The Impact of Exercise Rehabilitation and Physical Activity on the Management of Parkinson's Disease

A.M. Johnson, PhD; Q.J. Almeida, PhD

Disclosures

Geriatrics and Aging. 2007;10(5):318-321. 

In This Article

Neurological Rehabilitation Strategies

The most interesting advances in PD rehabilitation are being made within neurological paradigms. Therapeutic techniques that leverage this perspective are attempting either to create new pathways within the brain or to help patients create a cognitive overlay for the defective programs that are currently in use. These techniques focus on the development of new movement strategies.

Parkinson's disease gait research typically focuses on self-paced walking tasks and the differences between patients with PD when they are "on" and "off" their dopaminergic medications. These studies suggest that spatial impairments (e.g., decreased stride length) but not temporal characteristics (e.g., stride cadence) improve with dopaminergic treatment.[18,19] Therefore, one of the most promising avenues of neurological rehabilitation research involves the use of sensory enhancement to cue movement--both during gait training and in community ambulation. Both visual[20] and auditory[21] cues have been used successfully to produce significant changes among patients with PD. For example, visual step cues (patients are instructed to step toward parallel lines placed on the walking surface) have been demonstrated to improve the shuffling gait typical of patients with PD, with improvements persisting when patients are in an "off" period (with respect to their dopaminergic medications).[18,22] In one interesting study, Dam et al.[23] compared conventional physical therapy with "sensory-enhanced physical therapy." Both visual (in this case, footprints on which the patient walked during gait training) and auditory cues (alternating high and low tones during gait training to innervate leg lifts and drops, respectively) were added to the training program. While both conventional and sensory-enhanced therapy produced significant changes, sensory-enhanced therapy produced changes (improved gait velocity, stride length, and step cadence) that were maintained at 12 months, while the effects of conventional therapy were lost by 4 months. Outside the laboratory, patients report success with the use of visual cues (e.g., stepping over an inverted walking stick, or stepping toward a dot made on pavement with a laser pointer) to overcome "freezing" (a sudden absence of voluntary gait). Rhythmic auditory stimulation (e.g., listening to marching music) can also be used improve gait cadence during activities of everyday living.[24]

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