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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2004 Dec;75(12):1682–1687. doi: 10.1136/jnnp.2003.016550

Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson's disease

M Jobges 1, G Heuschkel 1, C Pretzel 1, C Illhardt 1, C Renner 1, H Hummelsheim 1
PMCID: PMC1738854  PMID: 15548482

Abstract

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.

Conclusion: 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.

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Selected References

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