Triggers for freezing of gait in individuals with Parkinson's disease: a systematic review

Carolina I Conde; Charlotte Lang; Christian R Baumann; Chris A Easthope; William R Taylor; Deepak K Ravi

doi:10.3389/fneur.2023.1326300

Triggers for freezing of gait in individuals with Parkinson's disease: a systematic review

Front Neurol. 2023 Dec 21:14:1326300. doi: 10.3389/fneur.2023.1326300. eCollection 2023.

Authors

Carolina I Conde¹, Charlotte Lang¹, Christian R Baumann^{2

3}, Chris A Easthope^{3

4

5}, William R Taylor^{1

3}, Deepak K Ravi¹

Affiliations

¹ Institute for Biomechanics, ETH Zürich, Zürich, Switzerland.
² Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
³ The LOOP Zurich - Medical Research Center, Zürich, Switzerland.
⁴ Lake Lucerne Institute, Vitznau, Switzerland.
⁵ creneo Foundation - Center for Interdisciplinary Research, Vitznau, Switzerland.

Abstract

Background: Freezing of Gait (FOG) is a motor symptom frequently observed in advanced Parkinson's disease. However, due to its paroxysmal nature and diverse presentation, assessing FOG in a clinical setting can be challenging. Before FOG can be fully investigated, it is critical that a reliable experimental setting is established in which FOG can be evoked in a standardized manner, but the efficacy of various gait tasks and triggers for eliciting FOG remains unclear.

Objectives: This study aimed to conduct a systematic review of the existing literature and evaluate the available evidence for the relationship between specific motor tasks, triggers, and FOG episodes in individuals with Parkinson's disease (PwPD).

Methods: We conducted a literature search on four online databases (PubMed, Web of Science, EMBASE, and Cochrane Library) using the keywords "Parkinson's disease," "Freezing of Gait", "triggers" and "tasks". A total of 128 articles met the inclusion criteria and were included in our analysis.

Results: The review found that a wide range of gait tasks were employed in studies assessing FOG among PD patients. However, three tasks (turning, dual tasking, and straight walking) emerged as the most frequently used. Turning (28%) appears to be the most effective trigger for eliciting FOG in PwPD, followed by walking through a doorway (14%) and dual tasking (10%).

Conclusion: This review thereby supports the utilisation of turning, especially a 360-degree turn, as a reliable trigger for FOG in PwPD. This finding could be beneficial to clinicians conducting clinical evaluations and researchers aiming to assess FOG in a laboratory environment.

Keywords: Parkinson’s disease; freezing; gait; tasks; triggers.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was financially supported by grants from The LOOP Zürich and the Vontobel Foundation. Open access funding by ETH Zurich.