Getting Around with Parkinson’s Disease

The Walk’n’Chair Journal

Wheelchair Walker for Parkinson's Disease | Walk'n'Chair

Parkinson’s disease is associated with the very noticeable resting tremor of the hands, rigidity and bradykinesia (small movements) of extremities. The axial muscles of the trunk are also affected. Truncal instability may cause the various gait disorders of Parkinson’s disease.

Most of the symptoms of Parkinson disease show remarkable changes with levodopa, so much so it is common to refer to the peak drug effect as “ON” and the minimum effect as “OFF”. Gait (walking) may get better or worse right after levodopa. So the disability of Parkinson’s disease changes over minutes to hours: from better to worse. After several years of taking levodopa, dyskinesia may occur with the ON – OFF cycle. These are slow writhing movements of the extremities, which usually last a few minutes after taking levodopa. In some, levodopa causes a reduction of blood pressure and dizziness when standing quickly (orthostatic hypotension). A person with dyskinesia or dizziness needs a place to sit or lean against until the symptoms resolve. A Walk’n’Chair is an ideal accessory for outings as it incorporates a wheelchair for resting!

Mortality from Parkinson’s disease is largely due to pneumonia and injury from falls.

Freezing of gait is a most troublesome symptom of Parkinson’s disease. It is as if the feet are glued to the floor and the first steps are small. Freezing occurs when starting walking and sometimes during turns.(8) Freezing causes injuries due to falls. Mortality from Parkinson’s disease is largely due to pneumonia and injury from falls.

The average patient with Parkinson’s disease has no mental changes. They are healthy and smart people who struggle against the disability by not giving up “Quality of Life” activities. People with Parkinson’s disease are normal active adults who do not stay inside and feel helpless. They remain active and push the limits of the disease. This means going outside. Rough terrain and movement uncertainties due to freezing or dyskinesia are all part of the deal.

Patients and support groups have many tricks to play on Parkinson’s disease. Almost a century ago, patients and neurologists discovered various “tricks” to assist in getting walking started. These tricks make use of intact functions such as vision, hearing, and tactile “overrides” to the faulty, overly slow movement system.

  • A visual override trick: Tape stripes placed on the floor in front of the patient allow some to get going from freezing.(4,9)
  • An auditory override trick: A metronome may pace the walking to keep steps larger and override freezing.(4,5,9)
  • A tactile override trick: A steady and stable surface to us as support will decrease unwanted movements and stabilize dyskinesia.(1, 7, 10)

The European guidelines for Parkinson’s disease strongly recommend using cues for the improvement of walking speed.(3) Most visual and auditory cues have only been used in the laboratory and require foreknowledge of kinematic parameters such as step size. It is our challenge to move these methods into real usage.

The Walk’n’Chair is a stable wheeled platform with an incredibly stable handgrip system. Vibration and positional uncertainty of the usual walkers send the wrong message to the sensory

Gait training does work to reduce falls in Parkinson’s disease.(2,6)

Walk’n’Chair helps to prevent falls while allowing active indoor/outdoor ambulation.

While the Walk’n’Chair is cleared by the FDA as a wheelchair (k935211), it does much more. In fact, it is an anti-wheelchair. That’s why we call it an Outdoor Activity Extender. It is our mission to keep people with mobility impairments such as Parkinson’s disease, disuse atrophy, mild stroke, neuropathy, and generalized weakness away from a sedentary reliance on a wheel chair.

The Walk’n’Chair morphs to meet the changing symptoms of Parkinson’s disease.

The Outdoor Activity Extender

References
1. Franzén, E.; Gurfinkel, V.S.; Wright, W.G.; Cordo, P.J.; Horak, F.B. Haptic touch reduces sway by increasing axial tone. Neuroscience 2011, 174, 216–223.
2. Jöbges, M.; Heuschkel, G.; Pretzel, C.; Illhardt, C.; Renner, C.; Hummelsheim, H. Repetitive training of compensatory steps: A therapeutic approach for postural instability in Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 2004, 75, 1682–1687.
3. Keus SJH, Munneke M, Graziano M, et al. European Physiotherapy Guideline for Parkinson’s disease. KNGF/ParkinsonNet; Netherlands: 2014.
4. McCandless, P.J.; Evans, B.J.; Janssen, J.; Selfe, J.; Churchill, A.; Richards, J. Effect of three cueing devices for people with Parkinson’s disease with gait initiation difficulties. Gait Posture 2016, 44, 7–11.
5. McIntosh, G.C.; Brown, S.H.; Rice, R.R.; Thaut, M.H. Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 1997
6. Protas, E.J.; Mitchell, K.; Williams, A.; Qureshy, H.; Caroline, K.; Lai, E.C. Gait and step training to reduce falls in Parkinson’s disease. Neuro Rehabil. 2005, 20, 183–190.
7. Rabin, E.; Chen, J.; Muratori, L.; DiFrancisco-Donoghue, J.; Werner, W.G. Haptic feedback from manual contact improves balance control in people with Parkinson’s disease. Gait Posture 2013, 38, 373–379.
8. Spildooren, J.; Vercruysse, S.; Desloovere, K.; Vandenberghe, W.; Kerckhofs, E.; Nieuwboer, A. Freezing of gait in Parkinson’s disease: The impact of dual-tasking and turning. Mov. Disord. 2010, 25, 2563–2570.
9. Suteerawattananon, M.; Morris, G.; Etnyre, B.; Jankovic, J.; Protas, E. Effects of visual and auditory cues on gait in individuals with Parkinson’s disease. J. Neurol. Sci. 2004, 219, 63–69.

Definitions
Bradykinesia – “smallness of movement”. In Parkinson’s disease, this results in slow and smaller than desired extremity movements. A characteristic miniature signature is a hallmark of bradykinesia.
Festination – shortening and quickening of the steps
Postural Instability – impairment of balance. Mitigated by sensory (haptic) feedback from a solid surface.
Stooped Posture – forward leaning during walking.
Marche a Petits Pas – “march of the small steps”. Related to bradykinesia, the step length is reduced in Parkinsons.
Propulsive gait – Forward leaning walking that accelerates towards a forward fall.
Retropulsive gait – Walking that leads to loss of balance in a backward direction. Related to the abnormal postural reflexes in Parkinsons.

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