ISSN 2490-3329 (Print)
ISSN 2303-7954 (Online)

Volume 49, Issue 2, Article 2

(Scr Med 2018:49:83-91)

The Importance of Rehabilitation Treatment in Patients with Parkinson’s Disease

Teodora Talić1,2, Tatjana Bućma1,2, Olivera Pilipović-Spasojević1, Luka Talić2

1 Institute for Physical Medicine and Rehabilitation “Dr Miroslav Zotović”, Banja Luka
2 Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina

DOI 10.7251/SCMED1802083T
UDC 616.858-008.6-02
COBISS.RS-ID 7836440


Parkinson’s disease (PD) is a chronic neurodegenerative disease with a slowly progressive course, having an average duration of about 15 years. It is characterized by akinesia/ bradykinesia, tremor, rigidity and postural instability. For the diagnosis of PD at least two of these four characteristics are required. There is a whole spectrum of non-motor symptoms (mood disorders, different levels of cognitive deficit, sleep disorders, fatigue, autonomic dysfunction). The patomorphologic base of PD is a disorder of the nigrostriatal dopaminergic mechanisms, metabolic damages, structural changes (hydrocephalus, tumors) or degenerative processes of presynaptic nigrostriatal dopaminergic projections or the striatum. Although the pharmacological approach is still essential, more systematic reviews and meta-analysis support the hypothesis on the positive effects of physiotherapy and intensive kinesiotherapy in PD patients. The main rehabilitation method for these patients is kinesiotherapy in its various forms, related to the individual therapeutic target, based on functional limits. Rehabilitation programs contain kinesiotherapeutic procedures for balance, posture, the range of motions- especially rotation of the trunk, strength, elongation, as well as exercise for functionally reduced motion types. The greatest emphasis in the rehabilitation process should be on the re-education of gait, which involves the optimization of initiation, speed, and length of steps. The aim of kinesiotherapy and occupational therapy is to bring the maximum functional independence of the patient and the occurrence of complications to a minimum.

In neurodegenerative disorders, all modalities for improving the gait function are essentially a lifelong activity. Therapeutic strategy comes down to the combination of pharmacotherapy and neurorehabilitation methods.

Key words: Parkinson’s disease, neurorehabilitation, gait.


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1. Dickson DW. Parkinson’s disease and parkinsonism: Neuropathology, Cold Spring Harb Perspect Med. 2012 Aug 1; 2(8): pii:a009258.
2. Bohlhalter S, Kćgi G. Parkinsonism: heterogeneity of a common neurological syndrome. Swiss Med Wkly, 2011, Nov 1;141:w13293.
3. Hirsch L, Jette N, Frolkis A, Steeves T, Pringsheim T. The incidence of parkinson’s disease: A systematic review and meta-analysis. Neuroepidemiology, 2016; 46:292-300.
4. Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of Parkinson’s disease: a systematic review and meta-analysis.Mov Disord. 2014;29:1583-90.
5. Poewe W. The natural history of Parkinson’s disease. J Neurol 2006; 253(Suppl 7):VII2-6.
6. Charlotte Haaxma CA, Bloem BR, Borm GB, Leendeis KL, Eshuis S, et al. Gender differences in Parkinson’s disease,J Neurol Neurosurg Psychiatry. 2007 Aug; 78(8): 819–24.
7. Lang ć, Obeso JA. Time to move beyond nigrostriatal dopamine deficiency in Parkinson’s disease. Ann Neurol, 2004; 55:761-5.
8. Braak H, Braak E, Yilmazer D, Shultz C, deVasRA, Jansen EN. Nigral and extranigral pathology inParkinson’s disease. J Neurol Transm Suppl 1995; 46: 15-31.
9. McAuley JH. The physiological basis of clinical deficits in Parkinson disease. Prog Neurobiol, 2003; 69(1): 27-48.
10. Volpicelli-Daley LA, Luk KC, Patel TP, Tanik SA, Riddle DM, Stieber A et al. Exogenous ?-Synuclein Fibrils Induce Lewy Body Pathology Leading to Synaptic Dysfunction and Neuron Death, Neuron,2011; 72, 1: Pages 57-71.
11. Calne D. A definition of Parkinson’s disease. Parkinsonism Relat Disord 2005; 11 (Suppl 1): S39-40.
12. Erro R, Stamelou M. The motor syndrome of Parkinson’s disease.Int Rev Neurobiol, 2017;132:25-32.
13. Bonnet AM, Czernecki V. Non-motor symptoms in Parkinson’s disease: cognition and behavior. Geriatr Psychol Neuropsychiatr Vieil. 2013 Sep;11(3):295-304.
14. Bassetti CL. Non-motor disturbances in Parkinson’s disease. Neurodegener Dis 2011; 8:92-108.
15. Stebbins GT, Goetz CG, Burn DJ, Jankovic J, Khoo TK, Tilley BC. How to identify tremor dominant and postural instability/gait difficulty groups with the movement disorder society unified Parkinson’s disease rating scale: comparison with the unified Parkinson’s disease rating scale. Mov Disord, 2013 May;28(5):668-70.
16. Marras C, Lang A. Parkinson’s disease subtypes. J Neurol Neurosurg Psychiatry 2013; 84(4): 409-15.
17. Moustafa AA, Chakravarthy S, Phillips JR, Gupta A, Keri S, Polner B, net al. Motor symptoms in Parkinson’s disease: A unified framework, Neurosci Biobehav Rev, 2016 Sep;68:727-40.
18. Shahed J, Jankovic J. Motor symptoms in Parkinson’s disease, Handb Clin Neurol; 83: 2007:329-42.
19. Sapir S, Ramig L, Fox C. Speech and swallowing disorders in Parkinson disease. Curr Opin Otolaryngol Head Neck Surg 2008; 16, 3:205–10.
20. Boonstra TA, van der Kooij H, Munneke M, Bloem BR. Gait disorders and balance disturbances in Parkinson’s disease: clinical update and pathophysiology. Curr Opin Neurol 2008; 21:461-71.
21. Schaafsma JD, Giladi N, Balash Y et al. Gait dynamics in Parkinson’s disease: relationship to Parkinsonian features, falls and response to levodopa. J Neurol Sci; 2003; 212:47-53.
22. Murray MP, Sepic SB, Gardner GM, Downs WJ. Walking patterns of men with parkinsonism. Am J Phys Med, 1978; 57: 278-94.
23. Rosin R, Topka H, Dichgans J. Gait initiation in Parkinson’s disease. Mov Disord, 1997;12:682–90.
24. Breniere Y, Do C. Control of gait initiation. J Mot Behav. 1991; 23: 235–40.
25. Burleigh JA, Horak FB, Nutt JG, Obeso JA. Step initiation in Parkinson’s disease: Influence of levodopa and external sensory triggers. Mov Disord, 1997;12: 206–15.
26. Morris ME, Lansek R, Matyas TA, Summers JJ. Stride length regulation in Parkinson’s disease. Normalization strategies and underlying mechanisms. Brain, 1996;119:551–68.
27. Thompson P, Marsden CD. Clinical neurological assessment of balance and gait disorders. In: Bronstein A et al, editors. Clinical Disorders of Balance Posture and Gait. London: Arnold, 1996:79–84.
28. Brown P, Steiger M. Basal ganglia gait disorders. In: Bronstein A et al, editors. Balance Posture and Gait. New York: Arnold with co-publishers Oxford University Press, 1996:156-67.
29. Hoehn MM, Yahr MD.Parkinsonism: onset, progression and mortality Neurology. 1967;17:427-42.
30. Fahn S, Elton RL, UPDRS program members. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB, editors. Recent Developments in Parkinson’s Disease, vol. 2. Florham Park, NJ: Macmillan Healthcare Information, 1987;153–163, 293–304.
31. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32(1):50-5.
32. Hamilton M. A rating scale for depression. Neurol, Neurosurg, and Psychiatry 1960;23: 56–62.
33. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189-98.
34. Morris, JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993; 43(11), 2412-14.
35. Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev 2013 Sep 10;9:CD002817.
36. Lima LO, Scianni A, Rodrigues-de-Paula F. Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson’s disease: a systematic review J Physiother 2013; 59:7-13.
37. Hirsch MA, Farley BG. Exercise and neuroplasticity in persons living with Parkinson’s disease. Eur J Phys Rehabil Med 2009;45:215-29.
38. Cohen AD. Neuroprotective effects of prior limb use in 6-hydroxydopamine-treated rats: possible role of GDNF. J Neurochem 2003;85:299-305.
39. Steiner B. Enriched environment induces cellular plasticity in the adult substantia nigra and improves motor behavior function in the 6-OHDA rat model of Parkinson’s disease. 2006;199:291-300.
40. Tillerson JL, Caudle WM, Reverón ME, Miller GW. Exercise induces behavioral recovery and attenuates neurochemical deficits in rodent models of Parkinson’s disease. Neuroscience. 2003; 119: 899-911.
41. Fisher BE, Petzinger GM, Nixon K, Hogg E, Bremmer S, Meshul CK, et al. Exercise-induced behavioral recovery and neuroplasticity in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse basal ganglia. J Neurosci Res 2004;77:378-90.
42. Mćtzler W, Liepelt I, Berg D. Progression of Parkinson’s disease in the clinical phase: potential markers. Lancet Neurol 2009;8:1158-11.
43. Spaulding SJ, Barber B, Colby M, Cormack B, Mick T, Jenkins ME. Cueing and gait improvement among people with Parkinson’s disease: a meta-analysis.Arch Phys Med Rehabil. 2013; 94: 562-70.
44. Miyai I, Fujimoto Y, Ueda Y, Yamamoto H, Nozaki S, Saito T, et al. Treadmill training with body weight support: its effect on Parkinson’s disease. Arch Phys Med Rehabil. 2000; 81: 849-52.
45. Mehrholz J, Kugler J, Storch A, Pohl M, Elsner B, Hirsch K. Treadmill training for patients with Parkinson’s disease. Cochrane Database Syst Rev 2015 Aug 22;(8):CD007830.
46. Lima LO, Scianni A, Rodrigues-de-Paula F. Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson’s disease: a systematic review V. J Physiother 2013; 59:7-13.
47. Hubble RP, Naughton GA, Silburn PA, Cole MH Trunk muscle exercises as a means of improving postural stability in people with Parkinson’s disease: a protocol for a randomised controlled trial. BMJ Open 2014 Dec 31;4(12).
48. Ramazzina I, Bernazzoli B, Costantino C. Systematic review on strength training in Parkinson’s disease: an unsolved question. Clin Interv Aging 2017; 12:619-28.
49. Vadala M, Vallelunga A, Palmieri L, Palmiesi B, Merales-Medina K, Iennitti T. Mechanisms and therapeutic applications of electromagnetic therapy in Parkinson’s disease. Behav Brain Funct 2015; 11: 26.

Manuscript received: June 17th, 2018
Manuscript accepted: November 19th, 2018