title: Rehabilitation for Parkinson's disease: Current outlook and future challenges.
abstract: Rehabilitation is considered as an adjuvant to pharmacological and surgical treatments for Parkinson's disease (PD) to maximize functional ability and minimize secondary complications. Originally, approaches were based on empirical experience, but growing evidence suggests that exercise-dependent plasticity constitutes the main mechanism underlying the effects of physiotherapy. Exercise increases synaptic strength and influences neurotransmission, thus potentiating functional circuitry in PD. In addition, exercise is a pivotal element of motor learning. PD patients retain a sufficient capacity of motor learning, though learning rates and performance are reduced in comparison to normal controls. Recent meta-analyses demonstrated that rehabilitation could induce short-lasting, but clinically important benefits, particularly for gait and balance. However, the interventions are largely heterogeneous (stretching, muscle strengthening, balance, postural exercises, occupational therapy, cueing, treadmill training), and there is still no consensus about the optimal approach. Innovative techniques have been recently proposed: virtual reality and exergaming, motor imagery and action observation, robot-assisted physiotherapy and non-conventional therapies (e.g.: dance, martial arts). The rehabilitative program for PD should be "goal-based" (targeted to practicing and learning specific activities in the core areas), but a number of practice variables (intensity, specificity, complexity) need to be identified and the program should tailored to the individual patients' characteristics.
authors.affiliation: Centre for Parkinson's Disease, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy; Unit of Rehabilitation and Functional Recovery, IRCCS S. Martino Hospital-IST, Genoa, Italy. Electronic address: giabbr@unige.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Abbruzzese
authors.affiliation: Centre for Parkinson's Disease, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy; Unit of Rehabilitation and Functional Recovery, IRCCS S. Martino Hospital-IST, Genoa, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Marchese
authors.affiliation: Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Avanzino
authors.affiliation: Centre for Parkinson's Disease, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy; Unit of Rehabilitation and Functional Recovery, IRCCS S. Martino Hospital-IST, Genoa, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pelosin
mesh_terms: D000203:Activities of Daily Living; D000818:Animals; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000639:trends*; D005544:Forecasting; D005684:Gait / Q000502:physiology; D006801:Humans; D010300:Parkinson Disease / Q000175:diagnosis* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000639:trends
keywords: Parkinson's disease; Physical exercise; Plasticity; Rehabilitation