Podcast: Freezing, moving and cueing – understanding gait and Parkinson’s disease


Author: Sarah McGrathPublished: 26 May 2022

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A composite image of Martina Mancini and David Little.

In this episode of the multi-award-winning Parkinson’s Life podcast, a Parkinson’s expert and a person with the condition discuss why gait impairment can “profoundly affect everyday life” – and how to manage the symptom

56-year-old David Little from Carlisle, UK, was once a firefighter – but when he was diagnosed with Parkinson’s in 2005, his life changed. “I didn’t realise anything was going to be a problem,” he reflects. “Nobody ever tells you these things.”

David started experiencing slowness, muscle stiffness and freezing – all indicators of gait impairment, a common symptom of Parkinson’s – and had to leave his job.

Now a volunteer for a charity that supports unpaid carers, David joined the Parkinson’s Life podcast to share his experience with Dr Martina Mancini from Italy.

Martina, who is an assistant professor in the department of neurology at the Oregon Health & Science University, Portland, US, says she was struck early in her career by “the gait impairments that people with Parkinson’s may experience – and that, paired together with a willingness to help improve patients’ daily life, got me very interested in Parkinson’s research”.

The impact of gait impairment

So what causes gait impairment – and how can it affect people with Parkinson’s?

“That’s a very complex question,” says Martina. “The mechanism of gait problems in Parkinson’s are still not completely understood, and studies have suggested that it is not one area in the brain causing gait problems, but multiple areas.”

She notes that gait problems may worsen as the condition progresses, and that “reduction in stride length, variability in upper body movement and reduction in arm swing” can all be impacted.

“Gait problems profoundly affect everyday life,” she says, “because they might cause a major burden and affect independence.”

An image of Dr Martina Mancini.

Dr Martina Mancini in Oregon.

This is something that resonates with David, who says the experience can be “frustrating”.

“Suddenly, you feel as if you can’t move your feet because they’re glued to the floor – and the more you try to move, the worse it gets,” he says. “I’ve been accused of being drunk in public places.”

Managing symptoms

Thankfully for David and others like him, there are treatments designed to help people experiencing these symptoms.

Martina’s work has involved research on ‘cueing’, for instance, which is “defined as the use of external stimuli, such as audio, visual or tactile stimuli, to facilitate movement”. Cueing can take various forms – from the “beat of a metronome” to a “visual line in the floor” to help guide stride length.

Cueing with wearable devices – that is, non-invasive electronic devices worn on the body – can help to address gait problems, says Martina. “With wearable technology, we can really push forward and try to identify freezing episodes during daily life.”

There are also actions people can take at home, and tactics to help with freezing episodes. David’s advice? “Exercise, exercise, exercise.”

“I practise quite a bit of yoga and tai chi, which helps me move more smoothly and concentrate on other movements – meaning I take control of my movements rather tha Parkinson’s controlling it.”

An image of David Little and his wife, Helen.

David Little with his wife, Helen.

This podcast was funded by Charco Neurotech, the company behind CUE1 – a wearable medical device designed to help alleviate gait impairment and support movement in people with Parkinson’s.

Read more:

Podcast: Getting involved in Parkinson’s disease research

Could a wearable device help ease Parkinson’s disease symptoms?

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