Some clients with Parkinson’s disease (PD) may experience difficulty moving from one piece of Pilates equipment to another after completing an exercise. This inability to propel the feet is a symptom of PD and is commonly referred to as “frozen gait.” With most clients, their unconscious mind gives them the commands necessary for their body to move and perform the next action. With PD, this automatic feature can sometimes be interrupted.
Fortunately, we often can help our client “reboot” the system with a conscious command originating from another part of the brain. Once the body makes the first move, another part of the brain takes over for locomotion—like the jumpstart of a car battery getting the engine going again.
Mayo Clinic Parkinson Specialist J. Eric Ahlskog, Ph.D., M.D. provides some possible suggestions you may make to your client in The Parkinson’s Disease Treatment Book:
- Swing one leg forward. Think about swinging the leg rather than walking. Start with a long leg swing that will place that leg far in front of you (but not so far that you fall).
- Try goose-stepping. This was the marching gait of German soldiers. They would stiffly lock their knees and march by taking long stiff steps. Envision what they looked like and keep this thought as you take your first step.
- Think about a drum major’s marching step, raising one leg straight up off the ground before placing it forward. Envision that same movement when you get stuck.
- Think about a drill sergeant’s marching cadence: “one-two, one-two, one-two…” You might even count out loud. This might get you started and help you mentally envision a marching step.
- Thinking of a certain musical tune may be helpful. For example, a gliding first step may come more easily if you hum “Blue Danube” in your mind and imagine a ballroom dancer gliding in that same way. A boogie or rock and roll tune that brings a dance step to mind may also work.
- Find a target on the floor and step on it. Sometimes people imagine they are stepping on a fly in front of them. Look for an imaginary fly on the ground and try to crush it; this may get your gait started.
- A variation on this involves using a laser pointer to create a target to step on. If you point the laser light 1-2 feet in front of you and then think about stepping on that tiny lighted spot that may get you going. Laser pointers are used by professors and lecturers and may be purchased at bookstores.
Consult with your client to see what tool works best. After your client begins moving, it is also common for a PD client to have difficulty maintaining the tempo, or to freeze again upon slowing down or stopping. One of my clients will put his hand on his wife’s shoulder when they are walking together to maintain a sense of rhythm in his gait, which he at times loses on his own. Impressively, he still skis and will count the ski lift towers and sing a song to himself like “one, two, three…and” to get ready to initiate push off from the ski lift and transfer his weight over his legs. This counting also becomes useful in Pilates exercises, such as with leg circles in the straps on the Reformer, to maintain fluid movement. If you think that your client is experiencing inconsistent or stilted movement, try leading with your voice “circle down 1,2,3,4, circle up 1,2,3,4” to maintain the rhythmic feel.
Despite all your clever tricks, sometimes nothing works. When this happens, it is often a medication issue. Your client generally knows from taking medication when “on” and “off” efficacy times occur relative to the dosage and the time the medication was taken. Schedule your appointments based on medication peak performance to get the most out of a session.
Brent Anderson PhD, PT, OCS of Polestar Pilates has a great recommendation for working with PD clients. He suggests that you provide a, “successful movement experience that exceeds their expectation.” PD clients may not always have the perfect Pilates form, but acknowledging and praising what they can do will empower them to recognize their own accomplishments and strive for success in the future.
A working relationship with a PD client can be challenging for a Pilates instructor, but it is extremely rewarding when your client experiences improved function. Understanding the common symptoms, such as freezing gait, can help you know what to expect and to work with greater patience.