Kinesia paradoxa, a remarkable phenomenon, reminds us that when we feel stuck, the brain is often just waiting for the right cue to unlock a hidden pathway.
Kinesia paradoxa in Parkinson’s Disease reveals that capability is not always lost, only inaccessible.We all harbor hidden pathways and potential. We need to unlock what has always been there.I am a neurologist specializing in Parkinson’s disease and movement disorders.
Studying these conditions offers a rare window into how theDuring my third-year clinical rotation in medical school, an elderly man in a wheelchair arrived at the clinic. His face was expressionless, his voice soft, and his hands trembled with that rhythmic “pill-rolling” motion, all hallmarks of Parkinson’s disease. So far, it was an ordinary encounter. But as the visit ended, the professor did something entirely unexpected. He reached into his desk drawer, pulled out a small ball, and tossed it to the patient. We students collectively gasped, certain it would strike him. Instead, the man raised his right arm and caught it—swiftly, and gracefully. For that brief instant, the disease seemed to vanish. I was transfixed. This man, who moments earlier seemed trapped in his body, revealed that the capacity for movement still existed—it was simply hidden. I found myself wondering:Over the years, I have witnessed this paradox countless times. Randall, who shuffles slowly across my exam room, once insisted he still jogs every morning. When I looked skeptical, he leaned forward, took a runner’s stance, and sprinted smoothly down the hallway. A man described in thecould barely walk, yet cycled effortlessly through the streets of the Netherlands. A retired professor, confined to a wheelchair, proudly showed me a video of himself swinging a golf club—his form still elegant, his body remembering the motion.in the basal ganglia, disrupting the brain’s ability to coordinate movement automatically. Actions that were once effortless, such as walking, writing, or buttoning a shirt, become deliberate and slow. This isn’t due to muscle weakness, but to the loss of the choreography that normally unfolds beneath awareness. And yes, this is the sameAt Dr. Ann Graybiel’s lab at MIT, elegant experiments explored dopamine’s role as mice learned to navigate a maze for a piece of cheese. At first, dopamine was released steadily throughout each trial, peaking when the mouse finally reached the reward. During this early, effortful phase, the dorsomedial striatum , the region linked to goal-directed behavior, was most active. But as the mice repeated the task, the dopamine pattern shifted. Spikes appeared only at the start and end , while activity during the run itself faded.Graybiel called this “task bracketing,” or “chunking.” Once the maze-running became automatic, the brain no longer needed continuous dopamine. Instead, brief bursts at the beginning and end were enough. This dopamineAnother key discovery, by Kravitz et al., revealed two opposing classes of neurons in the basal ganglia, the so-called “Go” and “No-Go” neurons:No-Go pathway: uses D2 receptors to inhibit competing actions. These inhibitory “No-Go” neurons act as gatekeepers, suppressing other motor programs when one is in progress, explaining why we can’t easily draw a square with one hand and a triangle with the other.neurons inhibit motion. As a result, movements once effortless become unreliable. Yet if jump-started, bypassing the difficulty of initiation, certain motor sequences can still flow smoothly through the brain’s residual “autopilot” circuits that require less dopamine. In Parkinson’s disease, the right cue—music, counting, or visual targets—can sometimes help patients bypass blocked motor circuit initiation. We can try to apply the same principle in our daily life, when we’re mentally or emotionally “stuck.”and mood. Start your day or your work with structure: a timed routine, a steady playlist, or a walk paced to beats. The brain responds powerfully to imagery. Visualize the next step—literally or metaphorically. Change your environment to shift perspective; even small adjustments can cue new patterns of action.you care about what you’re doing. Emotion isn’t the opposite of reason—it’s the ignition for it.Dopamine reinforces behavior bracketed by clear beginnings and endings. Create rituals that mark “start” and “finish” moments in your day. Celebrate small wins; they keep the reward loop alive., emotion, or habit, our task is not just to push harder, but to listen more deeply and to find the right cue to unlock what has always been there.Melo-Thomas, Liana and Schwarting, Rainer K. W."Paradoxical kinesia may no longer be a paradox waiting for 100 years to be unraveled" Reviews in the Neurosciences, vol. 34, no. 7, 2023, pp. 775-799. Snijders AH, Bloem BR. Cycling for Freezing of Gait. N Engl J Med. 2010;362:e46. doi:10.1056/NEJMicm0810287 Nonnekes J, Ružicka E, Nieuwboer A, Hallett M, Fasano A, Bloem BR. Compensation Strategies for Gait Impairments in Parkinson Disease: A Review. JAMA Neurol. 2019 Jun 1;76:718-725. doi: 10.1001/jamaneurol.2019.0033. PMID: 30907948.Kravitz AV, Freeze BS, Parker PR, Kay K, Thwin MT, Deisseroth K, Kreitzer AC. Regulation of parkinsonian motor behaviours by optogenetic control of basal ganglia circuitry. Nature. 2010 Jul 29;466:622-6.Cut-offs cut deep and wide, their emotional impact reverberating far beyond the combatants. Because much of the suffering is hidden, repair is challenging for everyone, not least of all therapists.Self Tests are all about you. Are you outgoing or introverted? Are you a narcissist? Does perfectionism hold you back? Find out the answers to these questions and more with Psychology Today.
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