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A new rating instrument to assess festination and freezing gait in Parkinsonian patients

Authors

  • Kerstin Ziegler PT,

    1. Neurologisches Krankenhaus München, Schön Kliniken, Center for Parkinson's Disease and Movement Disorders, Munich, Germany
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  • Frauke Schroeteler PT,

    1. Neurologisches Krankenhaus München, Schön Kliniken, Center for Parkinson's Disease and Movement Disorders, Munich, Germany
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  • Andres O. Ceballos-Baumann MD, PhD,

    1. Neurologisches Krankenhaus München, Schön Kliniken, Center for Parkinson's Disease and Movement Disorders, Munich, Germany
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  • Urban M. Fietzek MD

    Corresponding author
    1. Neurologisches Krankenhaus München, Schön Kliniken, Center for Parkinson's Disease and Movement Disorders, Munich, Germany
    • Neurologisches Krankenhaus München, Center for Parkinson's Disease and Movement Disorders, Schön Kliniken, Parzivalplatz 4, Munich D-80804, Germany
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  • Potential conflict of interest: This work was supported by a grant from the Deutsche Parkinson Vereinigung e.V. and the Deutsche Stiftung Neurologie e.V. to Prof. Ceballos-Baumann.

Abstract

Festination and freezing of gait (FOG) are sudden episodic inabilities to initiate or sustain locomotion mostly experienced during the later stages of Parkinson's disease (PD) or other higher-level gait disorders. The aim of this study was to develop a clinical rating instrument for short-interval rating of festination and FOG. Foot movements of 33 patients were video taped and rated during 12 episodes in a standardized course on a four-level interval scale according to severity. Motor blocks were provoked in four situations and by three levels of dual-tasking (tasks). Addition of the item scores produced a FOG score. The assessment requires less than 15 min. The inter-rater and re-test reliability of the FOG score is high (Kendall κ = 0.85–0.92, P < 0.0001). Variability of the item scale due to situations and tasks can be attributed to unidimensional group factors (Cronbach's α 0.84 and 0.94). Group comparisons and a logistic regression model show significant effects for both situations and tasks on the item scale (Friedman test: “situation”: P < 0.0001, “task”: P < 0.0001). Six patients with PD have significantly different scores during mobile (practical ON; 6.2 ± 3.9) and immobile (practical OFF; 15.8 ± 4.6) medication states (P < 0.05). The FOG score correlates with the 10 m number of steps (ρ = 0.58; P = 0.001) and with the self-evaluation of FOG (ρ = 0.51; P < 0.01). Our results encourage the further use of the FOG score to evaluate festination and FOG. © 2010 Movement Disorder Society

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