Parkinson’s disease is a progressive neurodegenerative disorder that affects movement. As Parkinson’s progresses, walking can become increasingly challenging. However, with treatment and lifestyle adjustments, most people with Parkinson’s can continue walking for many years after diagnosis.
What causes walking problems in Parkinson’s?
Parkinson’s disease is caused by low levels of dopamine in the brain. Dopamine helps transmit signals between the brain and muscles to produce smooth, purposeful movements. As dopamine levels fall, communication between the brain and muscles breaks down, leading to Parkinson’s motor symptoms like:
- Tremor – Shaking or trembling, especially in the hands.
- Rigidity – Stiffness and resistance to movement.
- Bradykinesia – Slowed movement and loss of spontaneous movement.
- Postural instability – Impaired balance and coordination.
These motor symptoms can make walking more difficult. Some specific walking problems seen in Parkinson’s include:
- Shuffling gait – Taking small, shuffling steps without lifting the feet properly.
- Freezing – Brief episodes where feet seem “glued” to the floor.
- Festination – Hurried gait with increasingly small, rapid steps that can lead to falling.
- Loss of arm swing – Reduced arm movement while walking.
- Stooped posture – Leaning or bending forward while walking.
- Turning problems – Difficulty with balance and coordination when turning.
Can Parkinson’s make you unable to walk?
In the early stages of Parkinson’s, walking ability is usually preserved or only mildly affected. However, as Parkinson’s progresses to more advanced stages, significant walking impairments can develop that may lead to an inability to walk independently.
Factors that can make independent walking impossible in advanced Parkinson’s include:
- Severe freezing episodes
- Frequent falls due to balance problems
- Extreme slowness of movement (bradykinesia)
- Overwhelming muscle rigidity
- Orthostatic hypotension – Low blood pressure on standing that causes dizziness.
Being wheelchair-bound or bedridden due to Parkinson’s walking problems is relatively uncommon and more likely to occur in late-stage Parkinson’s or with other underlying medical conditions. With appropriate treatment, most people with Parkinson’s can maintain the ability to walk even into advanced stages.
What treatments help with Parkinson’s walking problems?
The main treatments that help manage Parkinson’s walking and mobility issues include:
- Medications: Dopaminergic drugs like levodopa can minimize Parkinson’s symptoms. Other medications may also be used to treat rigidity, dyskinesia, and orthostatic hypotension.
- Deep brain stimulation: DBS delivers electrical impulses to parts of the brain involved in motor control. This can reduce motor fluctuations and dyskinesia.
- Physical therapy: PT aims to improve strength, balance, flexibility and gait. Strategies like cueing, treadmill training, and assisted walking devices may be used.
- Occupational therapy: OT helps maintain independence in daily activities through assistive equipment, home modifications, and safety strategies.
- Speech therapy: ST can improve soft voice volume to aid communication and speech exercises may help reduce drooling.
Non-pharmacological therapies are extremely beneficial for maintaining mobility. Exercise should also be continued if possible.
What lifestyle changes help Parkinson’s mobility?
Making certain lifestyle adjustments can also optimize mobility with Parkinson’s:
- Exercise regularly – Aerobic, strengthening, balance, and flexibility exercises.
- Practice movement strategies – Cueing, counting steps, rhythmic stepping.
- Prioritize good posture – Align head over shoulders, engage core muscles.
- Wear proper footwear – Low heels, non-slip soles, appropriate fit.
- Use assistive devices – Canes, walkers, wheeled walkers for added stability.
- Remove tripping hazards – Clear clutter, install grab bars and railings, improve lighting.
- Adopt fall prevention habits – Take your time, have someone accompany you.
It’s also helpful to plan and pace activities to avoid fatigue. Breaking tasks into smaller steps can make movements easier. Allow extra time for turns and transitions between movements.
What walking aids help with Parkinson’s disease?
Walking aids provide extra stability and support to compensate for Parkinson’s balance and gait issues. Commonly used walking aids include:
- Canes: Help take pressure off one side of the body. Use on the less affected side for support during walking.
- Walkers: Offer a wide stable base of support. 2-wheeled walkers allow forward propulsion. 4-wheeled walkers provide the most support.
- Hiking poles: Improve balance by distributing weight through four points. Help stabilize arm swing.
- Arm slings: Attach between two poles or walkers. Provide trunk support in an upright posture.
Other assistive devices like reachers, sock aids, and long-handled shoehorns can make dressing and daily tasks easier to perform standing up. Built up handles on utensils can also help with manual dexterity.
When should someone start using a wheelchair for Parkinson’s?
Most people with Parkinson’s will not require a wheelchair until very advanced stages, if ever. However, wheelchair use may be recommended if:
- Falls become frequent and severe despite walking aids.
- Freezing causes inability to initiate movement or long freeze episodes.
- Extreme slowness, rigidity, or imbalance impede mobility and safety.
- Orthostatic hypotension causes dizziness and lightheadedness on standing.
- Fatigue, shortness of breath, or pain limit endurance.
Using a wheelchair part-time can help conserve energy for important activities. It does not mean giving up on walking altogether. Many people use a wheelchair for long distances and still walk independently at home using aids.
What exercises help Parkinson’s mobility?
Regular exercise is crucial for maintaining mobility with Parkinson’s. Recommended exercises include:
- Aerobic exercise: Walking, swimming, cycling. Helps cardiovascular health, endurance, and constipation.
- Strengthening exercise: Resistance bands, weights, bodyweight exercises. Builds muscle power.
- Flexibility exercises: Yoga, stretches. Improves range of motion.
- Balance exercises: Tai chi, tandem stance. Challenges stability.
It’s ideal to exercise at least 2.5 hours per week, with a mix of flexibility, aerobic, and strengthening activities. Exercise should become more challenging over time but always remain safe. Work closely with a physical therapist or trainer to develop an appropriate exercise program.
How can physical therapy help with Parkinson’s walking problems?
Physical therapy aims to maximize function and mobility in Parkinson’s. PT walking interventions can include:
- Gait training: Practicing walking patterns and rhythmic stepping.
- Treadmill training: Uses external cues from the treadmill belt to improve gait.
- Cueing strategies: Rhythmic auditory or visual cues to optimize walking pattern.
- Assistive devices: Finding appropriate canes, walkers, wheeled walkers for support and safety.
PT also helps improve posture, balance, and strength through targeted exercises. Stretches and range of motion exercises enhance flexibility and prevent rigidity. PT can ensure assistive devices are correctly fit and sized.
What occupational therapy helps with Parkinson’s mobility?
Occupational therapy for Parkinson’s focuses on maintaining independence in all aspects of life. For mobility, OT interventions can include:
- Recommending adaptive equipment like grab bars, railings, raised toilet seats.
- Modifying the home environment to improve safety and accessibility.
- Teaching techniques for daily tasks like dressing, bathing, cooking.
- Addressing fatigue management, pacing, and energy conservation.
- Improving handwriting, typing, and fine motor skills.
OTs take a holistic view to keep people as active and engaged in life as possible. This includes assessing cognitive skills, mood, roles, and social support.
What are the most important Parkinson’s walking tips?
Key tips for walking well with Parkinson’s include:
- Use walking aids for stability and to prevent falls.
- Take purposeful, deliberate steps by thinking “heel-toe.”
- Build in extra time for turns, which are especially challenging.
- Initiate arm swings to help “pump” your walking rhythm.
- Aim for a heel-first landing rather than flat-footed.
- Walk to rhythms or music if it helps cue your steps.
- Avoid distracting multitasking while walking.
- Clear clutter and install handrails – a fall can lead to serious injury.
It’s also crucial to exercise regularly to maintain strength, flexibility, balance and endurance. Consult physical and occupational therapists who specialize in Parkinson’s for personalized guidance.
Conclusion
Parkinson’s disease often impairs walking and mobility. However, there are many effective treatments and lifestyle strategies to allow people with Parkinson’s to remain ambulatory for many years. Using walking aids, practicing movement strategies, exercising, and working with physical and occupational therapists can all help maximize independence and quality of life.
While Parkinson’s is progressive, maintaining the ability to walk is certainly possible through appropriate management. With proactive treatment and support, most people with Parkinson’s can continue enjoying active lives.