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

Abstract

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. To develop a method of repetitive training of compensatory steps to enhance protective postural responses by using training strategies based on recent neurophysiological research. 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. 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. 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.