Emma Bestaven, Etienne Guillaud, Mathieu De Sèze, Aupy Jerome, Pierre Burbaud, Jean-René Cazalets, Dominique Guehl
INCIA, Université de Bordeaux, France
DOI: 10.2340/20030711-1000003

Background: The course of Parkinson's disease is characterized by gait disturbance and falls, which affect patients' quality of life and engender high healthcare costs. These factors are not greatly improved by levodopa therapy or deep brain stimulation of the subthalamic nuclei. Indeed, the symptoms may even worsen with these treatment. Physiotherapy may be the most appropriate treatment to reduce the incidence of falls in these cases; how-ever, its benefits are modest.
Objective: To assess the effectiveness of trunk muscle strengthening in 10 patients with Parkinson's disease being treated with deep brain stimulation of the subthalamic nuclei who are affected by gait disturbances and falls.
Method: A standardized physiotherapy programme centred on trunk muscle strengthening was conducted. Its effectiveness was assessed using a clinical approach combined with video-based motion analysis.
Results: After 4 weeks of trunk muscle strengthening, the gait item on the Unified Parkinson's Disease Rating Scale (UPDRS, part 3) together with several gait kinematic parameters (step length, walking cycle duration variability, gait speed) were significantly improved and the number of falls decreased.
Conclusion: These preliminary findings suggest that physiotherapy centred on rachis mobility improves the quality of gait and reduces the number of falls in patients with Parkinson's disease who are being treated with deep brain stimulation of the subthalamic nuclei. This is a potentially useful supplement to the traditional physiotherapy approach, in addition to the pharmacological and surgical treatment of Parkinson's disease.

Over time, patients with Parkinson's disease treated operatively with subthalamic nucleus deep brain stimulation develop drug-resistant gait disturbance and falls. Traditional physiotherapy programmes for reducing the incidence of falls in these patients have modest effects. Thus, a physiotherapy programme based on trunk exercises could be helpful, since optimal axial motility and gait and posture quality are strongly linked. A specific programme was used for 10 patients with Parkinson's disease treated operatively with subthalamic nucleus deep brain stimulation. The programme involved 2 physiotherapy sessions per day for 5 days a week over a period of 4 consecutive weeks. Quality of gait improved and the number of falls decreased significantly. In conclusion, specific standardized rehabilitation of axial motility is potentially a useful supplement to the traditional physiotherapy approach in order to reduce falls in patients with Parkinson's disease who have been treated operatively with subthalamic nucleus deep brain stimulation.