The parkinsonian gait or feast is a typical gait seen in late-stage Parkinson's disease. Festinante comes from the Latin “festinare” which means quickly or quickly..
It is characterized by a shortening of the steps and an acceleration of these. This form of walking can be harmful as it may interfere with daily activities, as well as work or physical exercise..
Parkinsonian gait can be an important indicator of the existence of Parkinson's disease. This disorder is neurodegenerative, which means that it gradually damages various brain regions. It is usually associated with rigidity and tremors, although it produces more affectations. For example, dementia, cognitive impairment, depression, sleep problems, etc..
Parkinson's disease is accompanied by a deficit of dopamine in motor circuits of the brain. Specifically, the dopaminergic neurons of the substantia nigra degenerate. Actually, these neurons participate in other processes besides voluntary movement. Like attention, memory, the feeling of reward, humor, etc..
The main treatment for parkinsonian gait is physical therapy and care strategies.
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One of the most notable symptoms of Parkinson's is parkinsonian gait, which has the following characteristics:
- Difficulty starting or interrupting the march once it has started.
- When starting to walk, the trunk is bent forward, the knees are slightly bent as well as the hips and the elbows semi-flexed..
- The steps are very short and fast, resembling a kind of trot that increases as you walk. If you don't stop, you may fall. It is also observed that they are dragging their feet.
- In general, movement is as slow as possible (hypokinesia), and can reach a complete loss of movement in severe cases (which is known as akinesia)..
- In parkinsonian gait, significant stiffness of the limbs is observed, since there is muscular hypertonia, that is, high muscle tone.
- In normal gait, the heel is on the ground first than the toes. However, in parkinsonian gait the entire foot is placed on the ground at the same time..
It is also possible that in more advanced stages of the disease the toes are placed first and then the heel. However, this is less frequent.
On the other hand, these patients have decreased foot elevation during the swing phase of gait..
As the disease progresses, the heel is supported less and less. In addition, they tend to bear the load in the forefoot, accompanied by changes in load towards the medial areas of the foot..
This change in body load helps them compensate for the lack of balance that this gait produces..
- Healthy people tend to have a great variability in the tread pattern. However, Parkinson's patients have remarkably similar gaits to each other.
- Gait block: this is a short-lived episode (less than a minute) in which the gait stops and the patient feels that their feet are glued to the ground. Once that time has passed, they make a few hesitant movements before resuming their march.
The gait block usually appears when the patient must walk through narrow spaces such as through a door. It also appears in situations where the person has to react quickly, such as when the doorbell or telephone rings..
However, as the disease progresses, this blockage can appear in any context.
- Falls: they are not very common in the early stages of Parkinson's, but they become more frequent as the disease progresses. They arise, above all, by sudden changes in posture such as the twisting of the trunk.
They also appear when trying to carry out a task simultaneously while walking. They are also common when getting up or sitting down. Falls are usually forward by approximately 45% and laterally by 20%.
- In severe stages of Parkinson's disease, posture instability may be observed. Thus, the patient can no longer maintain balance during daily activities such as walking, standing or sitting. This is due to a lack of flexibility resulting from muscle stiffness..
- The patient seems to have no control over his gait and may feel exhausted as it is an inefficient gait..
The best way to treat parkinsonian gait is by intervening in the underlying condition, that is, in Parkinson's disease. However, this disorder has no cure, but there are ways to reduce discomfort and alleviate the symptoms of this condition..
L-DOPA treatment is often used to increase brain dopamine levels. However, it has diverse effects on the go. For example, this drug does not change the length of the stride or its speed, although it decreases the frequency of blocking walking and falling..
On the other hand, L-DOPA increases postural sway, so this drug is not highly recommended to reduce parkinsonian gait.
The best treatment is physical therapy (physiotherapy) which, through specific exercises, is taught to improve gait and reduce hypertonicity.
Professionals can also use visual or auditory cues to help patients improve their gait. For example, lines can be drawn on the ground to increase stride length.
On the other hand, auditory signals are usually rhythmic sounds produced by a metronome that help the patient maintain a regular gait, without acceleration..
Care strategies in which the patient is taught to focus on their own steps are also widely used..
Another treatment that has been shown to be effective is deep brain stimulation. This consists of implanting an electrode inside the brain of the patient. Specifically, in the peduncle-pontine nucleus, which participates in motor planning. While if it is done in the subthalamic nucleus, it reduces long-term gait block.
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