Compensation strategies can help PwPs walk better. More than three quarters of the patients use such a strategy, but knowledge about which alternative strategies might also work is still very limited. “And that is important, because the best strategy differs per person and per situation,” says rehabilitation doctor Jorik Nonnekes on the phone. Together with his team from Radboudumc in Nijmegen, he inventoried the knowledge of PwPs in this area. The results appeared in the journal on Wednesday Neurology.
“Parkinson affects areas of the brain where automated movements are controlled, making walking more difficult,” explains Nonnekes. “That varies from shuffling a bit to being literally stuck to the ground and unable to move. This often happens near a narrow passage such as a door or an elevator, or in the middle of a busy supermarket.”
The biological cause of Parkinson’s lies deep in the brain, where dying cells cause a dopamine deficiency. This can be tackled with medication, but by no means always means all symptoms disappear. The walking difficulties in particular are a nuisance for patients.
Fortunately, there are simple solutions. By looking for ‘detours’, automatic movements in the brain are addressed in a different way, so that walking is suddenly possible. “That works immediately,” says Nonnekes from his experience in his outpatient clinic for gait disorders in Parkinson’s.
Relieving walking difficulties
In previous research, he already made an inventory of what patients had come up with to alleviate their walking problems. “That resulted in no fewer than 59 unique tricks,” he says, “we then categorized them into the seven main strategies. But I don’t rule out that there are other tricks that work.”
The new study focused on the extent to which patients make optimal use of knowledge about strategies. 4,324 people with Parkinson’s and walking problems were asked about this via online platforms in the Netherlands and North America.
Many patients had never heard of the compensatory strategies
There appears to be still some work to be done. Nearly one in five participants had never heard of compensation strategies at all, and only 4 percent were aware of all seven categories. Only one in three had been educated about compensatory strategies by their healthcare provider. Others had read it somewhere or discovered it by chance. Nearly a quarter had never tried any of the strategies.
The right treatment is tailor-made, says Nonnekes. “What works very well for one person may be less effective for another. Even per patient, the best strategy may differ per moment, depending on the situation. Better walking can significantly improve the quality of life of PwPs as they become much more mobile and fall less – potentially breaking their hip.”
There are an estimated 63,000 people with Parkinson’s in the Netherlands. Most patients are already over sixty, but the disease can also develop at a young age. “The youngest patient in my outpatient clinic is in his twenties,” says Nonnekes.
Once a patient has found his best working detours, will they always work? Nonnekes: “There is still discussion about that. Sometimes the effect does indeed seem to diminish over time. One explanation could be that the alternative movement is also becoming automated and therefore more difficult. I personally think it’s because a larger area of the brain is affected over time. But in both cases it is important to look for alternatives that still work.”
A version of this article also appeared in NRC on the morning of September 9, 2021