The parkinsonian or feast gait is a typical gait seen in late-stage Parkinson's disease. Festinante comes from the Latin “festinare” which means fast or fast.
It is characterized by a shortening of the steps and an acceleration of these. This form of walking can be harmful as it may interfere with daily activities, such as work or physical exercise.
Parkinsonian gait can be an important indicator of Parkinson's disease. This disorder is neurodegenerative, which means that it gradually damages various brain regions. It is usually associated with rigidity and tremors, although it produces more affectations. For example, dementia, cognitive impairment, depression, sleep problems, etc.
Parkinson's disease is accompanied by a deficit of dopamine in motor circuits of the brain. Specifically, the dopaminergic neurons of the substantia nigra degenerate. Actually, these neurons participate in other processes besides voluntary movement. Like attention, memory, the feeling of reward, humor, etc.
The main treatment for parkinsonian gait is physical therapy and care strategies.
characteristics
One of the most notable symptoms of Parkinson's is parkinsonian gait, which has the following characteristics:
- Difficulties in starting the march or interrupting it once it has started.
- When starting to walk, the trunk is bent forward, the knees are slightly bent as are the hips and the elbows semi-flexed.
- The steps are very short and fast, resembling a kind of trot that increases as you walk. If you don't stop, you may fall. It is also observed that they are dragging their feet.
- In general, movement is as slow as possible (hypokinesia), and can reach a complete loss of movement in severe cases (which is known as akinesia).
- In parkinsonian gait, significant stiffness of the limbs is observed, since there is muscular hypertonia, that is, high muscle tone.
- In normal gait the heel is placed on the ground first than the toes. However, in Parkinsonian gait the entire foot is placed on the ground at the same time.
It is also possible that in more advanced stages of the disease the toes are placed first and then the heel. However, this is less common.
On the other hand, these patients have decreased foot elevation during the swing phase of gait.
As the disease progresses, the heel is supported less and less. In addition, they tend to bear the load in the forefoot, accompanied by changes in the load towards the medial areas of the foot.
This change in body load helps them compensate for the imbalance that this gait produces.
- Healthy people tend to show great variability in the tread pattern. However, Parkinson's patients have remarkably similar gaits.
- Gait block: this is a short-lived episode (less than a minute) in which gait stops and the patient feels that their feet are glued to the ground. After that time, they make a few hesitant movements before resuming their march.
The gait block usually appears when the patient must walk through narrow spaces such as through a door. It also appears in situations where the person has to react quickly, such as when the doorbell or telephone rings.
However, as the disease progresses, this blockage can appear in any context.
- Falls: they are not very common in the early stages of Parkinson's, but they become more frequent as the disease progresses. They arise, above all, from sudden changes in posture such as the turning of the trunk.
They also appear when trying to carry out a task simultaneously while walking. They are also common when getting up or sitting down. The falls are usually forward by approximately 45% and laterally by 20%.
- In severe stages of Parkinson's disease, posture instability may be observed. Thus, the patient can no longer maintain balance during daily activities such as walking, standing or sitting. This is due to a lack of flexibility due to muscle stiffness.
- The patient seems to have no control over his gait and may feel exhausted since it is an inefficient way of walking.
Treatment of parkinsonian gait
The best way to treat parkinsonian gait is by intervening in the underlying condition, that is, in Parkinson's disease. However, this disorder has no cure, but there are ways to reduce the discomfort and alleviate the symptoms of this condition.
L-DOPA treatment is often used to increase brain dopamine levels. However, it has diverse effects on the go. For example, this drug does not change the length of the stride or its speed, although it decreases the frequency of gait block and falls.
On the other hand, L-DOPA increases postural sway, which is why this drug is not highly recommended for reducing parkinsonian gait.
The best treatment is physical therapy (physiotherapy) which, through specific exercises, is taught to improve gait and reduce hypertonicity.
Professionals can also use visual or auditory cues to help patients improve their gait. For example, you can draw lines on the ground to increase your stride length.
On the other hand, auditory signals are usually rhythmic sounds produced by a metronome that help the patient maintain a regular gait, without acceleration.
Attention strategies in which the patient is taught to focus on his own steps are also widely used.
Another treatment that has been shown to be effective is deep brain stimulation. This consists of implanting an electrode inside the brain of the patient. Specifically, in the peduncle-pontine nucleus, which participates in motor planning. While if it is done in the subthalamic nucleus, it reduces the long-term blockade of the march.
References
- festinating gait. (sf). Retrieved on April 10, 2017, from Drugs: drugs.com.
- Festinating Gait. (sf). Retrieved on April 10, 2017, from Disease Pictures: diseasespictures.com.
- FESTINATION. (sf). Retrieved on April 10, 2017, from Parkinsons: parkinsons.org.uk.
- Parkinsonian and festive gait. (sf). Retrieved on April 10, 2017, from Neurowikia: neurowikia.es.
- Parkinsonian gait. (sf). Retrieved on April 10, 2017, from Wikipedia: en.wikipedia.org.
- Parkinson's Disease. (sf). Retrieved on April 10, 2017, from NIH Senior Health: nihseniorhealth.gov.