Objective: To provide an overview of available compensation strategies for gait impairments in Parkinson’s disease (PD) using an expert-opinion based methodology.

Background: Patients with PD use a wide variety of strategies to compensate for gait deficits, and in particular to compensate for freezing of gait. Examples include walking while rhythmically bouncing a ball, crossing the legs when walking and stepping over an inverted cane. Such strategies are aimed at maintaining an optimal gait pattern, as well as at regaining a normal gait pattern once an episode of freezing of gait has occurred. An overview and classification of available strategies is currently lacking, but this may contribute to understanding their underlying mechanisms and to develop focused rehabilitation techniques.

Methods: We collected video recordings of patients with PD who spontaneously informed us about the use of self-invented tricks and aids to improve their mobility. Specifically, we asked them to bring home videos showing strategies they were using to walk indoors or outdoors. In some cases, additional videos were recorded during the patients’ visits in the consulting room or in the hospital. Subsequently, six experts in the domain of freezing of gait studied the collected videos and devised them into categories of compensation strategies.

Results: Over a period of 4 years we collected 58 unique compensation strategies. We reached agreement on a classification scheme for compensation strategies for gait deficits in PD. This classification scheme entails seven categories of compensation strategies, which involve: 1) using internal cues, 2) using external cues, 3) changing the balance requests, 4) altering the mental state, 5) using motor imagery or action observation, 6) adapting a new walking pattern, 7) alternative forms of using the legs to move forward. All collected compensation strategies were classified using this scheme. Some compensation strategies involved a combination of the strategies described above.

Conclusions: Overarching working mechanisms of compensation strategies are thought to involve an allocation of attention to gait, the introduction of goal-directedness and the use of motor programs that are less overlearned than those used in normal walking. To validate the categorization system and to investigate the underlying mechanisms, future work is needed, including neuroimaging studies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/compensation-strategies-for-gait-impairments-in-parkinsons-disease/