Short- and Long-Term Efficacy of Intensive Rehabilitation Treatment on Balance and Gait in Parkinsonian Patients: A Preliminary Study with a 1-Year Followup
Parkinson’s disease (PD) is a neurodegenerative disease in which gait and balance disturbances are relevant symptoms that respond poorly to pharmacological treatment. The aim of this study was to investigate whether a 4-week inpatient multidisciplinary intensive rehabilitation treatment (MIRT) is effective in improving balance and gait and whether improvements persist at a one-year followup. We studied 20 PD inpatients (stage 3 Hoehn-Yahr) who underwent a MIRT. Outcome measures were UPDRS items for balance (30), falls (13), and walk (29), Berg Balance Scale, six-minute walking test, Timed Up and Go Test, and Comfortable-Fast gait speeds. Patients were evaluated at admission, at the end of the 4-week treatment, and at a 1-year followup. Pharmacological therapy was unchanged during MIRT and follow-up. All outcome measures improved significantly at the end of treatment. At 1-year follow-up control, UPDRS walk and Comfortable-Fast gait speeds still maintained better values with respect to admission ( , and , resp.), while the remaining scales did not differ significantly. Our results demonstrate that the MIRT was effective in improving balance and gait and that the improvement in gait performances was partially maintained also after 1 year. 1. Introduction Parkinson’s disease (PD) is a neurodegenerative disorder characterized by different motor symptoms (rigidity, akinesia, tremor, and impairment of balance and gait). Even though pharmacological treatment has changed the natural course of disease, gait and balance worsen over time and these disturbances progressively lead to major disability [1, 2]. Postural instability leads to falls: PD subjects often fall because they respond to a sudden loss of balance with abnormally short steps that are inadequate to recover equilibrium [3, 4]. Moreover, Parkinsonian patients present continuous gait disturbances (shorter stride length, reduced gait speed, increased variability of stride, and increased double support time) that, often associated with freezing and festination, lead to frequent falls [5, 6]. In the last five years, several studies have shown that physiotherapy strategies, including cueing techniques, treadmill training, and cognitive movement strategies, are useful in improving balance and gait in PD patients [7–10]. However, whether the effects of the rehabilitation on gait and balance persist over time and what the optimal content of exercise intervention is (the kind of exercises, the intensity, and the duration of treatment) remain open questions [11]. It has been recently hypothesized that the best
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