The effect of doorway characteristics on freezing of gait in Parkinson's disease

BackgroundFreezing of gait is a debilitating symptom in Parkinson's disease, during which a sudden motor block prevents someone from moving forward. Remarkably, doorways can provoke freezing. Most research has focused on the influence of doorway width, and little is known about other doorway characteristics influencing doorway freezing.ObjectiveFirstly, to provide guidelines on how to design doorways for people with freezing. Secondly, to compare people with doorway freezing to people without doorway freezing, and to explore the underlying mechanisms of doorway freezing.MethodsWe designed a web-based, structured survey consisting of two parts. Part I (n = 171 responders), open to people with Parkinson's disease with freezing in general, aimed to compare people with doorway freezing to people without doorway freezing. We explored underlying processes related to doorway freezing with the Gait-Specific Attention Profile (G-SAP), inquiring about conscious movement processes occurring during doorway passing. Part II (n = 60), open for people experiencing weekly doorway freezing episodes, inquired about the influence of specific doorway characteristics on freezing.ResultsPeople with doorway freezing (69% of Part I) had higher freezing severity, longer disease duration, and scored higher on all sub scores of the G-SAP (indicating heightened motor, attentional, and emotional thoughts when passing through doorways) than people without doorway freezing. The main categories provoking doorway freezing were: dimensions of the door and surroundings, clutter around the door, lighting conditions, and automatic doors.ConclusionWe provide recommendations on how to maximally avoid freezing in a practical setting. Furthermore, we suggest that doorways trigger freezing based on visuomotor, attentional, and emotional processes.