PD compensatory strategies

[Harriet Hill]

Hey Chrissy! Sorry for so many posts lately. I’m wondering if you have any resources and/or just suggestions of compensatory strategies for individuals with Parkinson’s dz? I have found several articles with a general list, but not an extensive list of specific strategies. (for example: ” (1) baseline gait; (2) external cueing; (3) internal cueing; (4) action observation; (5) motor imagery; and (6) adopting a new walking pattern”, and “The survey explained the seven main categories of compensation strategies. They are: internal cueing, like walking to a count in your head; external cueing, like walking in rhythm to a metronome; changing the balance requirement, like making wider turns; altering mental state, which includes relaxation techniques; action observation and motor imagery, which includes watching another person walk; adapting a new walking pattern, like jumping or walking backwards; and other forms of using the legs, like bicycling and crawling. Each category was explained and participants were asked if they were aware of it, if they’d ever used it, and if so, how it worked for them in a variety of contexts.”)

I’m looking for a list of compensatory strategies to use in clinic. For example, I recently heard of parallel white tape stripes to help with freezing. Do you have any more strategies like this? Or can you point me in the right direction to resources for these?

Thanks in advance for your help!

[Chrissy Durrough Lugge]

Hi Harriet,

Love the questions! Good timing on this one- I am actually current recording the updated Parkinson’s lecture and have some more info on external cueing/strategies in the new presentation! There’s not a ton out there directly comparing types of strategies. There is one article indicating that visual cues are better for individuals who freeze while auditory cues may be better for non-freezers.

In terms of practical, clinical ideas:
– If someone is consistently experiencing problems in their own space (e.g., freezing when entering their bathroom), I often recommend parallel lines running perpendicular to the walking path and spaced about a stride length apart. With this, it’s important that the lines cross the entire problem area. If the problem is a doorway, the lines should start a few steps outside the doorway and continue a few steps into the next room. Here’s a video example of what the lines may look like: https://www.youtube.com/watch?app=desktop&v=UzPdHYgMbGE
– In the community, I find attentional strategies to work fairly well. I encourage my patients to reflect on when they are freezing (where they are, what they’re doing, etc.) to identify patterns and then plan. If doorways are a problem, we experiment with different strategies (visually looking past the doorway, counting steps through the doorway, etc.), then plan how to implement them.
– For turning, I find the mental image of a clock often works well. Think of turning 90 degrees at a time- so step to 3:00 then 6:00 to do a 180. Counting steps during turns often works well.
– I’ve had patients use a tactile cue of tapping their leg before initiating gait to increase attention to taking a big first step.
– Picking a target on the floor to step to when initiating gait also works well.
– If it’s possible to implement, music or metronomes as auditory cues during gait can be helpful

That’s just a few off the top of my head. The strategies I end up recommending are typically pretty patient-centered. It is often difficult to make patients freeze in the clinic because they are less comfortable than at home, so that reflecting on patterns piece is key. Patient buy-in and remembering to utilize any strategy is the most important thing because attention to task will increase safety and reducing freezing itself.

Hope this helps!

Chrissy

[Harriet Hill]

Thanks SO much for these ideas and this ifno! I’ve never heard of the clock one, and I’ll definitely be trying it out. Love that it’s a portable mental image you can use anywhere!

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