What intervention is most suitable for a patient with Parkinson’s disease experiencing festinating gait?

The most suitable intervention for a patient with Parkinson’s disease who exhibits festinating gait is to use a toe wedge to displace the center of gravity backwards. Festinating gait is characterized by a rapid shuffling pattern with a progressive increase in speed and a tendency to lean forward, making it difficult for individuals to maintain balance and control their movements.

Using a toe wedge serves to shift the center of gravity posteriorly, which can help counteract the forward lean typical of festination. This adjustment can provide greater stability and increase the patient’s ability to control their gait by allowing for a more balanced posture. By displacing the center of gravity backwards, patients may find it easier to initiate and regulate their movements, thereby reducing the tendency to accelerate uncontrollably.

While increasing cadence using a metronome and utilizing laser markers to increase stride length could also assist in gait training, they may not directly address the underlying postural instability associated with festinating gait. Similarly, using a heel wedge to displace the center of gravity forward could exacerbate the tendency to lean forward rather than correcting it. Thus, the use of a toe wedge is the most strategic choice to enhance stability and improve gait mechanics for this patient population.