Freezing of gait in Parkinson's disease: a perceptual cause for a motor impairment?

While freezing of gait (FOG) is typically considered a motor impairment, the fact that it occurs more frequently in confined spaces suggests that perception of space might contribute to FOG. The present study evaluated how doorway size influenced characteristics of gait that might be indicative of freezing. Changes in spatiotemporal aspects of gait were evaluated while walking through three different-sized doorways (narrow (0.675 m wide x 2.1 m high), normal (0.9 m wide x 2.1 m high) and wide (1.8 m wide x 2.1 m high)) in three separate groups: 15 individuals with Parkinson's disease confirmed to be experiencing FOG at the time of test; 16 non-FOG individuals with Parkinson's disease and 16 healthy age-matched control participants. Results for step length indicated that the FOG group was most affected by the narrow doorway and was the only group whose step length was dependent on upcoming doorway size as indicated by a significant interaction of group by condition (F(4,88)=2.73, p<0.034). Importantly, the FOG group also displayed increased within-trial variability of step length and step time, which was exaggerated as doorway size decreased (F(4,88) 2.99, p<0.023). A significant interaction between group and condition for base of support measures indicated that the non-FOG participants were also affected by doorway size (similar to Parkinson's disease FOG) but only in the narrow doorway condition. These results support the notion that some occurrences of freezing may be the result of an underlying perceptual mechanism that interferes with online movement planning.