Ten thousand steps and more. Gait disturbances are common in Parkinson’s disease. To overcome difficulties, patients use their imagination to find so-called compensation strategies.
The team of Dr Anouk Tosserams, from the Radboud University Medical Center in Nijmegen, the Netherlands, published, Wednesday September 8, in Neurology, the medical journal of the American Academy of Neurology, a study of 4,324 people with Parkinson’s disease – which affects around 200,000 people in France – and with disabling walking disorders, including imbalance and freezing, a brutal trampling which blocks the march. 52% of participants reported having had one or more falls during the year.
The survey describes seven ways of walking, using internal or external cues: walking while counting in your head; walk in rhythm with a metronome; change the balance requirement, for example by making wider turns; change mental state using relaxation techniques; watching another person walk; adopt a new walking pattern – for example jumping or walking backwards, as if the person had to climb or step over an obstacle virtually; using their legs in other ways, such as riding a bike or crawling.
But patients do not necessarily know them. The study found that 17% of those surveyed had never heard of any of the compensation strategies, and 23% had never tried any. About half of them had acquired this knowledge on their own. Yet three-quarters of people with Parkinson’s using these techniques said they had a positive effect, the study said. With a caveat: it depends on the context in which they were used, for example indoors or outdoors, under time pressure or not. And, above all, a technique may be suitable for one person but not for another.
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The same goes for Arlette Welaratne, clinical research associate at Pitié-Salpêtrière (AP-HP), who adapts to each patient and has been offering since 2017, with neurologist Emmanuel Flamand-Roze, dance-rhythm-therapy workshops. The rhythm of the dance also helps with walking. “For patients, it is a question of replacing automatic walking by a ‘thought’ walk, without performing a double task such as telephoning, taking a dish out of the oven by backing up, etc. “, recalls Arlette Welaratne.
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