Understanding
Movement

Your body’s ability to move is dictated by your brain. The brain formulates the signal to begin walking, or move your arm, and then sends that signal down a neural pathway, through your nervous system, to the part of your body that your brain is instructing to move.

Normally, the body receives that signal and responds with the movement you want. The brain chooses the neural pathway it needs to send the message further down the body, and it just happens. You don’t have to consciously tell your body to start walking, or think about it at all — it’s automatic.

If your brain experiences some damage in critical areas, those automatic signals can have difficulty getting through.

Parkinson’s Disease (PD) occurs when the area of the brain responsible for transmitting movement-related messages begins to fail, resulting in a slow degeneration of the neural pathways that the brainwaves rely on to communicate with the body.

When the cells in this important part of the brain stop working, they stop producing dopamine, which is the chemical those messages rely on to be able to reach the body for movement and coordination.

As the level of dopamine drops to where the brain no longer has enough of this chemical to consistently connect with the body, movement and coordination progressively become affected — especially smooth and automatic movement that you’ve taken for granted. These symptoms gradually worsen over time, though the symptoms themselves, and the speed of progression, vary widely from person to person.

Parkinson’s primarily affects movement, but can also cause some cognitive changes, and impact emotions. It can become more difficult to focus on more than one thing at a time, and the process of thinking may become slower. People frequently report feelings of apathy, depression and anxiety.

PD can make movement more difficult, to the extent that it significantly increases the risk of falls, 1, 2, 3 however activity itself is vital to managing the condition. In fact, exercise has been shown to slow the progression of Parkinson’s Disease 37, so finding ways to remain as active as possible, exercising regularly, is incredibly important.

Learn more about Parkinson’s Disease

Understanding Parkinson’s Disease

How does PD affect movement?

Elderly Man with Walking Device

NexStride: A Moving Story

Sidney Collin, inspired by her meeting with Jack Brill, sought to change how people with Parkinson’s Disease move. By incorporating leading research into a mobility device to help with the symptoms of Parkinsonian gait or Freezing of gait, NexStride was born.

Cueing In NexStride

nextstride laser feature

NexStride is the first multi-cue daily assist device that attaches to any standard cane, walker, or walking pole. Users can activate the audio cue, visual cue, or both, and adjust to preferred speed and distance.

These visual and audio cues help users re-establish the connection between the brain and the body and allow the user to walk smoothly again.

Sources
  1. Sparrow D, DeAngelis TR, Hendron K, Thomas CA, Saint-Hilaire M, Ellis T. Highly challenging balance program reduces fall rate in parkinson disease. Journal of neurologic physical therapy : JNPT. 2016;40(1):24-30.doi:10.1097/npt.0000000000000111
  2. Understanding parkinson’s 2020; https://www.parkinson.org/understanding-parkinsons, 2020.
  3. Klamroth S, Steib S, Devan S, Pfeifer K. Effects of exercise therapy on postural instability in parkinson disease: A meta-analysis. Journal of Neurologic Physical Therapy. 2016;40(1):3-14.doi:10.1097/npt.0000000000000117
  4. Chen P-H, Liou D-J, Liou K-C, Liang J-L, Cheng S-J, Shaw J-S. Walking turns in parkinson's disease patients with freezing of gait: The short-term effects of different cueing strategies. International Journal of Gerontology. 2016;10(2):71-75.doi:https://doi.org/10.1016/j.ijge.2014.09.004
  5. Ginis P, Nackaerts E, Nieuwboer A, Heremans E. Cueing for people with parkinson's disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives. Annals of physical and rehabilitation medicine. 2018;61(6):407-413.doi:10.1016/j.rehab.2017.08.002
  6. Lundy-Ekman L. Basal ganglia, cerebellum, and movement. . Neuroscience: Fundamentals for rehabilitation. . 4 ed. St. Louis: Elsevier Saunders; 2013.
  7. King LA, Horak FB. Delaying mobility disability in people with parkinson disease using a sensorimotor agility exercise program. Phys Ther. 2009;89(4):384-393.doi:10.2522/ptj.20080214
  8. Parkinson’s disease. 2020; https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055, 2020.
  9. Understanding the basics of parkinson’s disease. 2020; https://www.apdaparkinson.org/what-is-parkinsons/.
  10. Hoehn M, Yahr M. Parkinsonism: Onset, progression, and mortality. Neurology. 2011;77(9):874-874.doi:10.1212/01.wnl.0000405146.06300.91
  11. Geroin C, Nonnekes J, de Vries NM, et al. Does dual-task training improve spatiotemporal gait parameters in parkinson's disease? Parkinsonism & related disorders. 2018;55:86-91.doi:https://doi.org/10.1016/j.parkreldis.2018.05.018
  12. Vitório R, Teixeira-Arroyo C, Lirani-Silva E, et al. Effects of 6-month, multimodal exercise program on clinical and gait parameters of patients with idiopathic parkinson's disease: A pilot study. ISRN Neurol. 2011;2011:714947-714947.doi:10.5402/2011/714947
  13. Vance RC, Healy DG, Galvin R, French HP. Dual tasking with the timed "up & go" test improves detection of risk of falls in people with parkinson disease. Phys Ther. 2015;95(1):95-102.doi:10.2522/ptj.20130386
  14. Mak MK, Pang MY. Balance confidence and functional mobility are independently associated with falls in people with parkinson's disease. Journal of neurology. 2009;256(5):742-749.doi:10.1007/s00415-009-5007-8
  15. Hubble RP, Silburn PA, Naughton GA, Cole MH. Trunk exercises improve balance in parkinson disease: A phase ii randomized controlled trial. Journal of neurologic physical therapy : JNPT. 2019;43(2):96-105.doi:10.1097/npt.0000000000000258
  16. Hass CJ, Malczak P, Nocera J, et al. Quantitative normative gait data in a large cohort of ambulatory persons with parkinson's disease. PLoS One. 2012;7(8):e42337-e42337.doi:10.1371/journal.pone.0042337
  17. Grobbelaar R, Venter R, Welman KE. Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate parkinson's disease: A randomized controlled trial. Gait & posture. 2017;58:294-299.doi:10.1016/j.gaitpost.2017.08.019
  18. Panyakaew P, Bhidayasiri R. The spectrum of preclinical gait disorders in early parkinson's disease: Subclinical gait abnormalities and compensatory mechanisms revealed with dual tasking. Journal of neural transmission (Vienna, Austria : 1996). 2013;120(12):1665-1672.doi:10.1007/s00702-013-1051-8
  19. Rafferty MR, Prodoehl J, Robichaud JA, et al. Effects of 2 years of exercise on gait impairment in people with parkinson disease: The pret-pd randomized trial. Journal of neurologic physical therapy : JNPT. 2017;41(1):21-30.doi:10.1097/NPT.0000000000000163
  20. Nilsson MH, Jonasson SB, Zijlstra GAR. Predictive factors of fall-related activity avoidance in people with parkinson disease-a longitudinal study with a 3-year follow-up. Journal of neurologic physical therapy : JNPT. 2020;44(3):188-194.doi:10.1097/npt.0000000000000316
  21. Bieńkiewicz MM, Rodger MW, Young WR, Craig CM. Time to get a move on: Overcoming bradykinetic movement in parkinson's disease with artificial sensory guidance generated from biological motion. Behavioural brain research. 2013;253:113-120.doi:10.1016/j.bbr.2013.07.003
  22. Kawasaki T, Mikami K, Kamo T, et al. Motor planning error in parkinson's disease and its clinical correlates. PLoS One. 2018;13(8):e0202228.doi:10.1371/journal.pone.0202228
  23. Ebersbach G, Ebersbach A, Edler D, et al. Comparing exercise in parkinson's disease--the berlin lsvt®big study. Movement disorders : official journal of the Movement Disorder Society. 2010;25:1902-1908.doi:10.1002/mds.23212
  24. Lord S, Baker K, Nieuwboer A, Burn D, Rochester L. Gait variability in parkinson’s disease: An indicator of non-dopaminergic contributors to gait dysfunction? J Neurol. 2011;258(4):566-572.doi:10.1007/s00415-010-5789-8
  25. Penko AL, Streicher MC, Koop MM, Dey T, Alberts JL. Dual-task interference disrupts parkinson s gait across multiple cognitive domains. Neuroscience. 2018;379:375-382
  26. Stuart S, Galna B, Delicato LS, Lord S, Rochester L. Direct and indirect effects of attention and visual function on gait impairment in parkinson's disease: Influence of task and turning. The European journal of neuroscience. 2017;46(1):1703-1716.doi:10.1111/ejn.13589
  27. Wilhelm JL, King LA. Exercise for persons with parkinson disease: Important considerations of medication, assessment, and training. Journal of neurologic physical therapy : JNPT. 2015;39(2):93-94.doi:10.1097/npt.0000000000000081
  28. Tomlinson CL, Herd CP, Clarke CE, et al. Physiotherapy for parkinson's disease: A comparison of techniques. The Cochrane database of systematic reviews. 2014;2014(6):Cd002815.doi:10.1002/14651858.CD002815.pub2
  29. Perestelo-Pérez L, Rivero-Santana A, Pérez-Ramos J, Serrano-Pérez P, Panetta J, Hilarion P. Deep brain stimulation in parkinson's disease: Meta-analysis of randomized controlled trials. Journal of neurology. 2014;261(11):2051-2060.doi:10.1007/s00415-014-7254-6
  30. Löfgren N, Conradsson D, Joseph C, Leavy B, Hagströmer M, Franzén E. Factors associated with responsiveness to gait and balance training in people with parkinson disease. Journal of neurologic physical therapy : JNPT. 2019;43(1):42-49.doi:10.1097/npt.0000000000000246
  31. Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in parkinson's disease. Lancet Neurol. 2013;12(7):716-726.doi:10.1016/S1474-4422(13)70123-6
  32. Lirani-Silva E, Lord S, Moat D, Rochester L, Morris R. Auditory cueing for gait impairment in persons with parkinson disease: A pilot study of changes in response with disease progression. Journal of neurologic physical therapy : JNPT. 2019;43(1):50-55.doi:10.1097/npt.0000000000000250
  33. Rochester L, Nieuwboer A, Baker K, et al. The attentional cost of external rhythmical cues and their impact on gait in parkinson’s disease: Effect of cue modality and task complexity. Journal of Neural Transmission. 2007;114(10):1243.doi:10.1007/s00702-007-0756-y
  34. Spildooren J, Vercruysse S, Heremans E, et al. Influence of cueing and an attentional strategy on freezing of gait in parkinson disease during turning. Journal of neurologic physical therapy : JNPT. 2017;41(2):129-135.doi:10.1097/npt.0000000000000178
  35. Bologna M, Guerra A, Paparella G, et al. Neurophysiological correlates of bradykinesia in parkinson's disease. Brain : a journal of neurology. 2018;141(8):2432-2444.doi:10.1093/brain/awy155
  36. Stuart S, Mancini M. Prefrontal cortical activation with open and closed-loop tactile cueing when walking and turning in parkinson disease: A pilot study. Journal of neurologic physical therapy : JNPT. 2020;44(2):121-131.doi:10.1097/npt.0000000000000286
  37. https://n.neurology.org/content/98/8/e859