Training of compensational strategies for impaired gross motor skills in Parkinson' disease

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Abstract
In Parkinson' disease, early impairments in the execution of gross motor skills threaten the patient' physical independence. Treatment is problematic, but findings from an earlier pilot study (Kamsma et al, 1994) indicated that systematic training of compensatory movement strategies is feasible. Such strategies must be based on the reorganisation of the kinesiology of the skills, resulting in sequences of simple movement elements that can be executed separately at a conscious level and without time constraints. The aim of this study was to investigate whether compensatory movement strategies could be implemented in an extensive training programme. An experimental group of 25 patients with Parkinson' disease learned alternative movement strategies for three important skill domains: chair-related (sitting in and rising from a chair), walking-related (gait initiation/termination, turning while walking) and bed-related (getting in and out of bed and turning in bed). The experimental group was followed for 1 year and their performance compared with that of a control group (n = 13), who participated in a non-specific, in-group exercise programme. Video analysis revealed that the experimental group showed consistent improvements in performance. Rating scales and questionnaires provided additional evidence of these improvements and application in daily life.