The clinical approach to gait disturbances in Parkinson's disease; maintaining independent mobility

Abstract

Gait is affected in all stages of Parkinson's disease (PD) and is one of the hallmarks for disease progression. The fear of getting into the wheel chair is one of the first thoughts many patients ask about when the diagnosis of PD is given. At the early stages of the disease gait disturbances are present and can be measured but in most patients it does not cause significant functional disturbances. In contrast, as the disease progress, gait disturbances and postural control abnormalities are becoming major causes for lost of mobility and falls. These unfortunate consequences should be forecasted at the early stages of the disease and a preventive approach should be taken. Treatment of gait disturbances at the early stages of the disease is mainly to encourage patients to exercise and walk daily and by drugs in those with disabling symptoms. At the advanced stages, treatment should be aggressive in order to keep the patient walking safely. Drugs, physiotherapy and functional neurosurgery should be used wisely for best outcomes and least side effects. When time comes and the risk of falls is very significant, walking aids should be suggested and if no other option is left, wheel chair is a very reasonable option to maintain mobility out of home, preserving quality of life and avoiding falls with all it severe consequences. © Springer-Verlag 2006.