Objective: Sensory system is impaired in PN. Sensory impairment can affect balance. PD patients have impaired balance. Thus, PD patients with PN are more likely to report impaired balance. The goal of the study is to explore gait improvement after PT in PD patient with co-existing PN utilizing a validate scale or tool called modified clinical test of sensory interaction on balance or CTSIB-M scale. We designed to utilize this scale because it assess how well an older adult is using sensory inputs when one or more sensory inputs are possibly compromised as in PN.

Background: For those of us who manage Parkinson Disease (PD), we know that gait impairment is one of the most disabling features of the disease. We also recognize that patients with peripheral neuropathy have a higer incidence of injuries while walking. We observed that PD patients with coexisting peripheral neuropathy ( PN) seemed to have an even more gait difficulty perhaps due to impaired sensory inputs with can compromise balance and walking even further. Physiotherapy (PT) interventions can improve gait regularity in patients with PD and PN while walking.

Methods: Case report.

Results: 2 male patients with PD and PN chart were reviewed. CTSIB-M score- Pre PT 95 and 95, Post PT 120 and 120. CTSIB-M maximum score is 120: representing a total of 120 seconds or 60 seconds per condition tested. There are 4 conditions tested. Timing begins each condition trial using a stopwatch. The trial is over when (a) the participant opens his/her eyes in an eyes closed condition, (b) raises arms from sides, (c) loses balance and requires manual assistance to prevent a fall.

Conclusions: Two patients with PD and PN with previous complaint of gait impairment had improvement in their balance as measured by modified CTSIB after a 4 week formal physiotherapy/PT . While the author recognized the limitation of the study being a case report, findings are reasonable to promote the health benefit of PT to PD patient with co- existing PN.

References: https://www.sralab.org/sites/default/files/2017-06/204Lmctsib.pdf.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-peripheral-neuropathy-impaired-gait-and-the-role-of-physiotherapy/