The effect of doorway characteristics on freezing of gait in Parkinson's disease

Helena M Cockx; Eefke M Lemmen; Richard J A van Wezel; Ian G M Cameron

doi:10.3389/fneur.2023.1265409

The effect of doorway characteristics on freezing of gait in Parkinson's disease

Front Neurol. 2023 Dec 4:14:1265409. doi: 10.3389/fneur.2023.1265409. eCollection 2023.

Authors

Helena M Cockx^#^{1

2}, Eefke M Lemmen^#¹, Richard J A van Wezel^{1

3}, Ian G M Cameron^{3

4

5}

Affiliations

¹ Department of Neurobiology, Faculty of Science, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.
² Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
³ Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.
⁴ OnePlanet Research Center, Nijmegen, Netherlands.
⁵ Faculty of Science, Education Center, Radboud University, Nijmegen, Netherlands.

^# Contributed equally.

Abstract

Background: Freezing of gait is a debilitating symptom in Parkinson's disease, during which a sudden motor block prevents someone from moving forward. Remarkably, doorways can provoke freezing. Most research has focused on the influence of doorway width, and little is known about other doorway characteristics influencing doorway freezing.

Objective: Firstly, to provide guidelines on how to design doorways for people with freezing. Secondly, to compare people with doorway freezing to people without doorway freezing, and to explore the underlying mechanisms of doorway freezing.

Methods: We designed a web-based, structured survey consisting of two parts. Part I (n = 171 responders), open to people with Parkinson's disease with freezing in general, aimed to compare people with doorway freezing to people without doorway freezing. We explored underlying processes related to doorway freezing with the Gait-Specific Attention Profile (G-SAP), inquiring about conscious movement processes occurring during doorway passing. Part II (n = 60), open for people experiencing weekly doorway freezing episodes, inquired about the influence of specific doorway characteristics on freezing.

Results: People with doorway freezing (69% of Part I) had higher freezing severity, longer disease duration, and scored higher on all sub scores of the G-SAP (indicating heightened motor, attentional, and emotional thoughts when passing through doorways) than people without doorway freezing. The main categories provoking doorway freezing were: dimensions of the door and surroundings, clutter around the door, lighting conditions, and automatic doors.

Conclusion: We provide recommendations on how to maximally avoid freezing in a practical setting. Furthermore, we suggest that doorways trigger freezing based on visuomotor, attentional, and emotional processes.

Keywords: Parkinson’s disease; doorways; freezing of gait; gait; surveys and questionnaires.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Operational Program European Regional Development Fund (OP ERDF) of the European Union under the “PROMPT” project (PROJ-00872) and the NWO/Crossover INTENSE programme.