Your Doctor Says You Have Gait Dysfunction – What You Should Know

Sometimes, it can feel like Parkinson’s is literally trying to pull you down to the ground as much as possible. Not only can the disease make you unbalanced, it negatively impacts your ability to walk itself. Doctors group these walking problems under the umbrella term “gait dysfunction,” and they not only make it harder for you to get from point A to point B, but increase your likelihood of suffering falls.

Unfortunately, gait dysfunction is a common symptom for Parkinson’s patients, so it is highly likely that you will need to find a way to deal with it as your disease progresses.

What does Parkinson’s gait dysfunction look like?

Parkinson’s gait dysfunction includes several specific features:

Shuffling Steps. Short, dragging steps with little-to-no foot clearance.

Slowness of Movement (aka Bradykinesia). Difficulty initiating movement and slow, stiff walking.

Freezing of Gait (FOG). This sudden, temporary inability to move the feet, often occurs when someone is turning or starting to walk.

Stooped Posture. You may find yourself leaning forward while walking, which can make balance more difficult.

Reduced Arm Swing. One or both arms may not swing naturally while walking.

Difficulty Turning. Parkinson’s patients frequently report having to take multiple small steps to turn around instead of pivoting smoothly.

What does it feel like to live with gait dysfunction? 

“I jokingly [say] a little leprechaun nailed my toes to the floor. I can not initiate that step!”

“My father had the leg freezing thing. Sometimes he’d be stuck in awkward places all night….too proud to call out for help.”

What does it feel like? Frustrating. Embarrassing. Exhausting. Scary. 

Here are some more general things to expect when dealing with gait dysfunction:

Loss of Control. People often describe feeling as though their body doesn’t respond the way they want. The brain sends the signal to move, but the legs don’t cooperate, leading to slow, awkward steps.

Slogging Through Heavy Mud. The act of walking may feel as if feet are stuck to the ground, making it difficult to take normal, fluid steps.

Stuck in Glue. Sudden “freezing” of movement can happen at any time, especially in crowded or narrow spaces. It can feel like your feet are glued to the floor even though you want to move forward.

Fear of Falling. You may feel unstable, especially if you experience a stooped posture or reduced arm swing, which affects balance. There’s a constant awareness that a fall could happen with any misstep.

Walking Takes Mental Energy… You’ve been walking without thinking about it since you were a toddler, but not anymore. With gait dysfunction, walking is a conscious effort. Every step might require significant concentration, which can be mentally exhausting.

…And Physical Energy. The difficulty of walking in a controlled manner can lead to fatigue, as you’re forced to put more energy into what once were automatic movements.

Unwanted Attention. Navigating stairs, narrow doorways, or busy environments can feel stressful and overwhelming. Simple tasks like getting up from a chair or turning around may take much longer and might cause people to stop and stare.

What do other people do to deal with their gait dysfunction?

“When I get ‘stuck’…I try to ‘count bounce’ or ‘count tap’…In essence, I have a mantra or a march, running in my head, ‘one, two, three, four, one, two, three, four…’ with every number I take a step and tap my hand on my leg.”

“I always push the shopping cart. It’s a good bumper and provides…a real good but temporary public walker. This also relieves some of the anxiety I feel about being in public, anxiety which always increases my Parkinson’s symptoms.”

“I was taught to make BIG movements. Easier said than done. Also focus on heel to toe stepping and landing flat. Proper shoes are key.”

“I discovered if I rock my spouse (he has PD) side to side he breaks out of it.”

“Counting usually works for my dad, or some kind of tone generator (a metronome) that makes a beat for you.”

“Sometimes when my dad’s foot can’t move at all, if he tries to stomp it in place instead of walking with it, he gets it going again. Also I carry a ribbon and put it down perpendicular in front of his foot and stepping over it somehow works.”

Is it possible to treat Parkinson’s gait dysfunction?

“First do you have [a] movement disorder specialist? If you do not get one.”

Treating Parkinson’s gait dysfunction may take a combination of medications, physical therapy, assistive devices and, in some cases, surgery. Worse, since Parkinson’s disease is progressive, gait dysfunction will naturally cause more problems as time goes by. Treatment aims to manage symptoms and improve mobility. 

Although you should discuss treatment options with your care providers, here’s an overview of the most common approaches:

Medications

Medications can help manage gait dysfunction, by addressing the dopamine deficiency in the brain.

Levodopa (with Carbidopa). The most common and effective medication for treating Parkinson’s motor symptoms – including gait issues. It increases dopamine levels, improving movement control.

Dopamine agonists. These mimic dopamine’s effects in the brain, although they are generally less effective than Levodopa. They may help with gait in early or less advanced stages.

MAO-B inhibitors. These drugs block the enzyme that breaks down dopamine, prolonging its effect and sometimes improving gait.

COMT inhibitors. Often used alongside Levodopa to enhance its effectiveness by preventing its breakdown in the body.

Physical Therapy and Rehabilitation

This type of treatment can be broken down further into three kinds of exercises: gait training, balance training, and strength and flexibility training.

Gait Training. Physical therapists can help retrain your brain to improve walking patterns. They often use techniques like verbal or auditory cues (e.g., clapping or metronome beats) to help overcome freezing episodes or encourage larger steps.

Balance Training. Exercises focused on improving balance and reducing the risk of falls are key. Tai Chi and dance therapy have been found beneficial.

Strength and Flexibility Training. This can help with posture, mobility, and overall body control, which can enhance stability and gait.

Occupational Therapy

Occupational therapists can help you modify your environment and daily activities to maintain independence and safety. They teach strategies for managing gait dysfunction in real-world settings, like navigating stairs or avoiding obstacles.

Cognitive and Visual Cues

External cues help you bypass the brain’s impaired automatic movement processes so you can get going again.

Auditory cues. Rhythmic beats, music, or even counting steps can help keep you moving or “jumpstart you” if you get stuck.

Visual cues. Stripes or lines on the floor can help you visualize where to step, which can improve stride length and reduce freezing episodes.

Deep Brain Stimulation (DBS)

DBS is a surgical option for people with advanced Parkinson’s who don’t respond well to medications. Electrodes implanted in the brain deliver electrical pulses that can help manage motor symptoms, including gait dysfunction. 

While not a cure, DBS can significantly improve mobility and reduce freezing episodes in some patients.

Experimental Therapies

Treatment options are always evolving. These two options are still relatively rare, but there are some doctors who use them.

Exoskeletons. These wearable robotic devices assist with walking by providing external support to your legs.

Virtual Reality Training. In some studies, VR has been used to simulate walking environments, helping individuals practice and improve their gait in a controlled, immersive setting.

Lifestyle Changes

Some of the main culprits associated with gait dysfunction include stiffness and rigidity and stress and anxiety. How can you minimize these things?

Regular Exercise. Walking, swimming, or cycling can help maintain mobility and flexibility while reducing the stiffness and rigidity associated with Parkinson’s. This can help prevent gait dysfunction from getting worse.

Mindfulness and Relaxation Techniques. Dealing with gait dysfunction is stressful – and more stress and anxiety can exacerbate gait issues like freezing. It’s a Catch-22! Thankfully, relaxation practices like meditation can help reduce your mental strain and improve walking patterns.

Botox Injections

That’s right, Botox! In some cases, Botox injections can be used to treat muscle rigidity in the legs that can contribute to gait difficulties. It relaxes the muscles, improving your range of movement.

Behavioral Interventions

Learning new walking strategies, such as consciously exaggerating your steps or taking large strides, can help improve gait. Therapists often teach techniques to overcome freezing episodes, like shifting your body weight side-to-side before stepping.

Will my gait ever get better?

Parkinson’s is such an individual disease that it is impossible to answer this question for a specific person. That being said, the general finding is that there are a variety of treatments that can improve gait – especially in the earlier stages of the disease. However, as Parkinson’s progresses, your gait dysfunction likely will as well.

How long can gait improvements last?

The duration of improvement to your gait dysfunction will depend on several factors, including the type of treatment, the stage of the disease, and individual variability. 

Here’s an overview of how long improvements may last with different treatments:

Medications

Some medications can lead to rapid improvements in motor symptoms, including gait. These improvements are usually noticeable within 30–60 minutes of taking the medication, and in the early stages of Parkinson’s, can last for several hours after taking a dose. 

However, as the disease progresses, people tend to experience fluctuations— “on” periods when the medication is working well and “off” periods when symptoms return. Over time (often 3–5 years after starting treatment), the duration of symptom relief after each dose may shorten, and adjustments to your medication regimen may be needed.

Deep Brain Stimulation (DBS)

Research suggests that DBS can lead to sustained benefits for 5–10 years – or more – though it is most effective in reducing motor complications like tremor, dyskinesia (involuntary movements), and “off” periods. However, the response to DBS can vary, and its effectiveness may diminish as Parkinson’s progresses.

Physical Therapy and Gait Training

With regular and consistent practice, physical therapy can lead to long-lasting improvements in gait. However, stopping therapy may result in a decline in gait function over time, particularly as the disease progresses. Continued therapy is often needed to maintain benefits.

Exercise Programs (Tai Chi, Dance Therapy, Yoga)

Exercise programs aimed at improving balance, strength, and flexibility can lead to improvements in gait that may last for months or years if you continue with regular exercise. These activities help maintain mobility and reduce stiffness, making it easier to walk with fewer disruptions, with some research suggesting patients who engage in regular exercise have a slower progression of motor symptoms.

Cueing Strategies (Auditory/Visual Cues)

For some individuals, repeated use of cues may help them internalize improved walking patterns, leading to more sustained benefits, but these effects typically require ongoing cueing or training to maintain.

Botox Injections

The effects of Botox typically last 3–4 months, after which the injections need to be repeated to maintain the benefits.

Assistive Devices

Walking aids like canes, walkers, or specialized devices that provide auditory or visual cues can lead to immediate and lasting improvements in gait, as long as the device is used. However, once the aid is removed, the person may revert to the previous gait dysfunction.

Behavioral and Cognitive Strategies

Cognitive strategies to manage freezing of gait or other gait issues, such as shifting weight or exaggerating steps, can provide short-term improvements while you’re actively focused on walking. These strategies often require consistent mental effort and may only last as long as the person can maintain concentration.

Should I get surgery for my gait dysfunction?

The effectiveness of surgery varies depending on your specific condition, the stage of the disease, and the particular symptoms being treated. That being said, surgery – particularly DBS – can significantly help improve gait dysfunction in many cases. 

Here’s how surgery can help… and its potential limitations.

Deep Brain Stimulation (DBS)

DBS is the most common surgical intervention for Parkinson’s disease. It involves implanting electrodes in specific parts of the brain (usually the subthalamic nucleus or globus pallidus), which are connected to a small device (similar to a pacemaker) implanted in the chest. This device sends electrical impulses to the brain, helping regulate abnormal signals that cause motor symptoms.

How DBS Helps with Gait Dysfunction

Motor Symptoms. DBS is particularly effective at reducing the stiffness and slowness associated with Parkinson’s, allowing for smoother and more natural steps. This can significantly improve your ability to walk.

Less Medication. Many people are able to reduce their medication doses after DBS surgery, which can help decrease side effects such as dyskinesia (involuntary movements) that might interfere with walking.

Longer “On” Periods. DBS can help extend the duration of “on” periods (when medication is working well) and reduce “off” periods (when symptoms return), providing more consistent motor control – including control over your gait.

Reduced FOG. DBS has been shown to reduce freezing of gait in some individuals, although the response is more variable. FOG is a complex symptom and doesn’t always respond as well as other motor symptoms like tremors or rigidity.

How Long DBS Benefits Last

While DBS can improve many of the motor symptoms related to Parkinson’s, it doesn’t stop the progression of the disease or the development of new or worsening symptoms. Still, DBS has been found to provide long-term improvements for 5–10 years or more in many patients. 

Factors Affecting How Successful DBS Is in Improving Your Gait 

Stage of Disease. DBS is most effective at improving gait when it’s performed in the early to middle stages of Parkinson’s. In advanced stages, gait issues – especially related to balance – are less responsive to DBS.

Freezing of Gait. DBS can reduce FOG in some patients, but it is less predictable. FOG that occurs in “off” periods often responds better to DBS than FOG that occurs in “on” periods.

Type of Gait Dysfunction. DBS tends to improve gait issues related to rigidity, slowness, and tremors. However, problems with balance, postural instability, and cognitive-related gait issues are generally less responsive.

Target DBS Area. The way DBS works, it targets a specific area in the brain (subthalamic nucleus vs. globus pallidus). Which one your surgery targets can influence how well the DBS improves your gait.

For example, stimulation of the subthalamic nucleus often leads to a more significant reduction in medication, while stimulation of the globus pallidus may have a more favorable effect on reducing dyskinesia.

Limitations of DBS in Gait Dysfunction

Although DBS is highly effective in treating certain motor symptoms, it may not fully resolve postural instability (balance problems) or certain types of gait dysfunction, particularly as the disease progresses. 

Moreover, DBS does not directly improve non-motor symptoms of Parkinson’s, such as cognitive impairment, depression, or autonomic dysfunction, which may indirectly affect mobility and gait.

Other Surgical Options

While DBS is the most common surgical treatment for Parkinson’s, there are other, less commonly used surgical interventions, including:

Lesioning Procedures (Thalamotomy or Pallidotomy). These involve destroying a small area of the brain (the thalamus or globus pallidus) that is causing motor symptoms. These procedures were more common before DBS but are used less frequently today because DBS is adjustable and reversible, while lesioning is permanent. Still, they can be helpful in reducing symptoms.

Focused Ultrasound. This non-invasive procedure uses sound waves to destroy targeted areas of the brain involved in motor symptoms. It is FDA-approved for treating tremors and is being explored as a treatment for other Parkinson’s symptoms, though its role in treating gait dysfunction is still under investigation.

Ongoing Research and Future Directions

As with all Parkinson’s treatments, research is always ongoing for better surgical options to improve results. These are currently some of the most promising.

Adaptive DBS. Newer advancements in DBS technology, such as adaptive DBS, automatically adjust the stimulation based on brain signals in real time. This could lead to better outcomes for motor symptoms, including gait dysfunction, and more consistent symptom control.

Combination Therapies. Researchers are exploring the combination of DBS with other therapies, such as medication adjustments or physical therapy, to improve outcomes in gait dysfunction.