Table 2 Reported ‘Altering the Mental State’ strategies for gait impairments in Parkinson’s disease
Principle mechanism | Phenomenology | Examples |
|---|---|---|
Reducing arousal | Facilitating general relaxation | Mindfulness Breathing techniques Meditation Yoga Qigong Tai chi Self-hypnosis Spirituality Low-intensity physical exercise* Doing something one loves Being on holiday Being somewhere one loves Listening to one’s favourite music Taking anxiolytic drugs, or medicinal cannabis |
Eliminating negative emotions and cognitions surrounding gait | Focussing on what you CAN do Rationalize stressful events Consciously stop worrying Thinking about one’s most positive experiences Using mantra’s, or positive affirmations Visualizing a successful situation Taking antidepressants | |
Decreasing external (social) pressure | Avoiding feeling rushed by other persons Communicating beforehand how one is feeling, so people can take it into account Pretending to be the only person around | |
Having a back-up plan in case of gait difficulties | Carefully planning out the walk beforehand ‘Crisis rehearsal’ of bottleneck areas of the route beforehand Walking a ‘test round’ indoors before heading outside Wearing laser shoes, without having to look at the projections Holding a cane, without using it for support Having someone close by | |
Increasing arousal | Internal factors | Getting angry at oneself and using that energy to walk Inflicting pain on oneself Getting ‘pumped’ through forceful self-talk or high-intensity physical exercise* Purposefully creating a time-pressure situation Pretending to be on stage, ready to perform in front of a large audience Challenging oneself to make each step better than the one before |
External factors | Being in ‘test’ situations, such as at the doctor’s office Being in an emergency, or otherwise thrilling situation |