title: Bicycling breaks the ice for freezers of gait.
abstract: Patients with freezing of gait (FOG) have episodic problems with generating adequate steps. This phenomenon is both common and debilitating in patients with Parkinson's disease (PD) or atypical parkinsonism. We recently presented a video case of a patient with longstanding PD and severe FOG, who showed a remarkably preserved ability to ride a bicycle. Here, we comment on the scientific and clinical implications of this single case observation, and show the video of a similar case. We first consider several pathophysiological explanations for this striking discrepancy between walking and cycling in PD. We then discuss the merits and shortcomings of cycling as a potential new avenue for rehabilitation and exercise training in patients grounded by FOG. Finally, we provide some directions for future research stimulated by this fascinating observation.
authors.affiliation: Department of Neurology and Parkinson Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands.
authors.forename: Anke H
authors.initials: AH
authors.lastname: Snijders
authors.forename: Ivan
authors.initials: I
authors.lastname: Toni
authors.forename: Evžen
authors.initials: E
authors.lastname: Ružička
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D001642:Bicycling / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology; D014741:Video Recording; D016138:Walking / Q000502:physiology