{
  "abstract": "Freezing of gait (FOG) is one of the most disabling motor symptoms of Parkinson's disease, yet a fundamental question remains unresolved: why does FOG occur at any given moment? Most research has focused on studying FOG once it is already manifest. The present work aims to synthesize recent observations and propose a conceptual framework in which FOG reflects a dynamic process unfolding across multiple stages and time scales. Subtle changes in gait dynamics and physiology can precede episodes by several seconds (Stage −1), and experimental paradigms show that individuals without clinically recognized freezing may exhibit brief episodes under sufficiently sensitive conditions (Stage −2). At longer time scales, prospective studies indicate that vulnerability to freezing may be detectable years before onset (Stage −3). This framework reflects the idea that FOG emerges from progressive instability across interacting motor, cognitive, autonomic, and environmental systems, rather than as an isolated event. The proposed framework includes a prodromal stage, a subclinical stage, an immediate prefreezing state, and the freezing episode itself (Stage 0). This framework integrates findings from wearable sensing, physiology, and clinical studies and emphasizes that FOG remains latent in Stage −3, may be elicited only under specific conditions in Stage −2, and becomes manifest as instability evolves toward imminent and overt freezing (Stages −1 and 0, respectively). Reframing FOG as a multistage process that includes an upstream phase raises new questions regarding mechanisms, classification, and intervention, and may, ultimately, inform strategies aimed at predicting and preventing freezing rather than simply reacting to it.",
  "abstract_shown": true,
  "affiliations": [
    "Center for the Study of Movement, Cognition, and Mobility Tel Aviv Sourasky University Medical Center ‐ Ichilov Tel Aviv Israel",
    "Department of Physical Therapy, Gray Faculty of Medical & Health Sciences, and Sagol School of Neuroscience Tel Aviv University Tel Aviv Israel",
    "Rush Alzheimer's Disease Center, Rush University Medical Center, and Department of Orthopaedic Surgery Rush Medical College Chicago Illinois USA",
    "School of Biomedical Engineering Tel Aviv University Tel Aviv Israel",
    "Department of Kinesiology and Health Sciences University of Waterloo Waterloo Canada",
    "Department of Rehabilitation Sciences Research Group for Neurorehabilitation (eNRGy), KU Leuven Leuven Belgium",
    "Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen the Netherlands",
    "Department of Neurology Oregon Health and Science University Portland Oregon USA",
    "Department of Biomedical Informatics and Department of Neurology Emory University School of Medicine Atlanta Georgia USA",
    "Clario, Part of Thermo Fisher Scientific Philadelphia Pennsylvania USA",
    "Department of Neurology University of Rochester Rochester New York USA",
    "University of Massachusetts Dartmouth College of Nursing and Health Sciences Dartmouth Massachusetts USA",
    "Parkinson’s Disease Research Clinic Macquarie University Brain Institute and Clinic Sydney Australia"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0,
        1,
        2,
        3
      ],
      "name": "Jeffrey M. Hausdorff",
      "orcid": "0000-0002-1608-0776"
    },
    {
      "affs": [
        4
      ],
      "name": "Kaylena A. Ehgoetz Martens",
      "orcid": "0000-0002-8488-2295"
    },
    {
      "affs": [
        5
      ],
      "name": "Moran Gilat"
    },
    {
      "affs": [
        6
      ],
      "name": "Jorik Nonnekes",
      "orcid": "0000-0003-2434-1427"
    },
    {
      "affs": [
        7
      ],
      "name": "Martina Mancini",
      "orcid": "0000-0002-4532-3984"
    },
    {
      "affs": [
        8
      ],
      "name": "J. Lucas McKay",
      "orcid": "0000-0002-8361-8943"
    },
    {
      "affs": [
        5,
        9
      ],
      "name": "Pieter Ginis",
      "orcid": "0000-0002-6762-3347"
    },
    {
      "affs": [
        10
      ],
      "name": "Jamie L. Adams"
    },
    {
      "affs": [
        11
      ],
      "name": "Jennifer R. Mammen",
      "orcid": "0000-0001-7858-9183"
    },
    {
      "affs": [
        4
      ],
      "name": "Erika E. Howe",
      "orcid": "0000-0002-4476-9431"
    },
    {
      "affs": [
        12
      ],
      "name": "Simon J. G. Lewis",
      "orcid": "0000-0002-4093-7071"
    },
    {
      "affs": [
        8
      ],
      "name": "Fay Horak",
      "orcid": "0000-0001-7704-5459"
    },
    {
      "affs": [
        5
      ],
      "name": "Alice Nieuwboer",
      "orcid": "0000-0003-1193-6229"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8v2h17920nm0y.bib",
  "cited_by": 0,
  "doi": "10.1111/ejn.70721",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13736152/",
  "id": "8v2h17920nm0y",
  "issns": [
    "0953-816X",
    "1460-9568"
  ],
  "landing_url": "https://doi.org/10.1111/ejn.70721",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Freezing of Gait: A Tribute to Nir Giladi"
    ],
    [
      "heading",
      "SPECIAL ISSUE REVIEW"
    ],
    [
      "heading",
      "Special Issue Review"
    ],
    [
      "openalex",
      "3612|Balance, Gait, and Falls Prevention"
    ]
  ],
  "openalex": "W7225293070",
  "pdf_url": "https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/ejn.70721",
  "pmcid": "PMC13736152",
  "pmid": "42983899",
  "published": "2026-11-04",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/8v2h17920nm0y.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:40Z",
      "native_id": "PMC13736152",
      "source": "pmc",
      "url": "https://doi.org/10.1111/ejn.70721"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "journal-openalex:F28",
      "subfield": "neuroscience"
    }
  ],
  "title": "Time to Move Upstream? A Framework for Expanding the Focus of Freezing of Gait to Prodromal, Subclinical, and Pre‐FOG Stages",
  "title_text": "Time to Move Upstream? A Framework for Expanding the Focus of Freezing of Gait to Prodromal, Subclinical, and Pre‐FOG Stages",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:40Z",
  "url": "https://research.draconitic.com/paper/8v2h17920nm0y",
  "venue": "The European Journal of Neuroscience",
  "versions": []
}