A study analyzed the methods used by those with the disease to improve walking in an attempt to overcome the characteristic walking difficulties
Tremor is not the only symptom of Parkinson’s disease. Just looking at the motor problems are there too stiffness and slowness of movements that cause severe walking impairment with sudden episodes of so-called festination (small hasty steps) or the opposite of freezing (freezing of steps). To avoid falls and resulting injuries patients take special precautions: eg walk to the beat of the metronome used to sulfate the notes. Give yourself a rhythm that is always useful for them: for example, on the sidewalk they walk better if they follow the steps according to the separating lines of the edge tiles. With rhythmic music such as tango or Irish dance they even dance better than they walk.
Patients experiment on their own
It is common experience of doctors to observe how patients discover for themselves the most varied strategies to overcome their handicaps. Eg many raise their knees as if they were marching. Such a gait, said steppage, counteracts the tendency to fall forward, already noticed by James Parkinson (the doctor who first described, in the nineteenth century, the disease that bears his name, ed) when he said that the sick seemed to chase their shadow for the bent forward attitude they assumed. Only with special physiotherapy treatments for dynamic postural training Patients can learn to use the body’s sensory, visual or cochlear information of balance by obtaining proper spinal alignment.
An abnormal response
The motor system of the parkinsonian responds abnormally to sensory stimuli with consequent altered execution of voluntary movements, first of all the path that is affected by the deficit of internal body representation – he explains Alfredo Berardelli, since October president of the Italian Society of Neurology -. The length of the steps is reducing without the patient realizing it and disturbances of posture, balance and global motor skills emerge, with an increased risk of falls.
The seven strategies
No one had ever tried to systematize the endless array of compensatory strategies that patients around the world invent every day, but Dutch researchers at Radboud University in Nijmegen headed by Anouk Tosserans have published in the latest issue of Neurology a research on 4,324 patients with whom they have identified 7: mimic the steps of those who precede, walk backwards, count their steps, use the exercise bike, crawl, relax and turn around with sweeping curves. In addition to pointing out that neither patients nor doctors know them all, they have shown that one can be good for one person, but not for another. Their effectiveness then changes according to the context in which they are performed (at home or in the gym for example), as well as depending on sex, age, the time elapsed since the beginning of the disease and the presence of complications such as freezing and, above all, the ability to implement them: those who fail standing can obviously not make use of either a metronome or rhythmic sounds.
Help for all comes from the so-called Walking Device, prostheses for walking, such as walkers or quadripod crutches, which, by widening the support base, give greater mobility to the body’s center of gravity and extend the range of movements. They improve balance and mobility and reduce falls, thereby increasing self-confidence and a sense of security. The so-called ADLs, activities of daily living, that is daily activities: for those affected by Parkinson’s disease, in fact, just drinking a coffee while walking can be difficult because they cannot do two things together and the attention must always be focused on the steps.
A crucial role in reducing physical disability and improving the quality of life belongs to locomotor activities: outdoors exercises such as Nordic walking with sticks, in the gym on training on a treadmill or walking with axillary or pelvic anti-gravity support by means of special elastic braces hanging from the ceiling. Unfortunately a problem that has always frustrated the physiotherapists there failure of Parkinsonians to memorize what they have learned in the previous training session. A functional magnetic resonance imaging study by University of London researchers led by Adam Hampshire just posted on Brain Communication finally explains why. Especially in the early stages of the disease, patients have no short memory, but they are slow to learn new tasks, a discovery that confirms the need to repeat the exercises indefinitely as in the so-called MIRT protocol, an intensive treatment developed by Giuseppe Frazzitta of the hospital of Gravedona (Como). The Dutch researchers from Nijmegen recommend carefully evaluating the ability to learn instructions, always calibrating the exercises on the individual patient. In fact, when a subject creates himself the most suitable exercise for him, then he remembers it very well.
October 14, 2021 (change October 14, 2021 | 20:15)
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