Everyone who has or treats people with Parkinson’s disease should check out an article titled “Compensation Strategies for Gait Impairments in Parkinson Disease” by Nonnekes et al in JAMA Neurology, June 2019.

Impaired walking, postural instability and falls are the main causes of disability in Parkinson’s, with cognitive impairment not far behind. They often do not respond to increasing doses of Levodopa. Sudden, brief episodes of inability to produce forward stepping, termed freezing of gait, are especially dangerous.

Compensation strategies are consciously generated goal-directed movements that can overcome the loss of control of automatic behaviors. Think of the widely used “big and loud” techniques. An early case report came from Denmark where a neurologist was shocked to learn that his patient who could hardly walk bicycled easily to and from the clinic.

The review article describes many strategies that patients themselves have identified. The list is long and includes bouncing a ball, crossing one’s legs, counting, knee-lifting, skating movements, making wider turns, walking sideways, and, yes, walking backwards.

Listen to your patients. They’ll tell you everything you need to know.

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