Elastic Priming of Gait: An Effective Patient‐Created Strategy for Freezing of Gait

Freezing of gait (FOG) is a common symptom in Parkinson's disease (PD) and is a significant cause of falls, disability, and reduced quality of life. ¹ Unfortunately, FOG is poorly understood pathophysiologically and remains difficult to treat. Beyond optimizing dopaminergic medications and considering surgical therapy, rehabilitation strategies are a mainstay of management. Behavioral strategies, such as using sensory cues or shifting weight to initiate gait, help reduce FOG. In addition, patients often develop their own compensatory strategies. ²

An 81‐year‐old right‐hand‐dominant male was assessed in clinic for PD. His symptoms began 7 years ago with the development of right‐sided rest tremor in the hand, right‐sided bradykinesia and rigidity, micrographia, and a slow, shuffling gait. Treatment with levodopa substantially improved his parkinsonism. 3 years after symptom onset, he developed FOG during gait initiation and turning. This was not dopamine responsive and progressed with increasing frequency and duration. Additional triggers included narrow spaces, doorways, navigating obstacles and crowds, and ambulating under time constraints. Physiotherapy strategies helped him avoid falls. However, to maintain safety during walking, he began using a 4‐wheel walker at home and for short distances, which was not associated with improvement in FOG, and an electric scooter for long distances. His other motor symptoms continued to be well‐managed with levodopa and non‐motor symptoms were non‐contributory.

At 81 years of age, he created his own strategy to address FOG while performing upper extremity exercises with resistance bands. He decided to secure resistance bands (TheraBand, Akron, OH) under the soles of his feet individually or simultaneously and hold them at the level of the handles of his 4‐wheel walker, such that the bands were mildly stretched superiorly and anteriorly (Video 1 and Video 2). He did not actively pull on the bands and passive elasticity helped facilitate gait initiation and maintenance. With the use of bands, he had a marked reduction of freezing of gait and was able to ambulate with improved stride length, amplitude, and speed. He used this strategy with and without his walker, and when ambulating longer distances, he further secured the bands on his feet by wearing them inside his shoes. He returned for follow‐up 1 year later and had continued success using resistance bands to manage FOG (Video 2).

Video 1.

Initial assessment at 81 years of age, with a unilateral resistance band. Baseline gait showed severe freezing of gait (FOG), with an inability to produce forward progression and reduced stride length and step height. FOG was exacerbated by turning. The patient frequently made lateral weight shifts to facilitate his gait. He brought a single resistance band to this assessment and unilateral use reduced FOG with increased mobility bilaterally. He had improved initiation and maintenance of gait, stride length, step height, speed, and turning. This strategy was demonstrated without and with a walker. Although visual stripes were present, they did not improve FOG. He typically used bilateral resistance bands in daily life, which was associated with further reduction of FOG.

Video 2.

Follow‐up assessment 1 year later, with bilateral resistance bands. Baseline gait with a walker showed similarly severe freezing of gait (FOG) compared to without a walker at this assessment and 1 year prior. He used the walker to make anterior–posterior weight shifts to facilitate his gait. The presence of visual stripes as a visual cue did not improve FOG. He brought two resistance bands to this assessment and bilateral use reduced FOG similar to his initial demonstration of unilateral use, despite progression of motor symptoms over a 1‐year period.

He shared his strategy with the hope of helping and inspiring others with FOG. The success of his strategy may be facilitated by good control of his other motor symptoms and the absence of cognitive impairment, which could interfere with the safe use of resistance bands. A similar strategy has been described where a patient overcame FOG by pulling on a band looped around their foot. ³ Whereas this strategy requires active engagement of the ipsilateral upper extremity to initiate a weight shift and perhaps focus attention on the task of ambulating, resistance bands appear to work through a passive, less cognitively demanding mechanism. A light, upward, elastic force on the lower extremities may provide an external cue for gait initiation, decrease the threshold for motor activation, and facilitate a natural gait pattern. Overall, elastic priming of gait with resistance bands can be a simple, accessible, and reproducible strategy for managing FOG and a potential tool for understanding its underlying mechanisms.

Author Roles

(1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript Preparation: A. Writing the first draft, B. Review and Critique.

J.L.C.: 1A, 1B, 1C, 3A, 3B.

GA: 1A, 3B.

J.R.S.: 1A, 1B, 3B.

Disclosures

Ethical Compliance Statement: Institutional review board or ethics committee approval was not required for this work. The patient provided written informed consent to publish this case report, including the use of video material. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.

Funding Sources and Conflicts of Interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work.

Financial Disclosures for the Previous 12 Months: The authors declare that there are no additional disclosures to report.