait: This describes a tendency for people with Parkinson’s to unintentionally speed up their steps, often feeling as though they are chasing their own balance.

Each of these symptoms significantly impacts mobility, safety, and independence.

Gait Apraxia in Parkinson’s Disease

Gait apraxia is another critical concern for Parkinson’s patients. In essence, gait apraxia in Parkinson’s disease refers to the brain’s difficulty in properly coordinating walking movements. It is not only a physical challenge but also has a cognitive element—people with Parkinson’s may know they need to walk, but their brain struggles to send the right signals to their muscles to initiate or sustain movement. This often leads to freezing episodes, where the patient may be unable to take a step despite the desire to move.

What Are the Causes of Parkinsonian Gait?

Parkinsonian gait is caused by the progressive degeneration of neurons in the brain that produce dopamine, a chemical responsible for coordinating movement. The exact cause of this degeneration is unknown, but it results in motor control issues. Several factors contribute to gait disturbances in Parkinson’s disease:

• Muscle Rigidity: Stiff muscles, especially in the legs and trunk, limit range of motion and make it difficult to take large steps or move smoothly.

• Postural Instability: Over time, the disease can affect balance, leading to a forward-leaning posture that makes walking more awkward and dangerous.

• Bradykinesia (Slowness of Movement): People with Parkinson’s often experience a general slowness in initiating and executing movement, including walking.

• Neurological Freezing: Freezing of gait episodes occur when the brain has difficulty coordinating the body’s movement, causing patients to feel like they are stuck and unable to take a step.
• Cognitive Factors: Parkinson’s disease is not only a movement disorder but also impacts cognitive function, which can affect the brain’s ability to plan and execute complex tasks such as walking and turning.

Treatment Options for Parkinsonian Gait

Managing Parkinsonian gait involves a combination of therapies, medications, and lifestyle changes. Here are some of the most effective treatment options:

1. Medication: The most common treatment for Parkinson’s symptoms, including gait issues, is levodopa, a medication that helps replenish dopamine in the brain. Other drugs like dopamine agonists and MAO-B inhibitors may also be prescribed to manage symptoms.
2. Deep Brain Stimulation (DBS): For patients whose symptoms don’t respond well to medication, DBS may be recommended. This surgical procedure involves implanting a device in the brain that sends electrical impulses to stimulate the areas that control movement.
3. Physical Therapy: Physical therapists play a critical role in helping people with Parkinson’s improve their gait and mobility. They use specialized exercises, gait training, and techniques like cueing (using visual or auditory signals to help patients start walking) to improve movement.
4. Occupational Therapy: Occupational therapists help patients develop strategies to perform daily tasks more safely and efficiently, particularly activities that involve standing, walking, and navigating spaces.
5. Assistive Devices: Devices like canes, walkers, and mobility scooters may be recommended to enhance stability and prevent falls.
6. Speech Therapy: Speech therapists can help with communication and swallowing issues, but they may also assist with gait training by focusing on breathing and coordination, which can support better movement.

Gait Training in Parkinson’s Disease

One of the most effective treatments for gait disturbances in Parkinson’s disease is gait training. Gait training in Parkinson’s disease focuses on helping patients practice and relearn proper walking mechanics through repetitive movement exercises. At Plexus Neuro and Stem Cell Research Centre, our rehabilitation programs emphasize individualized gait training exercises for Parkinson’s patients, with a special focus on improving strength, coordination, and posture.

What Does Gait Training for Parkinson’s Patients involve?

Our gait training programs involve several components:

1. Physical Therapy: Our expert physiotherapists design personalized exercise programs that focus on improving muscle strength, flexibility, and coordination. For Parkinson’s patients, this may include exercises like treadmill walking, leg-strengthening routines, and balance exercises.
2. Balance and Posture Correction: A crucial part of gait training is addressing posture. At Plexus, we incorporate exercises that focus on correcting the forward-leaning posture and strengthening the muscles that help patients maintain their balance.
3. Advanced Rehabilitation Techniques: At Plexus, we use state-of-the-art technologies such as robotic-assisted devices and virtual reality to support gait training. These technologies allow patients to practice their walking patterns in a safe, controlled environment, which can accelerate recovery and improve outcomes.
4. Home Exercise Program: Gait training does not stop at the clinic. Our team provides patients with gait training exercises for Parkinson’s that they can continue practicing at home, including weight-shifting exercises, heel-to-toe walking, and stepping routines designed to improve foot clearance.

Exercises to Improve Gait in Parkinson’s Disease

Exercise is a crucial part of managing Parkinsonian gait. A well-designed exercise program can help improve flexibility, strength, balance, and coordination. Here are some effective gait training exercises for Parkinson’s patients:

1. Treadmill Walking: Treadmill walking allows patients to practice their gait in a controlled environment, helping to improve stride length and walking speed. It can also help with posture correction.
2. Weight Shifting Exercises: These exercises help patients regain balance and control. They involve shifting weight from one foot to the other while maintaining an upright posture. This can be practiced in standing positions or while walking.
3. Stepping in Different Directions: Practicing stepping forward, backward, and sideways can help patients improve foot clearance and mobility. This exercise also reduces the risk of freezing episodes.
4. Heel-To-Toe Walking: This simple exercise encourages better foot movement by having patients practice walking in a straight line while placing the heel of one foot directly in front of the toes of the other. This helps correct shuffling and festinating gait.
5. Leg Strengthening Exercises: Strengthening the muscles of the legs and hips is crucial for improving gait. Squats, leg presses, and seated leg lifts can help build muscle strength and endurance.
6. Balance Exercises: Exercises that challenge balance, such as standing on one leg or using a balance board, can help improve postural control and prevent falls.
7. Rhythmic Auditory Stimulation (RAS): RAS involves walking to the beat of a metronome or music with a steady rhythm. This technique helps patients maintain a consistent walking pace and reduces the likelihood of freezing episodes.

Physiotherapy at Plexus

Physiotherapy is one of the most crucial aspects of Parkinson’s rehabilitation, and at Plexus, we believe in a comprehensive approach. Our Parkinson’s rehabilitation programs include a blend of physiotherapy, balance training, and neurorehabilitation exercises.

Poor posture is a significant issue for Parkinson’s patients. At Plexus, our rehabilitation plans pay special attention to the interplay between posture and gait. The stooped, forward-leaning posture often seen in Parkinson’s disease increases the risk of falls and exacerbates gait problems. Our physiotherapists work closely with patients to correct posture issues, teaching them how to stand taller, shift their center of gravity, and walk more confidently.

By strengthening the muscles, improving flexibility, and retraining the brain and body to work in harmony, patients experience improved movement and reduced risks of falls. 

Emerging Treatment Options for Parkinson’s Gait

In addition to traditional physical therapy and gait training, Plexus is also a pioneer in incorporating advanced therapies into rehabilitation plans. These include:

• Stem Cell Therapy: Plexus is recognized for its cutting-edge stem cell therapies, which aim to repair damaged cells and promote neural regeneration. While still an emerging field, stem cell therapy holds great promise in improving mobility and reducing symptoms in Parkinson’s patients.
• Robotic Gait Training: This is a highly specialized treatment designed to help patients regain walking ability through guided, repetitive movements that help retrain the brain and muscles.
• Virtual Reality-Based Exercises: By using virtual reality technology, patients can practice walking and balance in a simulated environment that mimics real-world challenges, helping them build confidence and improve coordination.

At Plexus, we understand that the road to recovery from Parkinson’s disease can be difficult, but you don’t have to navigate it alone. Our compassionate team is dedicated to providing the highest level of care, with a focus on individualized treatment plans that cater to each patient’s specific needs. Whether it’s through advanced physiotherapy, innovative technologies, or our personalized Parkinson’s rehabilitation programs, our goal is to help patients regain their independence and improve their quality of life.

For more information on our Parkinson’s rehabilitation programs and physiotherapy services, contact Plexus Neuro and Stem Cell Research Centre today.

WhatsApp at +91 89048 42087 or contact us at +91 78159 64668 (Hyderabad) or +91 82299 99888 (Bangalore).

FAQs

How is balance affected in Parkinson’s disease?

Balance is often compromised in Parkinson’s disease due to the degeneration of neurons that control movement and posture. This leads to postural instability, making it difficult to maintain an upright stance and increasing the risk of falls.

What are the gait issues with Parkinson’s disease?

Gait issues in Parkinson’s include shuffling steps, reduced arm swing, freezing of gait (where movement suddenly stops), and festinating gait (involuntarily quick, short steps). These problems make walking unstable and unsafe.

How can I improve my gait with Parkinson’s?

Gait can be improved through exercises like heel-to-toe walking, balance training, and weight-shifting exercises. Gait training with a physical therapist, combined with rhythmic cues like music, can also enhance walking ability.

What stage of Parkinson’s is difficulty walking?

Difficulty walking typically becomes more pronounced in the mid-to-late stages (stage 3 or 4) of Parkinson’s disease, when balance and motor control significantly deteriorate, increasing the risk of falls.