Table 2.

Management of gait dysfunction in PSP/CBS.

1. Pharmacologic therapy

a. Amantadine

i. Start at 50–100 mg daily and titrate at intervals of at least 2 weeks

ii. Do not exceed 100 mg TID.

iii. Monitor for psychosis, confusion, and constipation.

iv. Inspect for livedo reticularis and reassure patient that it is benign.

b. Coenzyme Q-10

i. Modest benefit on average but some patients respond well

ii. Use liposomal form (a liquid) at 100 mg TID

iii. If no benefit after 2 months, discontinue.

2. Non-pharmacologic therapy

a. Physical therapy

i. Early intervention recommended

ii. Focused on postural stability and gait re-training

iii. Balance, eye movement training and visual awareness training may help.

b. Exercise

i. Aerobic exercise

1. If tolerated and safe

2. Obtain approval from PCP or cardiologist if cardiovascular history is present.

ii. Recumbent bicycle is recommended.

c. Assistive devices

i. Cane should be prescribed with caution

1. Tripping hazard, as patients tend to carry cane hanging from wrist

2. Fails to prevent falls in other directions.

ii. Weighted walker

iii. Wheelchair

iv. A lightweight transport wheelchair is useful when the caregiver cannot lift a standard wheelchair into a car's trunk.