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Publication year
2008Source
Movement Disorders, 23 Suppl 2, 2, (2008), pp. S468-74ISSN
Publication type
Article / Letter to editor
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Organization
Neurology
Donders Centre for Cognitive Neuroimaging
Rehabilitation
Geriatrics
Former Organization
F.C. Donders Centre for Cognitive Neuroimaging
Journal title
Movement Disorders
Volume
vol. 23 Suppl 2
Issue
iss. 2
Page start
p. S468
Page end
p. 74
Subject
111 000 Intention & Action; 111 007 Freezing of gait in Parkinson Disease; DCN 1: Perception and Action; DCN 2: Functional Neurogenomics; EBP 2: Effective Hospital Care; EBP 4: Quality of Care; NCEBP 10: Human Movement & Fatigue; NCEBP 6:Quality of nursing and allied health care; UMCN 3.2 Cognitive Neurosciences; UMCN 3.2: Cognitive neurosciencesAbstract
The clinical assessment of freezing of gait (FOG) provides great challenges. Patients often do not realize what FOG really is. Assessing FOG is further complicated by the episodic, unpredictable, and variable presentation, as well as the complex relationship with medication. Here, we provide some practical recommendations for a standardized clinical approach. During history taking, presence of FOG is best ascertained by asking about the characteristic feeling of "being glued to the floor." Detection of FOG is greatly facilitated by demonstrating what FOG actually looks like, not only to the patient but also to the spouse or other carer. History taking further focuses on the specific circumstances that provoke FOG and on its severity, preferably using standardized questionnaires. Physical examination should be done both during the ON and OFF state, to judge the influence of treatment. Evaluation includes a dedicated "gait trajectory" that features specific triggers to elicit FOG (gait initiation; a narrow passage; dual tasking; and rapid 360 degrees axial turns in both directions). Evaluating the response to external cues has diagnostic importance, and helps to determine possible therapeutic interventions. Because of the tight interplay between FOG and mental functions, the evaluation must include cognitive testing (mainly frontal executive functions) and judgment of mood. Neuroimaging is required for most patients in order to detect underlying pathology, in particular lesions of the frontal lobe or their connections to the basal ganglia. Various quantitative gait assessments have been proposed, but these methods have not proven value for clinical practice.
This item appears in the following Collection(s)
- Academic publications [238441]
- Donders Centre for Cognitive Neuroimaging [3824]
- Electronic publications [122537]
- Faculty of Medical Sciences [90373]
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