The Practicalities of Assessing Freezing of Gait.
Freezing of gait (FOG) is a mysterious, complex and debilitating phenomenon in Parkinson's disease. Adequate assessment is a pre-requisite for managing FOG, as well as for assigning participants in FOG research. The episodic nature of FOG, as well as its multiple clinical expressions make its assessment challenging.



To highlight the available assessment tools and to provide practical, experience-based recommendations for reliable assessment of FOG.



We reviewed FOG assessment from history taking, questionnaires, lab and home-based measurements and examined how these methods account for presence and severity of FOG, their limits and advantages. The practicalities for their use in clinical and research practice are highlighted.



According to the available assessment tools severity of FOG is marked by one or a combination of multiple clinical expressions including frequency, duration, triggering circumstances, response to levodopa, association with falls and fear of falling, or need for assistance to avoid falls.



To date, a unique methodological tool that encompasses the entire complexity of FOG is lacking. Combining methods should give a better picture of FOG severity, in accordance with the precise clinical or research context. Further development of any future assessment tool requires understanding and thorough analysis of the specific clinical expressions of FOG.
Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.
Claudia
C
Barthel
Sobell Department for Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK.
Elizabeth
E
Mallia
Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.|Inserm, Grenoble, France.
Bettina
B
Debû
Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.
Bastiaan R
BR
Bloem
Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.|Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
Murielle Ursulla
MU
Ferraye
D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D010300:Parkinson Disease / Q000150:complications*
Parkinson disease; disability; evaluation; gait disorders; neurologic; objective measure
Parkinsonism Relat Disord. 2012 Feb;18(2):149-54
21968033
Lancet Neurol. 2015 Jul;14(7):768-78
26018593
Mov Disord. 2013 Sep 15;28(11):1509-19
24132839
Sensors (Basel). 2014 Apr 15;14(4):6819-27
24740014
Lancet Neurol. 2011 Aug;10(8):734-44
21777828
Brain. 2004 Jul;127(Pt 7):1650-60
15128621
PLoS One. 2013 Dec 31;8(12):e84423
24391953
Parkinsonism Relat Disord. 2014 Apr;20(4):447-51
24530016
Mov Disord. 2006 Sep;21(9):1419-24
16773644
Br J Neurosurg. 2008;22 Suppl 1:S16-8
19085348
Gait Posture. 2009 Nov;30(4):459-63
19660949
Neurorehabil Neural Repair. 2010 Oct;24(8):746-52
20453155
Behav Neurol. 2008;19(3):127-36
18641432
Parkinsonism Relat Disord. 2015 Nov;21(11):1362-6
26454703
J Neurosci Methods. 2008 Jan 30;167(2):340-8
17928063
Mov Disord. 2009 Apr 15;24(5):655-61
19127595
Brain. 2010 Jan;133(Pt 1):205-14
19773356
J Neurol. 2014 Sep;261(9):1763-7
24957299
Med Biol Eng Comput. 2016 Jan;54(1):223-33
26429349
Mov Disord. 2008 Nov 15;23(15):2129-70
19025984
Parkinsonism Relat Disord. 2000 Jul 1;6(3):165-170
10817956
Mov Disord. 2004 Aug;19(8):871-84
15300651
Neuroscience. 2008 Feb 6;151(3):921-8
18160225
Parkinsonism Relat Disord. 2012 Jan;18(1):25-9
21872523
Parkinsons Dis. 2014;2014:606427
25101189
Mov Disord. 2010 Jun 15;25(8):1012-8
20310009
Restor Neurol Neurosci. 2014;32(6):743-53
25079979
Parkinsonism Relat Disord. 2012 Jun;18(5):572-7
22445248
Parkinsonism Relat Disord. 2012 Nov;18(9):1022-6
22717367
J Neural Transm (Vienna). 2013 Apr;120(4):543-57
23328947
J Neuroeng Rehabil. 2013 Feb 13;10:19
23405951
Gait Posture. 2013 Jun;38(2):326-9
23332192
Neurosci Biobehav Rev. 2014 Jun;43:213-27
24769288
Lancet Neurol. 2012 Jul;11(7):589-96
22658702
IEEE Trans Neural Syst Rehabil Eng. 2014 May;22(3):685-94
24235277
Eur J Neurol. 2003 Jul;10(4):391-8
12823491
J Nerv Ment Dis. 1990 Oct;178(10):636-41
2230748
Neurology. 2001 Jun 26;56(12 ):1712-21
11425939
Mov Disord. 1992;7(1):2-13
1557062
Mov Disord. 2008;23 Suppl 2:S423-5
18668629
Curr Neurol Neurosci Rep. 2013 Jun;13(6):350
23625316
PLoS One. 2014 Sep 24;9(9):e106561
25250691
J Neural Transm (Vienna). 2015 Mar;122(3):403-10
25069586
Mov Disord. 2008;23 Suppl 2:S468-74
18668628
Neurophysiol Clin. 2015 Nov;45(4-5):305-13
26547546
Gait Posture. 2011 Jul;34(3):329-33
21715166