Objective: Patients with Parkinson’s disease (PD) use variety of strategies to compensate for their disorders of gait and balance. The goal of the present work is to overview these strategies and to classify them into key compensatory strategies. Analyzing the common traits of these strategies may contribute to understanding their mechanisms, and the development of focused rehabilitation techniques.

Background: The use of sensory or physical tricks for improving mobility in PD patients has been anecdotally recognized since James Parkinson first described the disease. These techniques have been used by patients and therapists to overcome freezing of gait (FOG), and improve fluidity of movement or balance. Proposed mechanisms include capitalizing on neural networks subserving goal-directed behavior to generate a new locomotor pattern; by-passing dysfunctional cortical-basal ganglia loops by using either internally-derived or external cues; or possibly basal ganglia rescue by endogenous dopaminergic or noradrenergic release.

Methods: Video recordings were collected of a sample of consecutive patients with PD with moderate to severe disease severity who spontaneously informed their treating neurologist or physiotherapist about the use of self-invented tricks and aids to improve their mobility, especially FOG. The patients were asked to bring home videos showing the strategies they were using to walk in or outdoors. In some cases, additional videos were recorded during the patients’ visits in the consulting room or hospital. All patients agreed in writing with the use of their recordings to analyze their compensation strategies and to publish them as possible hints for other patients. The patients’ video recordings were independently reviewed by movement disorders experts and the observed compensation approaches was classified into 5 categories: 1) Generation of a new locomotor pattern, 2) External cueing, 3) Internal cueing, 4) Mixed strategy, and 5) Unclassified.

Results: Preliminary results are not yet available.

Conclusions: This study provides a basis for classification of compensatory mechanisms used by PD patients and generates hypotheses for further studies exploring the physiological underpinnings of human motion. In addition, identification of compensatory strategies will play an important role in developing targeted methods for rehabilitation.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/compensation-strategies-for-gait-in-parkinsons-disease/