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Can reduce gait freezing (Parkinson’s evidence)

Evidence summary
In a paper based on expert recommendation in 2015, it was suggested that all patients with mild gait freezing should be referred to physiotherapy, which uses cues to help patients overcome freezing of gait episodes and the recommendation to maintain sufficient exercise levels [1]. Cycling was mentioned as a recommendation in particular, as it was found that People with Parkinson’s do not freeze when cycling but expert opinion in Moving Medicine recommended that this was only done if the patients were already actively cycling [1](a safe option may be use of portable pedal exerciser). In this paper, the recommendation for more severe freezing of gait is similar to mild freezing of gait but recommended the involvement of an occupational therapist in addition to advise about home adaptations [1]. Subsequently, a systematic review which looked at 20 randomised controlled trials found that physiotherapy treatments involving visual cueing, auditory cueing and treadmill training is likely to reduce freezing of gait. Interventions such as balance and coordination training, aquatic gait training and sensory (tactile) cues may show benefits but further studies are required [2]. During the focus group session in Moving Medicine, expert opinion is that freezing of gait does appear to improve with moderate to high intensity physical activity maintained over time.

Quality of Evidence
B Moderate 1 systematic review and 1 review paper support physical activity interventions helping freezing of gait symptoms especially if concurrent with auditory, visual and possibly sensory cuing.#

Strength of Recommendation
1 Strong. Reinforced by expert opinion

Conclusion
Alongside optimal medical management, health care professionals should consider referring people with Parkinson’s with freezing of gait to specialist physiotherapists as visual cueing, auditory cueing and treadmill training can help reduce freezing of gait. It is also recommended that patients with freezing of gait should maintain sufficient activity level, with expert opinion that freezing of gait appears to improve with moderate to high intensity physical activity maintained over time.

References
[1] Nonnenkes J et al. Freezing of gait: a practical approach to management. Lancet of Neurology 2015; 14: 768-778
[2] Rutz D and Benninger D Physical Therapy for freezing of gait and gait impairments in Parkinson’s Disease: A systematic review. American Academy of Physical Medicine and rehabilitation. 2020, Nov. 12(11) p:1140-1156

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