Gait Disorders in Parkinsonʼs Disease

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Abstract
Until recently, physical therapy treatment of gait disorders in Parkinson's disease (PD) was guided by clinical observations and a small number of brief reports on the effects of visual and auditory cues. Current research on the motor control of gait and the pathogenesis of movement disorders in PD has yielded important new implications for evidence based practice. The research suggests that when determining the treatment plan, physical therapists need to take into account the effects of basal ganglia dysfunction, drug induced movement disorders, age related changes, fear of falling, and disuse on gait performance. Basal ganglia deficits include difficulty in dual task performance and execution of long or complex movement sequences, as well as slowness in adapting the gait pattern in response to changing environmental demands. Although there is a fundamental disorder in the regulation of stride length, the ability to modulate walking cadence remains intact. The question that arises for clinicians is whether physical therapy should focus on teaching strategies to compensate for basal ganglia dysfunction or training of complex sequential movements and dual tasks with the hope that restitution of motor abilities can occur with practice.

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