A 68-year-old enthusiastic soccer player with idiopathic Parkinson disease (PD) had unpredictable, immobilizing freezing of gait, which did not respond even to high doses of dopaminergic medication. By kicking a tennis ball attached to a rubber band, he could reliably overcome freezing (video on the Neurology® Web site at www.neurology.org.).
Paradoxical kinesia is an enigmatic feature observed in advanced stages of PD.1 A deficit to execute motor sequences can be overcome by external visual or auditory cues.2 Enhanced activation of the lateral premotor cortex during paradoxical gait might compensate for the impaired function of supplemental motor area (SMA) and pre-SMA in PD (figure).
Figure Images shot during an on-phase with unpredictable freezing of gait
(A) Even with assistance, the patient is unable to walk continuously. (B) By kicking a tennis ball attached to a rubber band (left white arrow), he can dramatically speed up his walking. White arrows indicate the covered distance after 5 seconds.
Footnotes
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Disclosure: The authors report no disclosures.
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