PARKINSONIAN GAIT

QUESTIONS AND ANSWERS

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:

Healthline: Parkinsonian Gait