Freezing

You’re most likely to freeze when you’re walking, as walking is a series of individual movements that happen in a particular order. If one part of the sequence is interrupted, the whole movement can come to a stop.

Freezing is common when:

• you’re walking towards doorways, chairs or around obstacles
• you’re turning or changing direction
• you’re distracted by another task when you’re walking, and the ‘flow’ of walking is interrupted by an object, someone talking or if something else draws your attention
• you’re in a crowded place.

All of these will interrupt and stop you being able to keep a rhythm going.

Usually, the length of the steps we take changes when walking from smooth to uneven ground. If you have Parkinson’s you may find it difficult to make these changes automatically.

For example, you may be able to walk without a problem on uneven surfaces, but freeze when the floor is smoother or has a patterned surface. Or, the opposite might happen. You may find your walking pattern gets out of control and your steps get smaller and smaller. Many people who experience freezing are surprised that they have no problems going up or down stairs, but might freeze as soon as they are back on flat ground.

Not everyone with Parkinson’s experiences freezing. Freezing sometimes happens in the early stages of being diagnosed with the condition. In particular it can happen to people who don’t take medication for their condition straight away.

But it’s more likely to happen if you’ve had Parkinson’s for some time, and if you’ve been taking levodopa for a number of years. This is because after a while, you may have a milder response to levodopa.

No. Some people with Parkinson’s have ‘on’ and ‘off’ periods. Being ‘on’ is when a person’s symptoms are controlled, while being ‘off’ is when Parkinson’s symptoms come back and are difficult to manage.

Going from one to the other can happen very quickly. Some people have described it as like a light switch being turned on and off. Going ‘off’ can be a sign that your levodopa medication isn’t working as well as before.

Being ‘on’ or ‘off’ is different from freezing. People with Parkinson’s have told us that during ‘off’ periods, they might not be able to move at all, so walking, going up stairs or reaching for a cup will be very difficult. But when they freeze, it only affects certain movements or parts of their body. So, you might not be able to walk, but you might still be able to reach for an object. Be careful if this happens to you. If your feet freeze and you try to reach for support too far away, you may overbalance and fall.

There are different ways of managing freezing and ‘on' and 'off’ swings, so your specialist or Parkinson’s nurse should treat them as separate problems.

Freezing or shuffling can affect your balance and make you more likely to fall over.

Take care with activities such as walking along the side of waterways and crossing busy roads. Swimming may also be difficult if you experience freezing. Some people have told us they avoid using escalators or automatic walk-ways, for example in shopping centres, train stations and airports. You may find it helpful to have someone with you when doing these activities, where possible.

Speak to your GP, specialist or Parkinson’s nurse about the best treatment for your freezing. They can also refer you for therapy that may help. Treatments include:

Drugs

If you tend to freeze during ‘off’ periods, changes to the type and timing of your medication may help you ‘switch off’ less often. Talk to your specialist or Parkinson’s nurse about any changes to your medication. Don’t suddenly stop taking your medication as this can be dangerous.

When freezing happens during ‘on’ periods, or if it’s nothing to do with the change between ‘on’ and ‘off’ periods, this usually can’t be treated with Parkinson’s drugs.

Occupational therapy

An occupational therapist is a health professional who helps people be as independent as possible. They look at your everyday activities and can give advice on making your home or workplace safer or easier to manage. This may include showing you easier ways to do a task or activity such as getting in and out of bed. They can also give advice about aids or equipment to make doing things easier and safer.

An occupational therapist can help you find specific ways to move more easily around your home in areas that can cause you to freeze. They can also help you find ways to manage a freezing episode in other situations. If you have difficulties organising day-to-day life, or feel very anxious, an occupational therapist can help you learn techniques to manage these concerns.

Physiotherapy

If you freeze in a position where you’re stooped forward with your knees bent, heels off the ground and head forward, you’re more likely to fall, as the reflex that helps you keep your balance doesn’t work so well. The more you try to move your feet, the more unsteady you may become, making it more likely you’ll fall.

A physiotherapist can help you with techniques to reduce your risk of falling and hurting yourself when you freeze. These include exercises to strengthen the muscles that keep you upright (such as your leg muscles) and improve your posture and the way you walk. Examples include:

• learning to put your heel down first when you walk, as this will help you stay steady
• learning to deal with doing 2 things at the same time (like carrying something while walking) and making sure you know where to focus your attention
• straightening your body into a posture that will make you more stable
• learning to move your weight to one side ready to step forward with the opposite leg
• using different ‘cues’ (things you can do to encourage a movement to restart)
• learning to control your freezing in a variety of places and situations, so your memory will be triggered more quickly in real-life situations. Practising in areas of your home where you usually freeze can be particularly useful.

Your physiotherapist can also give you advice on walking aids. It’s important to get professional advice because if you don’t choose the right one, they might make freezing worse rather than better. Some walking aids, such as Zimmer frames, aren’t always recommended for people with Parkinson’s, so speak to a professional before you use one.

Many people with Parkinson’s walk better without any aids, but only once they’ve learned movement skills to manage the problem.

Surgery

Deep brain stimulation is a type of surgery that can help some people with Parkinson’s.

It’s not suitable for everyone, but some people find it helps their freezing.

A tendency to freeze won’t disappear, but you can improve control over your freezing by using a range of strategies. There is a wide range of techniques that use a specific strategy or a ‘cue’ to trigger your movement once you’ve frozen. Knowing these will help you to deal with freezing, may reduce any worries you have when it happens and will help you take control. We’ve listed some methods below that have been recommended by occupational therapists and physiotherapists with experience of working with people with Parkinson’s.

Remember that different methods may work in different situations and at different times during your condition. So, try a few things to find out which strategies work best for you and use them to restart your movement. Many of the methods can also help you swallow food and drink too if this doesn’t happen automatically. You may even find ways to reduce or avoid freezing altogether.

What to do when you freeze or can’t get started

If a movement isn’t flowing well, making the effort to think about each separate part of a familiar or simple movement can help you get going.

If your feet freeze you may fall over so make sure that any family, friends and carers know about your freezing and know how to help when it happens.

The first thing to do when you feel yourself freeze is to stop moving or slow down. This gives you time to refocus on balance, think about your next move and prepare your body to start again, which can reduce any risk of falling.

The plan method

Try the following:

• STOP: calm yourself and take a breath.
• THINK: what do you want to do?
• PLAN: how are you going to do it?
• DO: complete the task or movement.

The weight shift method

• When you freeze, don’t try to move forward straight away. Instead, gently move most of your weight to one leg (this is what normally happens when you go to walk). Shifting your weight to your one supporting leg like this will let you step forward with the opposite foot. To help with this count ‘1, 2, 3, step’ or say ‘ready, steady, go’ to yourself to get moving again.
• You may be able to restart walking again by gently rocking your head and shoulders from side
  to side. This rocking can help you shift your body weight to your supporting leg.
• It may help to say something to yourself as you do this, like ‘move my weight to left leg, then step with right’ (or vice versa). You may have to rock from leg to leg to release the weight on each foot before stepping off.

Sound and vision cueing methods

Using counting, sound or a rhythm can often help, for example:

• Walk on the spot to keep the stepping rhythm going, such as when you stop to open a door.
• Decide after freezing and pausing which foot you’re going to step with first, then step forward after saying something like ‘1, 2, 3, step’ or ‘ready, steady, go’. You can say this out loud or silently to yourself. If you have someone with you when you freeze, they could say this for you.
• If an area causes you to freeze, using rhythm might help you pass through a ‘trouble spot’ without a problem. You could sing or hum a tune as you walk (in your mind or out loud). Count your steps from 1 to 10 (start counting again when you get to 10), or say out loud, ‘one, two, one, two, one, two’ or ‘left, right, left, right, left, right’. This sort of method helps keep a rhythm going and can reduce freezing in doorways.
• Say a ‘trigger’ word silently to yourself such as ‘step’, ‘go’ or ‘swallow’ to restart walking or to swallow food or drink.
• If freezing is a frequent problem, you could download music onto your smartphone, so you can listen to it as you walk, to help prevent freezing.
• Use a metronome to restart your walking. A metronome is a device used by musicians. It produces a regular tick or beat that helps them keep to a rhythm. You can find them easily online or in musical instrument shops. Check you can use the small control buttons before you buy one.

Using your imagination

If you find it hard to start a movement, try doing the action in your mind first. Try to imagine or remember doing the action in detail, without any movement difficulties. Thinking about actions in this way is sometimes called ‘mental rehearsal’. Sports people and musicians often use this technique.

Some people have told us they freeze in busy places, such as supermarkets, stations, social events or town centres. If this happens, learn to give yourself time to stop, look and plan your route at regular points.

You can try the following:

• Step to one side, out of the main flow of other people, and if possible touch something solid like a wall to help your balance.
• Look at the area ahead of you, checking for anything in the way, such as boxes, other people, benches, street lights or trolleys.
• Decide the exact route you’ll take, or guess the number of steps you’ll need, before walking towards that point.

Repeat this method of pause, look, plan and walk as often as you need to. Or, if you have guessed the number of steps, start counting them and aim to be at your destination by the number of steps you have guessed.

If none of these methods work and you urgently need to start moving again after freezing, try gently bending your knees and walking on in that position.