Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson's disease.
BACKGROUND
Postural instability (PI) is a common and serious problem in Parkinson's disease (PD). Dopaminergic medication is of negligible use and a positive effect of deep brain stimulation on this issue has not been reported.


OBJECTIVE
To develop a method of repetitive training of compensatory steps to enhance protective postural responses by using training strategies based on recent neurophysiological research.


METHODS
Fourteen patients with PD took part in a multiple baseline design study and were trained for 14 days in an ambulant setting consisting of two daily sessions.


RESULTS
After training, the length of compensatory steps increased and the step initiation shortened. In a gait analysis, the cadence and the step length increased, gait velocity improved, and the period of double support shortened. The "mobility" subscore of a quality of life questionnaire (PDQ-39) also improved. All these changes were significant (p < 0.05). These effects were stable for two months without additional training.


CONCLUSIONS
The repetitive training of compensatory steps is an effective approach in the treatment of PI and should be applied if PI is evident clinically or in a patient's history.
Jöbges
M
M
Neurologisches Rahabilitationszentrum Leipzig, University of Laipzig, Bennewitz, Germany. joebges@sachsenklinik.de
Heuschkel
G
G
Pretzel
C
C
Illhardt
C
C
Renner
C
C
Hummelsheim
H
H
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011187:Posture; D011788:Quality of Life; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*