
PARKINSONIAN GAIT
Parkinsonian Gait, commonly known as Parkinson’s Walk, differs from typical adult gait in that those afflicted use very brief, shuffled steps with minimal foot lift. At Medical City Children’s Orthopedics and Spine Specialists, our expert Parkinsonian Gait Doctors are dedicated to diagnosing and treating children and ensuring comprehensive care is tailored to each patient’s needs. With advanced techniques and a compassionate approach, our team is here to help your child lead a healthy life.
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Parkinsonian Gait
The youngest recorded person to acquire Parkinsonian gait is a 12-year-old boy. He was diagnosed with juvenile Parkinson’s disease, a rare form of Parkinson’s disease affecting children under the age of 21. The causes of Juvenile Parkinson’s disease stem from a genetic mutation. The boy’s symptoms include tremors, stiffness, and slow movement. He also walks with a Parkinsonian gait, which appears as a slow, shuffling, and unsteady walking pattern.
The boy’s case is significant because it is the youngest known case of Parkinsonian gait. It also raises awareness of juvenile Parkinson’s disease, which rarely occurs and gets misdiagnosed. As of this date, a cure does not exist for juvenile Parkinson’s disease, but treatments exist that can help to manage the symptoms.
These treatments include medication, physical therapy, and speech therapy. The boy is currently receiving treatment, and doctors continue to manage his symptoms.
Walking Symptoms
Parkinsonian Gait, commonly known as Parkinson’s Walk, differs from a typical gait in that it uses very brief, shuffled steps. There is minimal foot lift. The foot is laid flat on the ground because there is little flexibility in the knee, ankle, or foot. Therefore, leading to an exceptionally short stride length.
To start moving, one has to flex the foot, bend the knee, and roll onto the ball of the foot. Parkinsonian Gait lacks the knee and foot flexion that characterizes our typical movement. This makes it challenging for people who experience it to walk.
When turning, a person might very slowly swing or move the leg, and with uneven surfaces, slopes, and steps it becomes hard to negotiate. Those who possess Parkinsonian Gait frequently have a stooped posture and a little forward lean. Rapid, brief steps appear to prevent overbalancing, and diminished arm movement is frequently apparent.
QUESTIONS AND ANSWERS
What is causing my child's Parkinsonian gait?
A Parkinsonian gait is characterized by a shuffling and unsteady walking pattern similar to that seen in Parkinson’s disease. It can result from various underlying factors, including neurological conditions, medication side effects, or other health issues. The doctor will conduct a thorough evaluation to identify the specific cause and provide information on the underlying condition responsible for the gait abnormality.
Can my child's Parkinsonian gait be treated or improved?
Parents are typically concerned about the treatment and management of their child’s Parkinsonian gait. They may ask about therapies, medications, or interventions that can help improve their child’s mobility and overall quality of life. The doctor can discuss treatment options, rehabilitation, and management strategies to address the specific condition causing the Parkinsonian gait.
What is the prognosis for my child's condition, and what can we expect in the future?
Walking differently can be a medical indication that something is wrong. Make an appointment with one of our pediatric orthopedists to ensure everything is fine.
How Muscle Activity Disrupts Balance and Posture in Parkinson’s Disease
Abnormal muscle patterns are a key reason why balance issues show up in Parkinson’s disease, especially as the condition progresses. In a healthy walk, your muscles work like a well-choreographed dance. While opposing muscle groups alternate between contracting and relaxing to keep you steady and upright. But with Parkinsonian gait, there’s often a breakdown in this teamwork.
Specifically, muscles at the back of the legs, called antagonist muscles, can contract at the wrong times or remain overactive. Without proper counterbalance from muscles at the front of the legs, this disrupts the center of gravity and can cause one to fall backward. As a result, maintaining a steady posture becomes much harder, which adds to the risk of balance problems and falls.
Parkinsonian Gait Causes?
Parkinson’s disease is characterized by the death of nerve cells and decreased production of the neurotransmitter dopamine in the basal ganglia, a region of the brain. Moreover, dopamine is used by the basal ganglia to bring neurons together. Therefore, this implies that connections are reduced when dopamine levels become low. Your child’s smooth motions are controlled by the basal ganglia.
Also, this region of the brain cannot perform that task as well when there are fewer connections there. Otherwise, this results in Parkinsonian gait and other Parkinson’s disease movement symptoms. Additionally, there is some evidence to suggest that in patients with Parkinson’s disease, anxiety might trigger gait freezing or exacerbate it. The condition Parkinson’s also frequently manifests as anxiety. However, this subject needs additional study.
How Parkinsonian Gait Relates to Other Symptoms
Parkinsonian gait rarely occurs in isolation. It often appears alongside other classic Parkinson’s symptoms, which can further complicate movement and daily activities.
- Bradykinesia (Slow Movements): This refers to the general slowness of movement found in Parkinson’s. Children may move more sluggishly, have difficulty with small, precise motions (like buttoning a shirt), and may even blink less frequently or show reduced facial expressions.
- Freezing Episodes: Sometimes, a child with Parkinsonian gait may experience “freezing of gait,” where it feels as though their feet are suddenly glued to the floor and they cannot take another step. These episodes can be triggered or worsened by anxiety or changes in the environment.
- Increased Risk of Falls: Freezing episodes and slowed reaction times mean that the risk of falling is significantly higher. This can make children hesitant to walk or participate in physical activities, which in turn can reduce their overall mobility and independence.
Understanding how these symptoms interact is crucial for tailoring treatment and support, as managing Parkinsonian gait often means addressing more than just walking difficulties. Anxiety, balance, and fine motor control all play a part in a child’s movement and safety.
What is Freezing of Gait and Why Is It Risky?
Freezing of gait can occur with Parkinsonian gait. A person suddenly feels unable to move their feet forward.
It can feel like their shoes are glued to the floor. This temporary loss of movement often comes without warning.
It may happen when starting to walk, turning, or navigating through doorways or crowded areas.
The main risk is a higher chance of falling. The feet freeze while the body keeps moving, causing a loss of balance.
These episodes can lead to a fear of walking. People may limit movement to avoid falls.
Reduced movement affects independence and quality of life for both children and adults.
Understanding this symptom is important. Talking with your doctor helps you find strategies to stay safe and active.
What is Abnormal Muscle Co-Activation and How Does It Affect Parkinsonian Gait?
Movement relies on muscle groups working together and in opposition.
When bending a joint, agonist muscles contract while antagonist muscles relax to allow the motion.
This teamwork ensures smooth and efficient steps.
Sometimes both muscle groups contract at once. This co-contraction adds stability, like when writing with a pen.
A little of this is normal, especially during precise movements.
In Parkinson’s disease, this balance is disrupted. Muscles on both sides of a joint contract too much at once.
Instead of moving freely, both sets tighten, making joints stiff and resistant to motion.
This is called abnormal muscle co-activation.
The resulting rigidity and shuffling are hallmarks of Parkinsonian gait. Joints refuse to bend, and steps become hesitant.
Walking looks like the person’s knees and ankles are locked.
Researchers link this pattern to changes in the basal ganglia and cerebellum, key brain areas affected by Parkinson’s disease.
Doctors treat Parkinsonian gait with certain approved medicines. Notably, people with Parkinson’s disease whose symptoms don’t get better also have other therapies that may help their gait.
How Do Audio and Visual Cues Help with Parkinsonian Gait?
For children and adults living with Parkinsonian gait, audio and visual cues serve as practical tools for improving walking patterns. These cues prompt the brain to use alternative pathways to initiate and control movement, effectively sidestepping some of the challenges created by the underlying neurological changes.
Therapists may recommend placing strips of colored tape on the floor as visual markers. These create clear targets to help guide each step, which can encourage a longer, more confident stride and break up the shuffling pattern so common in Parkinsonian gait. Similarly, counting steps aloud or walking to the steady beat of a metronome—both forms of auditory cues—can help regulate rhythm and pace, making it easier to start walking, keep moving, and prevent “freezing” episodes (when forward motion involuntarily pauses).
Importantly, these strategies can be adapted for each child’s unique needs. If your child tends to freeze in tight spaces or slows down on uneven ground, cues can be tailored to match those situations—whether it’s adjusting the spacing of visual markers or changing the tempo of an auditory signal. Technologies and aids used commonly in therapy settings, such as metronomes, music with a regular beat, or even apps designed for gait training, g—can also be used at home or in clinics to continue practicing these methods.
Using these cues consistently, alongside standard therapies and under the supervision of a physical or occupational therapist, can help make walking less of a challenge and support your child’s mobility and independence.
Exercises to Improve Gait
Parkinsonian gait will improve with physical therapy and other activities that teach other “strategies” for walking. Some of these workouts are doable at home. To determine which exercises help, patients can try some of the above therapies:
Increasing Range of Movement and Mobility
Your child’s stability, gait, and stiffness can improve by increasing flexibility. For example, if your child is old enough, try these workouts:
- Sit your child on a chair and slant their upper body to the right and left at the waist.
- Turn your child’s upper body to the right and left while crawling on all fours. As your child turns, they should raise the arm on the side they are turning to.
In addition to these stretches, decades of research have shown that using audio or visual cues can be a helpful tool for people with Parkinsonian gait. These cues work by allowing the brain to find alternative ways to transmit walking instructions—essentially helping the body bypass damaged neural pathways and form new ones. Physiotherapists may use verbal cues, rhythmic counting, or even visual aids laid on the floor to encourage smooth, confident movement. For example, counting out loud or stepping to a rhythmic beat can help reconnect the mind and body, making each step more controlled.
Strengthen Your Child’s Lower Body as Well
Strength training can help your child become more balanced, cover more ground, and even walk faster. The following exercises will help:
Leg Presses
Use your child’s legs to push a weight away from his or her body while seated.
Squats
Set your child in an upright position with their legs a little wider than hip-width apart. To prevent your child’s knees from crossing, your child should bend their knees while pulling their glute muscles back.
Exercise Bike
Using a recumbent electric bicycle, which is a stationary cycle with a back your child can lean on while standing with their legs straight out in front, will help strengthen their legs.
Frequently Get Into and Out of a Chair
Your child may build up their leg and core muscles by repeatedly sitting down and getting up. Additionally, it aids in the development of practical skills.
Why do these strategies matter? By combining targeted exercises with cueing techniques, your child may not only take longer and more confident steps but also break through those frustrating moments when their feet seem “stuck.” These approaches can reduce the risk of falls and increase muscle tone, flexibility, and bone strength, helping your child maintain their independence and well-being for longer. As always, consult with your child’s doctor or physical therapist to create a personalized plan that addresses their specific needs and abilities.
How Physiotherapists Use Cues and Aids to Support Better Movement
Physical therapists incorporate a variety of strategies to help children with Parkinsonian gait move more smoothly and confidently. One well-established approach involves the use of cues—either audio or visual—that prompt the brain to discover new pathways around impaired connections.
For example, therapists may place brightly colored tape or markers on the ground to guide footsteps and encourage longer, more deliberate strides. Sometimes, they’ll use rhythmic cues like clapping, metronomes, or even counting aloud together with your child. This rhythm helps synchronize brain and body, making walking feel more natural and less likely to ‘freeze up’ mid-step.
Additionally, therapists might encourage children to focus on saying “heel-toe” out loud with every step, or to follow a certain beat when walking next to a caregiver. These simple techniques, used consistently in therapy sessions or daily routines, can gradually help children develop new and more stable movement patterns—even when the usual pathways in the brain aren’t working as well as they should.
Potential Benefits of Improving Parkinsonian Gait
Enhancing your child’s Parkinsonian gait can have far-reaching effects on both physical health and overall well-being. By focusing on gait improvement, children often experience fewer falls and a lowered risk of injuries from losing balance. With more stable walking, daily activities become easier and less stressful, leading to greater independence and confidence in movement.
Beyond these practical benefits, targeted exercises and interventions can also promote healthier muscle tone, increase flexibility, and support stronger bone density. These physical gains work together to help maintain overall mobility while supporting general health for longer periods. Importantly, as children gain confidence in their walking, they may become more eager to participate in social activities and hobbies, further enhancing quality of life and emotional resilience.
Choosing Medical City Children’s Orthopedics and Spine Specialists
Always consult with your doctor if your child begins to walk differently. If you come to one of our Medical City Children’s Orthopedics & Spine Specialists offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX, our pediatric orthopedic doctors will examine your child and recommend the best treatment option to repair the problem and get your child back playing.
As previously mentioned, our doctors at the Medical City Children’s Orthopedics and Spine Specialists will examine your child and understand the reasons for an unusual gait. At that point, the doctor will prepare an individualized treatment plan for your child if he finds the cause of the unusual gait. After correcting the problem, your child will resume his or her favorite activities. For athletes, it may take up to a year before they can resume their sport.
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Footnote:
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