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G. Singh1, K.A. Monroe1, A. Tatro1
1Russell Sage College, Physical Therapy, Troy, United States
Background: Freezing of Gait (FoG) is one of the major gait disturbances seen in Parkinson’s Disease (PD). The pathophysiology behind FoG is not well understood, but there are several hypotheses that have been proposed.While medications such as levodopa can improve some of the symptoms of PD, there are no medications that have been proven to slow the progression of this disease. Exercise has been shown to improve motor and nonmotor symptoms of PD.
Exercises that have been studied in existing literature include aquatic training, curved-walking training, slackline training, action observation training, dance therapy, and the use of cueing as an adjunct with exercise.
Exercises that have been studied in existing literature include aquatic training, curved-walking training, slackline training, action observation training, dance therapy, and the use of cueing as an adjunct with exercise.
Purpose: While several studies focused on the effectiveness of exercise on FoG in individuals with PD, there is not a consensus on the most effective form of exercise. The purpose of this systematic review was to compare the existing literature to determine best practice for improving FoG.
Methods: Three databases were searched including PubMed, PEDro, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search terms included: Therapeutic Exercises, Freezing, Gait, Parkinson’s Disease and Exercise. A total of 10 articles were analyzed by 2 independent researchers through individual quality assessment as well as group meetings.
Results: This review provides evidence-based support that exercises such as those involving treadmill training, slackline training, action observation training, or aquatic obstacle training may be beneficial in reducing FoG in individuals with PD. Literature suggests that cueing as an adjunct to physical therapy may be beneficial in improving FoG in individuals with PD. A variety of underlying physiological mechanisms that may contribute to improvement in FoG are proposed, however, researchers are unable to determine what is the exact mechanism for this improvement. Literature suggest that cueing shift attention to the task, resulting in improved gait parameters and hence decreased FoG. Action observation training can lead to increased recruitment of the motor network and mirror neuron system, which has been found to be functionally correlated to decreased FoG. Additionally, more complex and functional a task is, the more likely it will translate to better outcomes for individuals with PD. Literature suggests that 12 sessions over a period of 4-6 weeks may be appropriate to see short term improvements in FoG in individuals with PD. However, inconsistencies between exercise protocols make it difficult to determine which intervention is most appropriate.
Conclusion(s): This systematic review provides evidence that exercises such as treadmill training, slackline training, programs supplemented by individualized cueing, action observation training, or aquatic obstacle training may decrease FoG in individuals with PD. Without more information and stronger evidence from RCTs, we cannot determine with certainty which type of exercise program is most effective in decreasing FoG in these individuals.
Implications: Adjunct training along with traditional PT might help improve freezing of gait in individuals with PD, however careful selection of augmentative or external cues are necessary based on individual patients in order to gain best results.
Funding, acknowledgements: NA
Keywords: Parkinson Disease, Freezing of Gait, Exercise
Topic: Neurology: Parkinson's disease
Did this work require ethics approval? No
Institution: Russell Sage College
Committee: IRB
Reason: It is a systematic review completed by DPT students under the guidance of PT Faculty member
All authors, affiliations and abstracts have been published as submitted.
