Bettina Debû1,2, Clecio De Oliveira Godeiro3,4,5, Jarbas Correa Lino3,4,6, Elena Moro7,3,4. 1. University Grenoble Alpes, Grenoble, France. Bettina.debu@univ-grenoble-alpes.fr. 2. INSERM U1216, Grenoble, France. Bettina.debu@univ-grenoble-alpes.fr. 3. INSERM U1216, Grenoble, France. 4. Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France. 5. Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil. 6. Division of Neurology, CHU Amiens, Amiens, France. 7. University Grenoble Alpes, Grenoble, France.
Abstract
PURPOSE OF REVIEW: Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS: It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
PURPOSE OF REVIEW: Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS: It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
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