An Overview of Different Treatment Approaches to Improve Gait and Balance in Parkinson’s Disease (PD): A Narrative Review

Abstract

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by resting tremor, bradykinesia, rigidity, postural instability and gait disability. Impaired gait and balance can be severely disabling for the patient making it difficult for them to carry on with their day-to-day activities. The effects of levodopa on gait and balance are quite controversial with some studies even describing levodopa as a double-edged sword; this and the progressive nature of the disease makes exercise therapy of utmost importance for the improvement of symptoms. However, designing an appropriate exercise regime for PD patients is not an easy task given the motor learning difficulties seen in these patients. Even though a variety of exercise interventions like treadmill, balance, resistance, multicomponent training, complementary approaches, aquatic therapy, cueing, virtual reality training are being used in the PD gait and balance rehabilitation, there still exists a lack of clarity about the type, right combination, duration and intensity of exercises to be used in order to help the patient achieve maximum results. This narrative review will evaluate different exercise approaches used in the gait and balance rehabilitation of PD patients and in the end the potential ways to improve upon the current practice will be discussed. Key words: Parkinson’s disease, gait, balance.