Donders Institute for Brain, Cognition, and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
Anke H. Snijders, M.D. and Bastiaan R. Bloem, M.D.
April 01, 2010
N Engl J Med 2010; 362:e46 | The New England Journal of Medicine as published by New England Journal of Medicine.
A 58-year-old man with a 10-year history of idiopathic Parkinson’s disease presented with an incapacitating freezing of gait (Panel A, Video 1). The patient had severe difficulties initiating gait and was able to take only a few shuffling steps when provided with a visual cue (the examiner’s foot placed in front of the patient). Attempts to walk evolved rapidly into forward festination and ultimately a fall to the ground. Axial turning was impossible. However, the patient’s ability to ride a bicycle was remarkably preserved (Panel B, Video 2). Gait freezing recurred instantaneously after he dismounted the bicycle. This striking kinesia paradoxica may be explained by the bicycle’s rotating pedals, which may act as an external pacing cue. Alternatively, the motor-control mechanisms involved in gait as compared with other activities engaging the legs, such as cycling, could be affected differentially in Parkinson’s disease. Cycling may offer a useful approach for exercise training in patients with Parkinson’s who are “grounded” by severe freezing of gait. (Editor’s note: In Video 2, the patient is not wearing a safety helmet because in the Netherlands, unlike the United States, wearing a safety helmet is neither required by law nor customary.)
The above article is © Copyright 2010 Massachusetts Medical Society.