Towards Personalized Rehabilitation for Gait Impairments in Parkinson's Disease

Jorik Nonnekes, Alice Nieuwboer, Jorik Nonnekes, Alice Nieuwboer

Abstract

Non-pharmacological interventions are essential in the management of gait impairments in Parkinson's disease. The evidence for these interventions is growing rapidly. However, studies evaluating these interventions do generally evaluate a one-size-fits-all concept, and do usually not distinguish between subgroups, treatment dose and delivery mode. For two main reasons, this approach will not reach the full potential of gait rehabilitation. First, non-pharmacological interventions (e.g., external cueing) can improve gait in certain patients, but have no effect or sometimes even exacerbate gait deficits in others. Second, the success and benefit of gait rehabilitation relies on therapy adherence and training intensity achieved, and multi-target therapy not tailored to the individual runs the risk of hitting nothing. Hence, to apply non-pharmacological interventions in an individualized and evidence-based manner, clinicians and therapists need to know which patient characteristics predict the efficacy of various training modes and what type of training delivery works best. Current evidence is not sufficient to develop such personalized rehabilitation programs. In this viewpoint, however, we describe how tailored use of gait rehabilitation can be reached within a 20-year time frame.

Keywords: Gait; Parkinson’s disease; balance; falls; freezing of gait; personalized medicine; physiotherapy; rehabilitation.

Figures

Fig. 1.
Fig. 1.
Potential factors influencing effectiveness of non-pharmacological intervention of gait impairments. Various domains that impact on gait deficits in Parkinson’s disease.

References

    1. Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A (2011) Freezing of gait: Moving forward on a mysterious clinical phenomenon. Lancet Neurol 10, 734–744.
    1. Nonnekes J, Goselink RJM, Ruzicka E, Fasano A, Nutt JG, Bloem BR (2018) Neurological disorders of gait, balance and posture: A sign-based approach. Nat Rev Neurol 14, 183–189.
    1. Bloem BR, Hausdorff JM, Visser JE, Giladi N (2004) Falls and freezing of gait in Parkinson’s disease: A review of two interconnected, episodic phenomena. Mov Disord 19, 871–884.
    1. Canning CG, Paul SS, Nieuwboer A (2014) Prevention of falls in Parkinson’s disease: A review of fall risk factors and the role of physical interventions. Neurodegener Dis Manag 4, 203–221.
    1. Nonnekes J, Snijders AH, Nutt JG, Deuschl G, Giladi N, Bloem BR (2015) Freezing of gait: A practical approach to management. Lancet Neurol 14, 768–778.
    1. van der Marck MA, Klok MP, Okun MS, Giladi N, Munneke M, Bloem BR, Force NPFFT (2014) Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson’s disease. Parkinsonism Relat Disord 20, 360–369.
    1. Ginis P, Nackaerts E, Nieuwboer A, Heremans E (2017) Cueing for people with Parkinson’s disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives. Ann Phys Rehabil Med. doi:10.1016/j.rehab.2017.08.002
    1. Rahman S, Griffin HJ, Quinn NP, Jahanshahi M (2008) The factors that induce or overcome freezing of gait in Parkinson’s disease. Behav Neurol 19, 127–136.
    1. Studer V, Maestri R, Clerici I, Spina L, Zivi I, Ferraz-zoli D, Frazzitta G (2017) Treadmill training with cues and feedback improves gait in people with more advanced Parkinson’s disease. J Parkinsons Dis 7, 729–739.
    1. Mehrholz J, Kugler J, Storch A, Pohl M, Hirsch K, Elsner B (2015) Treadmill training for patients with Parkinson’s disease. Cochrane Database Syst Rev, CD007830.
    1. Strouwen C, Molenaar EALM, Munks L, Keus SHJ, Zijl-mans JCM, Vandenberghe W, Bloem BR, Nieuwboer A (2017) Training dual tasks together or apart in Parkinson’s disease: Results from the DUALITY Trial. Mov Disord 32, 1201–1210.
    1. Walton CC, Mowszowski L, Gilat M, Hall JM, O'Callaghan C, Muller AJ, Georgiades M, Szeto JYY, Ehgoetz Martens KA, Shine JM, Naismith SL, Lewis SJG (2018) Cognitive training for freezing of gait in Parkinson’s disease: A randomized controlled trial. NPJ Parkinsons Dis 4, 15.
    1. Bloem BR, de Vries NM, Ebersbach G (2015) Nonpharma-cological treatments for patients with Parkinson’s disease. Mov Disord 30, 1504–1520.
    1. Nombela C, Hughes LE, Owen AM, Grahn JA (2013) Into the groove: Can rhythm influence Parkinson’s disease? Neu-rosci Biobehav Rev 37, 2564–2570.
    1. Schenkman M, Moore CG, Kohrt WM, Hall DA, Delitto A, Comella CL, Josbeno DA, Christiansen CL, Berman BD, Kluger BM, Melanson EL, Jain S, Robichaud JA, Poon C, Corcos DM (2018) Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: A phase 2 randomized clinical trial. JAMA Neurol 75, 219–226.
    1. King LA, Wilhelm J, Chen Y, Blehm R, Nutt J, Chen Z, Serdar A, Horak FB (2015) Effects of group, individual, and home exercise in persons with Parkinson disease: A randomized clinical trial. J Neurol Phys Ther 39, 204–212.
    1. Leavy B, Roaldsen KS, Nylund K, Hagstromer M, Franzen E (2017) “Pushing the Limits”: Rethinking motor and cognitive resources after a highly challenging balance training program for Parkinson disease. Phys Ther 97, 81–89.
    1. Ginis P, Heremans E, Ferrari A, Bekkers EMJ, Canning CG, Nieuwboer A (2017) External input for gait in people with Parkinson’s disease with and without freezing of gait: One size does not fit all. J Neurol 264, 1488–1496.
    1. Nieuwboer A, De Weerdt W, Dom R, Bogaerts K (2002) Prediction of outcome of physiotherapy in advanced Parkinson’s disease. Clin Rehab 16, 886–893.
    1. Strouwen C ME, MUnks L, Broeder S, Ginis P, Bloem BR, Nieuwboer A, Heremans E (2018) Determinants of dual-task training effect size in Parkinson’s disease: Who will benefit most? J Neurol Phys Ther, in press.
    1. Heremans E, Nackaerts E, Vervoort G, Broeder S, Swinnen SP, Nieuwboer A (2016) Impaired retention of motor learning of writing skills in patients with Parkinson’s disease with freezing of gait. PLoS One 11, e0148933.
    1. Khalil H, Bajwa JA (2015) Barriers and facilitators in physical rehabilitation for Parkinson’s disease in the Arabian world. Mov Disord Clin Pract 2, 227–229.
    1. Nonnekes J, Benda N, van Duijnhoven H, Lem F, Kei-jsers N, Louwerens JWK, Pieterse A, Renzenbrink B, Weerdesteyn V, Buurke J, Geurts ACH (2018) Management of gait impairments in chronic unilateral upper motor neuron lesions: A review. JAMA Neurol 75, 751–758.
    1. Del Din S, Godfrey A, Mazza C, Lord S, Rochester L (2016) Free-living monitoring of Parkinson’s disease: Lessons from the field. Mov Disord 31, 1293–1313.
    1. Horak FB, Mancini M (2013) Objective biomarkers of balance and gait for Parkinson’s disease using body-worn sensors. Mov Disord 28, 1544–1551.
    1. Tosserams A, Araujo R, Pringsheim T, Post B, Darweesh SKL, IntHout J, Bloem BR (2018) Underrepresentation of women in Parkinson’s disease trials. Mov Disord. doi:10.1002/mds.27505
    1. Hamburg MA, Collins FS (2010) The path to personalized medicine. N Engl J Med 363, 301–304.

Source: PubMed

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