Tips to stop a freeze

Freezing is the term used to describe the temporary inability to move. It can affect your speech, walking, eyes and even the use of your hands in tasks such as writing. Freezing more commonly affects walking. Many people describe freezing as the feeling of having their feet glued to the floor.  Freezing tends to occur when you begin to walk and when you turn or change directions.

• “Off ” freezing tends to occur in the morning (after a prolonged period without medicine) or at the end of a medicine dose as its effects on movement wear off.
• “Off ” freezing can improve with medicine adjustment. Off freezing improves by reducing off time and increasing on time. The first step is taking your medicines on time. If freezing is worse in the morning it may be helpful to keep your first dose of medicine at the bedside and take it before you get up if you freeze upon awakening.

Freezing may not improve with medicine if it occurs during the medicine “on” state. In such cases, physical and occupational therapy are a very important part of treatment. “There are different strategies to break freezing and get the person moving again,” says physical therapist Ann Zylstra. “A simple change in your walking pattern or using sound and visual cues may help.” Freezing tends to occur when initiating walking such as immediately upon standing, with turns, times of stress or crowded areas.   The following tricks can you help you break a freeze:

• Take a big exaggerated marching step to get started.
• Stepping backwards or over a line (real or imaginary) or object can break the freeze.
• Use sound with a tempo that can stimulate marching to help you reduce freezing.
• For some, simply singing and counting your steps can help.
• Use visual ques such as walking over lines (either imaginary or lines of tape placed on the floor). Some walkers and canes have laser lines that shine on the floor, giving you a line to walk over.
• Change directions using big movements. Make wide turns rather than sharp pivots.
• Identify areas or situations that cause anxiety. Avoid them if possible. Alternatively, focus on techniques to reduce the anxiety.

Freezing tends to occur in certain places. Narrow, crowded spaces such as hallways, doorways, elevators, closets and bathrooms are common spots for freezing episodes. Stress, fatigue and anxiety can also worsen freezing. Ann Hatley-Settles, occupational therapy assistant offers the following tips.

• Keep a diary of where you freeze and try and find ways to open up the space making the rooms appear bigger and less cluttered.
• Reduce clutter, simplify room furnishings, and eliminate loose rugs and boldly patterned carpet.
• Make sure your rooms have good lighting for ease in navigation.
• Use tape to place lines on the floor a step distance apart in places that you tend to freeze (usually small places such as doorways, closets, and bathroom).
• Avoid crowded areas planning to visit places in off times before or after the crowds. 

Treatment for freezing is a team effort. The best way to reduce your freezing is to review these recommendations with your physician and ask for a referral to a physical and occupational therapists to help you find strategies that work for you.

 Author:  Ann Zylstra, PT and Ann Hatley-Settles, COTA

Copyright 2011 Northwest Parkinson's Foundation Wellness Center

www.nwpf.org/wellness