Gait impaired Parkinson’s disease patients can benefit from compensation strategies to overcome walking difficulties, but they need to be informed about a wider range of available strategies and offered an individually tailored solution, according to Dutch researchers.

With gait impairments one of the most common and disabling symptoms of Parkinson’s disease, the researchers explored the types of ‘detours’ adopted by patients to maintain or improve their mobility. These so-called compensation strategies might include walking paced by imaginary counting, mimicking the gait of another person, or adapting unusual walking patterns such as walking backwards, or lifting up the knees high.

A survey of 4,324 patients revealed that most knew at least one compensation strategy, but 23% had never tried any only 4% of patients were aware of all seven possible approaches.

In about half cases patients had developed their own compensation strategy after reading about them or hearing from others, and only a third had received professional advice on overcoming gait impairment.

Aside from walking aids and alternatives to walking, ‘external cueing’ via metronome, vibrating socks or stepping over lines was the most widely known category of compensation strategies, followed by internal cueing through self-prompting or mental arithmetic — known by 47% and 45% of patients respectively, the authors wrote in Neurology.

Action observation and motor imagery was the least known category. Remaining options included altering mental state and using a new walking pattern.

While changing balance requirements and external cueing generally had the highest (76%) and lowest (62%) success rates, respectively, efficacy varied greatly depending on personal and and contextual factors.

For example, internal cueing allowed patients to start walking but was less effective in helping them stop. Meanwhile, action observation and motor imagery was more effective outdoors than in narrow spaces.

The authors also observed that the efficacy of strategies could diminish over time as patients face increased disability or exacerbate gait deficits during stress-inducing or multi-task situations, they observed.

The authors noted that while scientific work and clinical recommendations had  focused on external cueing strategies – possibly because it was readily measured – it was the least effective method rated according to patients reports. In practice, patients often preferred strategies based on changing the balance requirements and altering the mental state, possibly because these were more accessible and feasible and did not require specific devices or adaptations to the environment and were less noticeable to bystanders.

Since the efficacy of compensation strategies based on self report was high, patients with gait difficulties should be made aware of all possible options, they suggested.

“Integrating the use of compensation strategies into educational programs, or developing a dedicated online platform about the various available strategies, might facilitate finding a suitable strategy for every person with Parkinson’s disease who experiences gait impairments,” they recommended.

“The choice of compensation strategies for gait impairment in Parkinson’s disease should be tailored to the individual patient, as well as to the context in which the strategy needs to be applied,” they added.