People without Parkinson’s disease (PD) do not think about their walking. Their arms naturally swing, and their feet naturally land on the heels with each step. They can walk and talk and carry bags, purses and plates of food without difficulty.
Individuals with PD tend to lose their automatic movements. Especially as Parkinson’s advances, it may bring with it a variety of symptoms that are uncommon in early stages, such as problems with walking (gait abnormalities) and poor balance (postural instability). Feet begin to shuffle and performing two tasks at once becomes more difficult. Turning becomes challenging, often leading to a freezing episode and sometimes a fall.
Movement and Sensory Changes
People with PD have trouble regulating the speed and/or size of their movements. Movements are bradykinetic (too slow) or hypokinetic (too small).
Movement System Changes
These changes can lead to challenges controlling movements, including:
- Starting and stopping movements
- Automatically controlling muscles
- Linking different movements to accomplish one task (e.g., moving from sitting to standing)
- Finishing one movement before beginning the next (e.g., not completely turning around before sitting down)
Sensory System Changes
These changes can lead to challenges, particularly noticing and correcting movement and voice issues, including:
- Slowness or smallness of movements (e.g., when told to make the movement bigger, a person with PD may feel the movement is now “too big”)
- Lack of movement (e.g., an arm that does not swing during walking)
- Changes in posture
- Changes in voice volume (e.g., when told to speak louder, a person with Parkinson’s may feel they are shouting)
Walking Changes
Parkinson’s disease can change how a person walks. Slow movement, stiffness and rigidity make walking normally harder. There are many PD-related walking changes:
- Smaller steps
- Slower speed
- Less trunk movement (especially rotation)
- A narrow base of support (feet too close together)
- Less or absent arm swing (on one side of the body or both)
- Trouble turning
- The feet land flat on the floor with each step instead of on the heel (can lead to shuffling and falls)
- Festination or shuffling (quick, small, involuntary steps forward; often accompanied by stooped posture)
- Retropulsion (quick, small, involuntary steps backward)
Freezing
Some people experience “freezing,” the temporary, involuntary inability to move. This can occur at any time, though it tends to occur when initiating a step, turning or navigating through doorways. It can be a serious problem, as it may increase risk of falling.
Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson’s Foundation Center of Excellence.
