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 × 2.1 m high), normal (0.9 m wide × 2.1 m high) and wide (1.8 m wide × 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.

Individuals with Parkinson's disease (PD) commonly experience freezing of gait under time constraints, in narrow spaces, and in the dark. One commonality between these different situations is that they may all provoke anxiety, yet anxiety has never been directly examined as a cause of FOG. In this study, virtual reality was used to induce anxiety and evaluate whether it directly causes FOG. Fourteen patients with PD and freezing of gait (Freezers) and 17 PD without freezing of gait (Non-Freezers) were instructed to walk in two virtual environments: (i) across a plank that was located on the ground (LOW), (ii) across a plank above a deep pit (HIGH). Multiple synchronized motion capture cameras updated participants' movement through the virtual environment in real-time, while their gait was recorded. Anxiety levels were evaluated after each trial using self-assessment manikins. Freezers performed the experiment on two separate occasions (in their ON and OFF state). Freezers reported higher levels of anxiety compared to Non-Freezers (p<0.001) and all patients reported greater levels of anxiety when walking across the HIGH plank compared to the LOW (p<0.001). Freezers experienced significantly more freezing of gait episodes (p = 0.013) and spent a significantly greater percentage of each trial frozen (p = 0.005) when crossing the HIGH plank. This finding was even more pronounced when comparing Freezers in their OFF state. Freezers also had greater step length variability in the HIGH compared to the LOW condition, while the step length variability in Non-Freezers did not change. In conclusion, this was the first study to directly compare freezing of gait in anxious and non-anxious situations. These results present strong evidence that anxiety is an important mechanism underlying freezing of gait and supports the notion that the limbic system may have a profound contribution to freezing in PD.

The main objective of this study was to determine how manipulating the amount of sensory information available about the body and surrounding environment influenced freezing of gait (FOG), while walking through a doorway. It was hypothesized that the more limited the sensory information, the greater the occurrence of freezing of gait. Nineteen patients with Parkinsoǹs disease who experience freezing of gait (PD-FOG) walked through a doorway or into open space in complete darkness. The three doorway conditions included: (i) FRAME (DARK) – walking through the remembered door frame; (ii) FRAME - walking through the door with the door frame illuminated; (iii) FRAME+BODY - walking through the door (both the door and the limbs illuminated). Additionally, two conditions of walking away from the doorway included: (iv) NO FRAME (DARK) - walking into open space; (v) NO FRAME+BODY - walking into open space with the limbs illuminated, to evaluate whether perception (or fear) of the doorway might account for FOG behaviour. Key outcome measures included: the number of freezing of gait episodes recorded, total duration of freezing of gait, and the percentage of time spent frozen. Significantly more freezing of gait episodes occurred when participants walked toward the doorway in complete darkness compared to walking into open space (p<0.05). Similar to previous studies, velocity (p<0.001) and step length (p<0.0001) significantly decreased when walking through the door in complete darkness, compared to all other conditions. Significant increases in step width variability were also identified but only when walking into open space (p<0.005). These results support the notion that sensory deficits may have a profound impact on freezing of gait that need to be carefully considered.