Kinesia paradoxa

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Kinesia paradoxa

Kinesia paradoxa is a phenomenon most often seen in people with Parkinson's disease where individuals who

typically experience severe difficulties with the simple movements may perform complex movements easily.[1]

Specifically, kinesia paradoxa focuses on walking, referring to the sudden ability to demonstrate smooth, fluid

movements in people that previously had problems with walking easily. This new discovery does not just happen to

an individual randomly, but must be stimulated using various types of visual or auditory cues.

This phenomenon is generally stimulated to help improve the mobility of people with akinesia.[2]

Akinesia consists

of changes in walking pattern, freezing of gait (FOG), and losses of balance (LOBs). FOG occurs in the middle of

stride, cutting off walking, and making it fairly difficult for a person to re-initiate a movement. Kinesia paradoxa

can be used as a management strategy to overcome this.[3]

LOBs are when a person has difficulty maintaining an

upright position and lose their balance, eventually leading to them falling.[2]

Since Parkinsons disease is a

progressive disease, patients symptoms continue to worsen with time and they often develop visible differences in

their walking that greatly affects their quality of life. These differences include shuffling of steps, decreased stride

length, and decrease in overall movement. Kinesia paradoxa is not able to be stimulated in everyone with

movement disorders; persons who can stimulate this phenomenon demonstrate visible improvements in mobility

including, increased stride length, more fluidity in strides, less FOGs incidents, less LOBs, and those that appeared

to be completely frozen previously can regain their movement.[2]

More recently, kinesia paradoxa is also being used

to treat children with Asperger's syndrome. Children with Asperger's demonstrate excellent skills in drawing,

modeling, building, and computer games, but often struggle with everyday motor tasks such as walking or catching a

ball. Kinesia paradoxa is currently being explored to help aid these individuals in focusing their attention and

improving their efficiency in these simple motor tasks.[4]

History

One of the first studies on kinesia paradoxa was conducted in 1967 by James Martin.[5] He examined the effects of

different visual cues to facilitate natural walking and found that transverse lines that were one or two inches wide

and a contrasting color produced the maximum effect. He studied the effects from different obstacles, types of lines,

different contrasts, and how outside stimuli affected kinesia paradoxa.[5]

Since this primary study, more progress

has been made to explore this topic and methods to stimulate it. It is still fairly new in the research field and there is

much more future research to be conducted before this topic can be fully understood.

Mechanism of action

There is currently no known mechanism to explain kinesia paradoxa, but it is believed to be a normal property of

the motor system.

[6]

The reasoning behind the sudden movement is still very unclear and a variable topic of researchthat has not yet been studied electrophysiologically.

[7]There are a few hypotheses that are currently being studied

which include:

Additional feedback to the brain

Individuals with Parkinson's have a lack of dopaminergic cells which results in the difficulty with movement.

Providing additional feedback to the brain can help overcome the problems individuals have with internal cueing.[8]

Circuits in the brain

Visual cues are believed to activate specific motor pathways in the brain. These pathways allow the damaged circuits

from Parkinson's to be bypassed, resulting in normal motor function. Cerebellar sensory-motor pathway are currentlybeing explored to try and prove this hypothesis.

[8]
http://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Dopaminergic_cell_groupshttp://en.wikipedia.org/w/index.php?title=Feedbackhttp://en.wikipedia.org/w/index.php?title=Brainhttp://en.wikipedia.org/w/index.php?title=Cerebellumhttp://en.wikipedia.org/w/index.php?title=Neural_circuithttp://en.wikipedia.org/w/index.php?title=Neural_circuithttp://en.wikipedia.org/w/index.php?title=Cerebellumhttp://en.wikipedia.org/w/index.php?title=Brainhttp://en.wikipedia.org/w/index.php?title=Feedbackhttp://en.wikipedia.org/w/index.php?title=Dopaminergic_cell_groupshttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Hypotheseshttp://en.wikipedia.org/w/index.php?title=Electrophysiologyhttp://en.wikipedia.org/w/index.php?title=Motor_systemhttp://en.wikipedia.org/w/index.php?title=Mechanism_of_actionhttp://en.wikipedia.org/w/index.php?title=Stimulus_%28physiology%29http://en.wikipedia.org/w/index.php?title=Contrast_%28vision%29http://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Efficiencyhttp://en.wikipedia.org/w/index.php?title=Attentionhttp://en.wikipedia.org/w/index.php?title=Motor_skillhttp://en.wikipedia.org/w/index.php?title=Asperger_syndromehttp://en.wikipedia.org/w/index.php?title=Movement_disorderhttp://en.wikipedia.org/w/index.php?title=Quality_of_lifehttp://en.wikipedia.org/w/index.php?title=Progressive_diseasehttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=Balance_%28ability%29http://en.wikipedia.org/w/index.php?title=Parkinsonian_gaithttp://en.wikipedia.org/w/index.php?title=Akinesiahttp://en.wikipedia.org/w/index.php?title=Stimulatehttp://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Phenomenon


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Part of the initiation, not the pathway

If the circuits in the brain do not play a role in stimulating kinesia paradoxa, the initiation of this stimulation should

be explored to be a possible explanation.[7]

Additional firing within the brain could be a possible explanation to these

improved movements.

Possible genotype

A possible genotype might make an individual more likely to be able to stimulte kinesia paradoxa, but currently

there is no current research on this idea.[7]

It is difficult to support this idea with scientific research.

Benefits

It has been documented that people with Parkinson's disease experience a dramatic change in lifestyle due to their

symptoms. Since this disease is classified as a progressive disorder, symptoms only continue to worsen and

improvement is rarely seen. A persons walking ability is one area that a difference is dramatically noticeable. Due to

these dramatic changes in walking, patients have problems completing simple household tasks on their own. The y

often suffer from social isolation because they are embarrassed by their symptoms or their symptoms prevent themfrom leaving their home. As symptoms worsen, almost always is there a decrease in physical activity, which puts

these individuals at a greater risk for many other diseases such as heart disease. Through kinesia paradoxaa patient

is able to dramatically improve their walking ability, with improvements in one or even all aspects of walking.

Improvements include larger stride length, more fluid movements, increase arm swing, decreased shuffling of steps,

less incidents of FOG, and fewer LOBs. These all improve the mobility of a person and help improve their quality of

life. They are able to complete more household tasks independently, since movements through doorways and

hallways is easier, as well as participate in activities within the community. People suffering from Parkinsons

disease often tend to experience some form of depression after diagnosis, but with kinesia paradoxa this could be

overcome.[2]

Kinesia paradoxa also seems to be one of the better forms of treatment or management strategy used compared to

the other available options. The current options to treat akinesia are not always effective and their effects tend to

wear off quickly. Dopaminergic medications are the most commonly used form of treatment to attempt to replace the

lack of dopamine in Parkinsons patients. These medications have shown to be ineffective for a majority of patients

and often result in long-term negative secondary effects.[8]

FOGs and LOBs often respond poorly and often

paradoxically to these types of medications.[9]

Brain surgery is also a possible strategy to manage side effects, but is

very disruptive and invasive. Many surgeries result in severe discomfort for the patient and often have no resulting

effect.[8]

Another alternative is deep brain stimulation (DBS), which seems to be effective in many cases. DBS

seems very promising, but is a very new area of research that can result in serious complications.[7]

Due to this, it is

not a primary treatment method just yet.

Concerns

The main concern with kinesia paradoxa is that as soon as the virtual cues or obstacles are removed, the person

almost immediately returns to their old walking pattern consisting of shuffling of steps, FOG, and LOBs.[10]

The

possibility of retraining a person to internally cue is being explored, but thus far has been ineffective. Based on

studies, it has been demonstrated that the longer a person has suffered from Parkinsons the less this treatment works.

The more severe the symptoms are, the more dramatic a visual cue must be in order to be effective.[10]

L-dopa

medications and their effects on kinesia paradoxa should also be explored further to see if they play an important

role in stimulating kinesia paradoxa.[6]

For this to be a worthwhile form of treatment or management strategy for

Parkinsons patients, it must be able to be stimulated consistently and with ease. Some methods that will be described

in detail later are simple and low in cost, but are only temporary methods. The more permanent methods are
http://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Obstaclehttp://en.wikipedia.org/w/index.php?title=Effectivenesshttp://en.wikipedia.org/w/index.php?title=Therapyhttp://en.wikipedia.org/w/index.php?title=Symptomshttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=Symptomshttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=Management_strategyhttp://en.wikipedia.org/w/index.php?title=L-DOPAhttp://en.wikipedia.org/w/index.php?title=Symptomshttp://en.wikipedia.org/w/index.php?title=Therapyhttp://en.wikipedia.org/w/index.php?title=Effectivenesshttp://en.wikipedia.org/w/index.php?title=Obstaclehttp://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Deep_brain_stimulationhttp://en.wikipedia.org/w/index.php?title=Brain_surgeryhttp://en.wikipedia.org/w/index.php?title=Depression_%28mood%29http://en.wikipedia.org/w/index.php?title=Heart_diseasehttp://en.wikipedia.org/w/index.php?title=Physical_exercisehttp://en.wikipedia.org/w/index.php?title=Solitudehttp://en.wikipedia.org/w/index.php?title=Progressive_diseasehttp://en.wikipedia.org/w/index.php?title=Symptomshttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Genotypehttp://en.wikipedia.org/w/index.php?title=Brain


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extremely high in cost and this must be weighed when determining the most suitable treatment method for a patient.

Methods to stimulate

Internal cueing is often noted to be the first to disappear, but persons with Parkinson's disease are usually still able to

elicit external cues.[11]

Due to this some form of external cue is necessary to stimulate kinesia paradoxa. Once FOG

occurs, it is often very difficult for a person to fight it and immediately return to normal walking, so kinesia

paradoxa must be stimulated before this occurs to prevent it all together. Contrast, size of the cue, loudness of the

cue, and many more features must be analyzed in order to determine the most effect method to stimulate kinesia

paradoxa for a person.[7]

Each person will respond differently to each cue, so great exploration and experimentation

must be completed before finding the optimal method. Below specific examples of visual cues, auditory cues, and

methods of attention focusing are discussed in great deal focusing on the benefits and concerns of each method.

Visual cues

There are a variety of visual cues that are able to stimulate kinesia paradoxa, some more effective than others. For

these visual cues there are a variety of factors that must be considered. The most important factor is contrast, because

the more visible the feature the more likely it is to effectively stimulate kinesia paradoxa. For visual cues, the size

of the visual cue is also important, but there is no standard size that is used, it just depends on the individual.

Tile and floor patterns

Alternating floor tiles can help stimulate kinesia paradoxa. If this method is effective for an individual it can make

maneuvering about the house much easier. Individuals can focus on stepping specifically over one color tile.[7]

Lines or pieces of paper on the floor

Stepping over a piece of paper on the floor or having lines visible on the ground can often be very effective and is

very cheap method. contrast is extremely important in this method: if the floor is dark, then white paper or lines are

most effective and if the floor is light colored, then dark paper or lines are most effective. For lines to be most

beneficial they must be transverse in the direction of walking. zig-zag or sideways lines have been shown to not be

nearly as effective. A simple computer piece of paper has been shown to work, but in the case of lines often

something only one to two inches in width is helpful in improving the mobility through kinesia paradoxa.[7]

Refer to the first video in external links of a man that can overcome his akinesia with a simple paper cue. Note, how

quickly he returns to his previous walking style after the paper cues are gone.[12]

Obstacles on the ground

Large obstacles placed at the feet of an individual such as blocks or another person s foot have been shown to be

very effective in stimulating kinesia paradoxa.[5]

For this method, cost is also not a concern but a serious problem isthat sometimes the patient believes that they are taking a much larger step than they actually are. This results in the

individual stepping directly on the obstacle or tripping over it if it is too large. This can be dangerous and result in

additional falls, so an appropriate size of the obstacle must be determined for each individual.[7]

Manipulations to currently used walking aids

Simple manipulations to walking aids that are already being used by the individual have been shown to be extremely

effective, but do not result in tripping incidents as the obstacles described above. Three examples include inverting a

walking cane, adding zip ties to a walker, having a tennis ball swing from a cane. Inverting a walking cane creates a

simple u-shaped curve on the ground that the individual can focus on stepping over.[5]

The zip ties have the same

effect. Brightly colored zip ties create the most contrast and act as a guide when an individual is walking. With zipties, they are large enough to be effective, but not strong enough to trip an individual; if they cannot step over tem
http://en.wikipedia.org/w/index.php?title=Contrast_%28vision%29http://en.wikipedia.org/w/index.php?title=Guidehttp://en.wikipedia.org/w/index.php?title=Guidehttp://en.wikipedia.org/w/index.php?title=Guidehttp://en.wikipedia.org/w/index.php?title=Contrast_%28vision%29http://en.wikipedia.org/w/index.php?title=Tennis_ballhttp://en.wikipedia.org/w/index.php?title=Walker_%28mobility%29http://en.wikipedia.org/w/index.php?title=Cable_tieshttp://en.wikipedia.org/w/index.php?title=Assistive_canehttp://en.wikipedia.org/w/index.php?title=Mobility_aidhttp://en.wikipedia.org/w/index.php?title=Worryhttp://en.wikipedia.org/w/index.php?title=Obstaclehttp://en.wikipedia.org/w/index.php?title=Akinesiahttp://en.wikipedia.org/w/index.php?title=Zig-zaghttp://en.wikipedia.org/w/index.php?title=Contrast_%28vision%29http://en.wikipedia.org/w/index.php?title=Contrast_%28vision%29http://en.wikipedia.org/w/index.php?title=Stimulatehttp://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Visual_systemhttp://en.wikipedia.org/w/index.php?title=Hearing_%28sense%29http://en.wikipedia.org/w/index.php?title=Visualhttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Cost


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completely, the zip ties are able to easily bend with their walking.[7]

The final method is having a tennis ball swing

from a cane. The individual can focus on kicking the ball with each step and overcome many cases of FOG.[13]

Virtual cueing spectacles

These are a fairly new discovery that are still be explored through research. This device is worn exactly like a pair of

glasses by the individual and projects lines at the patients feet. When the individual is stationary, the lines appear to

be also but as soon as the individual looks up slightly and begins to walk the lines scroll as well encouraging them to

step over the appearing obstacle. The goal with this new device is to be able to be worn at all times, and studies have

shown that these cueing glasses continue to remain effective with time. The only concern with this device is that they

are high in cost and not every Parkinson's patient would be able to afford them.[2]

Refer to the second, third, and fourth external link to see different types of virtual cueing spectacles being used to

overcome akinesia. Each is of a different form, but effectively helps the individual improve fluidity in their

walking.[14][15][16]

Auditory cues

visual have been shown to be the most effective method in stimulating kinesia paradoxa, but in some cases auditory

cues have also been beneficial. With auditory cues the volume must be considered and the consistency of the beat. In

almost all cases of auditory cues, it is all about following a rhythm. The most common methods to stimulate kinesia

paradoxa with auditory cues is listening to music, using a metronome, or walking to specific commands. By

listening to music, an individual can focus on walking to the exact beat of the music and the music often eliminates

outside distractions. A metronome produces regular tick sounds, so similar to music an individual can easily follow

the beat being produced. A final auditory cue is walking to specific commands, such as marching commands like a

soldier. Having another individual dictate these commands is most useful. All of these techniques are variable, and

their effectiveness varies with each individual. There are also numerous other methods to create auditory cues, but

the ones discussed are some of the most common.[7]

Focusing attention

Kinesia paradoxa can very easily be stimulated by visual and auditory cues, but there is an additional method that

does not require any external cues. By having an individual focus all their attention on walking or another

movement, they are sometimes able to control akinesia in its early stages. For example, in a common household

akinesia is much more common because the patient is not only focusing on their walking because of the excess of

additional distractions in the home.[17]

Often eliminating some of these distractions and learning to focus all attention

on walking can help improve mobility. This is also true when participating in other activities such as cycling. When

an individual focuses only on their pedaling, they are often able to facilitate smooth movements.[18]

This method is

only effective in very rare cases and those that are not extreme, so if proven unhelpful visual and auditory cues

should be explored further.

External Pacing

Kinesia paradoxa can also be stimulated by external pacing cues such as cycling,[19]

or walking on a treadmill.[20]

Exercises such as cycling or walking have been shown to enhance gait, mobility and quality of life in patients with

Parkinsons Disease.[21][22]

Because of these aforementioned benefits, external pacing cues such as cycling or

treadmill use could play and important role in the rehabilitation and exercise training of patients with Parkinson's

disease who are grounded by freezing of gait. In addition, it has been suggested that the ability to cycle could be an

important component in diagnosis of Parkinsons Disease.[23]
http://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Gaithttp://en.wikipedia.org/w/index.php?title=Treadmillhttp://en.wikipedia.org/w/index.php?title=Cyclinghttp://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Effectivenesshttp://en.wiktionary.org/wiki/facilitatehttp://en.wikipedia.org/w/index.php?title=Pedalinghttp://en.wikipedia.org/w/index.php?title=Cyclinghttp://en.wikipedia.org/w/index.php?title=Akinesiahttp://en.wikipedia.org/w/index.php?title=Attentionhttp://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Auditory_systemhttp://en.wikipedia.org/w/index.php?title=Visual_systemhttp://en.wikipedia.org/w/index.php?title=Stimulatehttp://en.wikipedia.org/w/index.php?title=Variable_and_attribute_%28research%29http://en.wikipedia.org/w/index.php?title=Metronomehttp://en.wikipedia.org/w/index.php?title=Rhythmhttp://en.wikipedia.org/w/index.php?title=Beat_%28music%29http://en.wikipedia.org/w/index.php?title=Loudnesshttp://en.wikipedia.org/w/index.php?title=Sensory_cuehttp://en.wikipedia.org/w/index.php?title=Auditory_systemhttp://en.wikipedia.org/w/index.php?title=Stimulatehttp://en.wikipedia.org/w/index.php?title=Visual_systemhttp://en.wikipedia.org/w/index.php?title=Akinesiahttp://en.wikipedia.org/w/index.php?title=Parkinson%27s_diseasehttp://en.wikipedia.org/w/index.php?title=Glasseshttp://en.wikipedia.org/w/index.php?title=Machinehttp://en.wikipedia.org/w/index.php?title=Research


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Article Sources and Contributors 7

Article Sources and ContributorsKinesia paradoxa Source: http://en.wikipedia.org/w/index.php?oldid=534970139 Contributors: A412, BD2412, Bearcat, Eeekster, Filing Flunky, Graham87, Ketiltrout, LCRO86, Malcolma,

MorganByrd, Niceguyedc, Rjwilmsi, SchreiberBike, William Avery, 1 anonymous edits

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