Freezing of gait is responsible for 61% of falls in Parkinson's disease. If you live with or care for someone with PD, you will almost certainly encounter it. The good news is that there are specific, proven techniques to help break a freeze — and with practice, they become second nature.
What's actually happening during a freeze
During a freezing episode, communication between the basal ganglia, the supplementary motor area (which plans sequences of movement), and the pedunculopontine nucleus (PPN, the brain's "walking centre") breaks down. The person wants to walk, they're trying to walk, but the dopaminergic signal that would normally trigger the next step in the gait cycle isn't getting through. Their upper body may continue its forward momentum while their feet stay planted, which is exactly why freezing leads to falls.
Importantly, FOG is not the same as akinesia (inability to initiate any movement) — during a freeze, the person can often move their arms, speak, and even turn their head normally. It is specifically the locomotor programme that stalls. A freeze typically lasts a few seconds to a minute, though it can feel much longer for everyone involved. They most commonly happen:
- In doorways — the brain struggles with the transition between spaces
- When turning — especially in tight spaces like bathrooms
- When starting to walk — the initiation of movement is disrupted
- When approaching a destination — a chair, the car, a doorway
- Under stress or time pressure — anxiety worsens freezing significantly
- During "off" periods — when levodopa/carbidopa (Sinemet) levels drop between doses, restoring the dopamine deficit
What to do in the moment
First: what NOT to do
Do not grab their arm and pull. This is the most common instinct and the most dangerous. Pulling someone who is frozen throws them off balance and can cause both of you to fall. Do not push them from behind. Do not rush them or say "just walk."
Instead, try these techniques in order. Different things work for different people, so experiment to find what works best for your loved one.
Stay calm and give them a moment
Take a breath yourself. Anxiety is contagious, and stress makes freezing worse. Say something reassuring like "Take your time, there's no rush." Sometimes a freeze will pass on its own within a few seconds.
Try a verbal counting cue
Stand near them (not behind) and count rhythmically: "One, two, three, STEP." This works because external auditory cues bypass the damaged basal ganglia circuitry and instead route the movement command through the frontal cortex and cerebellar pathways — intact brain regions that can take over gait initiation. Many people find this is the most reliable technique.
Use a visual target
Place your foot in front of theirs and ask them to step over it. Or point to a spot on the floor and say "Step to here." You can also shine a laser pointer to create a line on the floor. The visual target gives the brain something concrete to aim for.
Shift weight side to side
Ask them to gently rock from one foot to the other, like a slow pendulum. This weight shifting can "unlock" the freeze by re-engaging the walking pattern. Once they're rocking, ask them to take a step on the next shift.
Try marching in place
Ask them to lift their knees high, as if marching. Sometimes the exaggerated movement pattern is easier for the brain to initiate than a normal step. Once they're marching, they can often transition into walking.
Suggest a direction change
If they're frozen heading forward, try asking them to take a step sideways or even backwards first. Sometimes a different direction of movement can bypass the freeze, and then they can redirect forward.
The music trick
Many people with PD can walk perfectly in time to music even when they can't walk on their own. The rhythm provides a continuous external cue. If your parent freezes frequently, try humming a marching song or playing music with a strong beat on your phone. Some families keep a small Bluetooth speaker handy for walks.
Preventing freezing episodes
While you can't eliminate freezing entirely, you can reduce how often it happens:
Widen the turns
Tight pivoting turns are a major trigger. Encourage your parent to make wide, sweeping U-turns instead of pivoting on the spot. In hallways, walk in a large arc rather than making a sharp turn at the corner.
Slow down at doorways
Doorways are the number one trigger. Approach them deliberately, pause just before the threshold, then step through with a conscious, large step. Some people find it helps to aim for a specific spot on the floor just past the doorway.
Time activities with the levodopa cycle
Freezing is much worse during "off" periods — the windows when levodopa/carbidopa (Sinemet) has worn off and dopamine levels in the brain drop. Schedule trips to the shops, doctor's appointments, and outings during "on" periods when the medication is at peak effect (typically 30-90 minutes after a dose). Keep a log to understand your parent's on-off fluctuation pattern. If off periods are unpredictable, discuss adding an MAO-B inhibitor (rasagiline, selegiline) or a COMT inhibitor (entacapone) with the neurologist to extend levodopa's duration.
Reduce stress
Stress and anxiety are powerful freezing triggers. The more someone worries about freezing, the more likely it is to happen. A calm, unhurried environment makes a real difference. Never stand behind someone and say "hurry up."
Use environmental cues at home
Place strips of colored tape on the floor at common freezing points — doorways, the entrance to the bathroom, the approach to favourite chairs. These visual cues give the brain a target to step over, reducing freezing before it starts.
Talk to a physical therapist about cueing strategies
A PT experienced with Parkinson's can assess which types of cues work best for your parent and create a personalised toolkit. The APTA clinical practice guidelines give a strong recommendation for external cueing to reduce freezing of gait, backed by high-quality evidence.
When freezing gets worse
If your parent's freezing episodes are becoming more frequent or longer, tell their neurologist. This can indicate:
- Levodopa dose needs adjusting — the neurologist may change the timing, add a controlled-release formulation, or supplement with a dopamine agonist (pramipexole, ropinirole, or the rotigotine patch)
- The disease is progressing — worsening FOG may reflect advancing Hoehn and Yahr stage and cholinergic (acetylcholine) depletion, not just dopamine loss
- A new factor is contributing — anticholinergic medications (including some over-the-counter antihistamines and bladder drugs), benzodiazepines, or cognitive decline can all worsen freezing
- For severe, medication-resistant FOG, deep brain stimulation (DBS) targeting the subthalamic nucleus or pedunculopontine nucleus (PPN) is being studied in clinical trials
Freezing is one of the most manageable symptoms of PD when the right strategies are in place. It takes practice — for both you and your parent — but the cueing techniques described above work for the vast majority of people. Be patient with each other as you figure out what helps most.
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