Skip to main content

Advertisement

SpringerLink
Log in

Managing Gait, Balance, and Posture in Parkinson’s Disease

  • Movement Disorders (S Fox, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kudlicka A, Clare L, Hindle JV. Executive functions in Parkinson’s disease: systematic review and meta-analysis. Mov Disord. 2011;26:2305–15.

    Article  PubMed  Google Scholar 

  2. Isella V, Melzi P, Grimaldi M, Iurlaro S, Piolti R, Ferrarese C, et al. Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson’s disease. Mov Disord. 2002;17:366–71.

    Article  PubMed  Google Scholar 

  3. Morris R, Lord S, Lawson RA, Coleman S, Galna B, Duncan GW, et al. Gait rather than cognition predicts decline in specific cognitive domains in early Parkinson’s disease. J Gerontol Ser A. 2017;72:1656–62.

    Article  Google Scholar 

  4. Marras C, McDermott MP, Rochon PA, Tanner CM, Naglie G, Lang AE, et al. Predictors of deterioration in health-related quality of life in Parkinson’s disease: results from the DATATOP trial. Mov Disord. 2008;23:653–9. quiz 776

    Article  PubMed  Google Scholar 

  5. Vitale C, Falco F, Trojano L, Erro R, Moccia M, Allocca R, et al. Neuropsychological correlates of Pisa syndrome in patients with Parkinson’s disease. Acta Neurol Scand. 2016;134:101–7.

    Article  CAS  PubMed  Google Scholar 

  6. Lord S, Rochester L, Hetherington V, Allcock LM, Burn D. Executive dysfunction and attention contribute to gait interference in “off” state Parkinson’s disease. Gait Posture. 2010;31:169–74.

    Article  PubMed  Google Scholar 

  7. Smulders K, van Nimwegen M, Munneke M, Bloem BR, Kessels RPC, Esselink RAJ. Involvement of specific executive functions in mobility in Parkinson’s disease. Parkinsonism Relat Disord. 2013;19:126–8.

    Article  PubMed  Google Scholar 

  8. Latt MD, Menz HB, Fung VS, Lord SR. Acceleration patterns of the head and pelvis during gait in older people with Parkinson’s disease: a comparison of fallers and nonfallers. J Gerontol A Biol Sci Med Sci. 2009;64:700–6.

    Article  PubMed  Google Scholar 

  9. Horak FB, Mancini M, Carlson-Kuhta P, Nutt JG, Salarian A. Balance and gait represent independent domains of mobility in Parkinson disease. Phys Ther. 2016;96:1364–71.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Müller MLTM, Bohnen NI. Cholinergic dysfunction in Parkinson’s disease. Curr Neurol Neurosci Rep. 2013;13:377.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Foreman KB, Wisted C, Addison O, Marcus RL, Lastayo PC, Dibble LE. Improved dynamic postural task performance without improvements in postural responses: the blessing and the curse of dopamine replacement. Parkinson Dis. 2012;2012:692150.

    CAS  Google Scholar 

  12. Curtze C, Nutt JG, Carlson-Kuhta P, Mancini M, Horak FB. Levodopa is a double-edged sword for balance and gait in people with Parkinson’s disease. Mov Disord. 2015;30:1361–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Devos D, Defebvre L, Bordet R. Dopaminergic and non-dopaminergic pharmacological hypotheses for gait disorders in Parkinson’s disease: pharmacology of parkinsonian gait disorders. Fundam Clin Pharmacol. 2010;24:407–21.

    Article  CAS  PubMed  Google Scholar 

  14. Boonstra TA, van der Kooij H, Munneke M, Bloem BR. Gait disorders and balance disturbances in Parkinson’s disease: clinical update and pathophysiology. Curr Opin Neurol. 2008;21:461–71.

    Article  PubMed  Google Scholar 

  15. Perez-Lloret S, Peralta MC, Barrantes FJ. Pharmacotherapies for Parkinson’s disease symptoms related to cholinergic degeneration. Expert Opin Pharmacother. 2016;17:2405–15.

    Article  CAS  PubMed  Google Scholar 

  16. Nonnekes J, Timmer MHM, de Vries NM, Rascol O, Helmich RC, Bloem BR. Unmasking levodopa resistance in Parkinson’s disease: unmasking levodopa resistance IN PD. Mov Disord. 2016;31:1602–9.

    Article  CAS  PubMed  Google Scholar 

  17. Devos D, Moreau C, Dujardin K, Cabantchik I, Defebvre L, Bordet R. New pharmacological options for treating advanced Parkinson’s disease. Clin Ther. 2013;35:1640–52.

    Article  CAS  PubMed  Google Scholar 

  18. Moreau C, Devos D, Defebvre L. Acetylcholinesterase inhibitors and gait: a steadying hand? Lancet Neurol. 2016;15:232–3.

    Article  PubMed  Google Scholar 

  19. Ebersbach G. Exercise matters in patients with PD—another piece of evidence: Parkinson disease. Nat Rev Neurol. 2015;11:9–10.

    Article  PubMed  Google Scholar 

  20. Oguh O, Eisenstein A, Kwasny M, Simuni T. Back to the basics: regular exercise matters in Parkinson’s disease: results from the National Parkinson Foundation QII Registry study. Parkinsonism Relat Disord. 2014;20:1221–5.

    Article  CAS  PubMed  Google Scholar 

  21. Speelman AD, van de Warrenburg BP, van Nimwegen M, Petzinger GM, Munneke M, Bloem BR. How might physical activity benefit patients with Parkinson disease? Nat Rev Neurol. 2011;7:528–34.

    Article  PubMed  Google Scholar 

  22. Mulligan HF, Hale LA, Whitehead L, Baxter GD. Barriers to physical activity for people with long-term neurological conditions: a review study. Adapt Phys Act Q. 2012;29:243–65.

    Article  Google Scholar 

  23. Woollacott MH, Shumway-Cook A, Nashner LM. Aging and posture control: changes in sensory organization and muscular coordination. Int J Aging Hum Dev. 1986;23:97–114.

    Article  CAS  PubMed  Google Scholar 

  24. Woollacott MH, Shumway-Cook A. Changes in posture control across the life span—a systems approach. Phys Ther. 1990;70:799–807.

    Article  CAS  PubMed  Google Scholar 

  25. Bronte-Stewart HM, Minn AY, Rodrigues K, Buckley EL, Nashner LM. Postural instability in idiopathic Parkinson’s disease: the role of medication and unilateral pallidotomy. Brain J Neurol. 2002;125:2100–14.

    Article  Google Scholar 

  26. Shivitz N, Koop MM, Fahimi J, Heit G, Bronte-Stewart HM. Bilateral subthalamic nucleus deep brain stimulation improves certain aspects of postural control in Parkinson’s disease, whereas medication does not. Mov Disord. 2006;21:1088–97.

    Article  PubMed  Google Scholar 

  27. Visser M, Marinus J, Bloem BR, Kisjes H, van den Berg BM, van Hilten JJ. Clinical tests for the evaluation of postural instability in patients with Parkinson’s disease. Arch Phys Med Rehabil. 2003;84:1669–74.

    Article  PubMed  Google Scholar 

  28. Hunt AL, Sethi KD. The pull test: a history. Mov Disord. 2006;21:894–9.

    Article  PubMed  Google Scholar 

  29. Jacobs JV, Horak FB, Tran VK, Nutt JG. Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006;77:322–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bloem BR, Beckley DJ, van Hilten BJ, Roos RA. Clinimetrics of postural instability in Parkinson’s disease. J Neurol. 1998;245:669–73.

    Article  CAS  PubMed  Google Scholar 

  31. Munhoz RP, Li J-Y, Kurtinecz M, Piboolnurak P, Constantino A, Fahn S, et al. Evaluation of the pull test technique in assessing postural instability in Parkinson’s disease. Neurology. 2004;62:125–7.

    Article  CAS  PubMed  Google Scholar 

  32. Jacobs JV, Horak FB, Van Tran K, Nutt JG. An alternative clinical postural stability test for patients with Parkinson’s disease. J Neurol. 2006;253:1404–13.

    Article  PubMed  Google Scholar 

  33. Nonnekes J, Goselink R, Weerdesteyn V, Bloem BR. The retropulsion test: a good evaluation of postural instability in Parkinson’s disease? J Parkinson Dis. 2015;5:43–7.

    Google Scholar 

  34. Ebersbach G, Gunkel M. Posturography reflects clinical imbalance in Parkinson’s disease. Mov Disord. 2011;26:241–6.

    Article  PubMed  Google Scholar 

  35. Ganesan M, Pal PK, Gupta A, Sathyaprabha TN. Dynamic posturography in evaluation of balance in patients of Parkinson’s disease with normal pull test: concept of a diagonal pull test. Parkinsonism Relat Disord. 2010;16:595–9.

    Article  PubMed  Google Scholar 

  36. Frenklach A, Louie S, Koop MM, Bronte-Stewart H. Excessive postural sway and the risk of falls at different stages of Parkinson’s disease. Mov Disord. 2009;24:377–85.

    Article  PubMed  Google Scholar 

  37. Rocchi L, Chiari L, Horak FB. Effects of deep brain stimulation and levodopa on postural sway in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2002;73:267–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Nantel J, McDonald JC, Bronte-Stewart H. Effect of medication and STN-DBS on postural control in subjects with Parkinson’s disease. Parkinsonism Relat Disord. 2012;18:285–9.

    Article  PubMed  Google Scholar 

  39. Maurer C, Mergner T, Xie J, Faist M, Pollak P, Lücking CH. Effect of chronic bilateral subthalamic nucleus (STN) stimulation on postural control in Parkinson’s disease. Brain J Neurol. 2003;126:1146–63.

    Article  CAS  Google Scholar 

  40. Horak FB, Mancini M. Objective biomarkers of balance and gait for Parkinson’s disease using body-worn sensors. Mov Disord. 2013;28:1544–51.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Beuter A, Hernández R, Rigal R, Modolo J, Blanchet PJ. Postural sway and effect of levodopa in early Parkinson’s disease. Can J Neurol Sci. 2008;35:65–8.

    Article  PubMed  Google Scholar 

  42. Revilla FJ, Larsh TR, Mani A, Duker AP, Cox C, Succop P, et al. Effect of dopaminergic medication on postural sway in advanced Parkinson’s disease. Front Neurol. 2013;4:202.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Johnson L, Rodrigues J, Teo W-P, Walters S, Stell R, Thickbroom G, et al. Interactive effects of GPI stimulation and levodopa on postural control in Parkinson’s disease. Gait Posture. 2015;41:929–34.

    Article  PubMed  Google Scholar 

  44. St George RJ, Carlson-Kuhta P, Nutt JG, Hogarth P, Burchiel KJ, Horak FB. The effect of deep brain stimulation randomized by site on balance in Parkinson’s disease. Mov Disord. 2014;29:949–53.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Guehl D, Cuny E, Benazzouz A, Rougier A, Tison F, Machado S, et al. Side-effects of subthalamic stimulation in Parkinson’s disease: clinical evolution and predictive factors. Eur J Neurol. 2006;13:963–71.

    Article  CAS  PubMed  Google Scholar 

  46. Colnat-Coulbois S, Gauchard GC, Maillard L, Barroche G, Vespignani H, Auque J, et al. Bilateral subthalamic nucleus stimulation improves balance control in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2005;76:780–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. St George RJ, Nutt JG, Burchiel KJ, Horak FB. A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD. Neurology. 2010;75:1292–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Allen NE, Sherrington C, Paul SS, Canning CG. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord. 2011;26:1605–15.

    Article  PubMed  Google Scholar 

  49. Yang Y, Qiu WQ, Hao YL, Lv ZY, Jiao SJ, Teng JF. The efficacy of traditional Chinese Medical Exercise for Parkinson’s disease: a systematic review and meta-analysis. PLoS One. 2015;10:e0122469.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  50. Cascaes da Silva F, Iop Rda R, Domingos Dos Santos P, Aguiar Bezerra de Melo LM, Barbosa Gutierres Filho PJ, da Silva R. Effects of physical-exercise-based rehabilitation programs on the quality of life of patients with Parkinson’s disease: a systematic review of randomized controlled trials. J Aging Phys Act. 2016;24:484–96.

    Article  PubMed  Google Scholar 

  51. Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. 2012;366:511–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Bloem BR, Grimbergen YA, Cramer M, Willemsen M, Zwinderman AH. Prospective assessment of falls in Parkinson’s disease. J Neurol. 2001;248:950–8.

    Article  CAS  PubMed  Google Scholar 

  53. Pickering RM, Grimbergen YAM, Rigney U, Ashburn A, Mazibrada G, Wood B, et al. A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord. 2007;22:1892–900.

    Article  PubMed  Google Scholar 

  54. Wood BH, Bilclough JA, Bowron A, Walker RW. Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry. 2002;72:721–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis. 2013;2013:906274.

    PubMed  PubMed Central  Google Scholar 

  56. Almeida LRS, Sherrington C, Allen NE, Paul SS, Valenca GT, Oliveira-Filho J, et al. Disability is an independent predictor of falls and recurrent falls in people with Parkinson’s disease without a history of falls: a one-year prospective study. J Parkinsons Dis. 2015;5:855–64.

    Article  PubMed  Google Scholar 

  57. Lindholm B, Nilsson MH, Hansson O, Hagell P. External validation of a 3-step falls prediction model in mild Parkinson’s disease. J Neurol. 2016;263:2462–9.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Paul SS, Canning CG, Sherrington C, Lord SR, Close JCT, Fung VSC. Three simple clinical tests to accurately predict falls in people with Parkinson’s disease. Mov Disord. 2013;28:655–62.

    Article  PubMed  Google Scholar 

  59. Duncan RP, Cavanaugh JT, Earhart GM, Ellis TD, Ford MP, Foreman KB, et al. External validation of a simple clinical tool used to predict falls in people with Parkinson disease. Parkinsonism Relat Disord. 2015;21:960–3.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Takakusaki K. Functional neuroanatomy for posture and gait control. J Mov Disord. 2017;10:1–17.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Clark DJ. Automaticity of walking: functional significance, mechanisms, measurement and rehabilitation strategies. Front Hum Neurosci [Internet]. 2015 [cited 2018 Jan 9];9. Available from: https://www.frontiersin.org/articles/10.3389/fnhum.2015.00246/full.

  62. Patel P, Lamar M, Bhatt T. Effect of type of cognitive task and walking speed on cognitive-motor interference during dual-task walking. Neuroscience. 2014;260:140–8.

    Article  CAS  PubMed  Google Scholar 

  63. Schubert T. The central attentional limitation and executive control. Front Biosci. 2008;13:3569–80.

    Article  PubMed  Google Scholar 

  64. Nieuwboer A, Giladi N. Characterizing freezing of gait in Parkinson’s disease: models of an episodic phenomenon. Mov Disord. 2013;28:1509–19.

    Article  PubMed  Google Scholar 

  65. Galna B, Lord S, Burn DJ, Rochester L. Progression of gait dysfunction in incident Parkinson’s disease: impact of medication and phenotype. Mov Disord. 2015;30:359–67.

    Article  CAS  PubMed  Google Scholar 

  66. Giladi N, Nieuwboer A. Understanding and treating freezing of gait in parkinsonism, proposed working definition, and setting the stage. Mov Disord. 2008;23(Suppl 2):S423–5.

    Article  PubMed  Google Scholar 

  67. Hely MA, Reid WGJ, Adena MA, Halliday GM, Morris JGL. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord. 2008;23:837–44.

    Article  PubMed  Google Scholar 

  68. Baker K, Rochester L, Nieuwboer A. The effect of cues on gait variability—reducing the attentional cost of walking in people with Parkinson’s disease. Parkinsonism Relat Disord. 2008;14:314–20.

    Article  PubMed  Google Scholar 

  69. Ginis P, Heremans E, Ferrari A, Bekkers EMJ, Canning CG, Nieuwboer A. External input for gait in people with Parkinson’s disease with and without freezing of gait: one size does not fit all. J Neurol. 2017;264:1488–96.

    Article  PubMed  Google Scholar 

  70. Ginis P, Nackaerts E, Nieuwboer A, Heremans E. 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 [Internet]. 2017 [cited 2018 Jan 8]; Available from: http://linkinghub.elsevier.com/retrieve/pii/S1877065717304049.

  71. Barthel C, Mallia E, Debû B, Bloem BR, Ferraye MU. The practicalities of assessing freezing of gait. J Parkinsons Dis. 2016;6:667–74.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Giladi N, McDermott MP, Fahn S, Przedborski S, Jankovic J, Stern M, et al. Freezing of gait in PD: prospective assessment in the DATATOP cohort. Neurology. 2001;56:1712–21.

    Article  CAS  PubMed  Google Scholar 

  73. Forsaa EB, Larsen JP, Wentzel-Larsen T, Alves G. A 12-year population-based study of freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord. 2015;21:254–8.

    Article  CAS  PubMed  Google Scholar 

  74. Macht M, Kaussner Y, Möller JC, Stiasny-Kolster K, Eggert KM, Krüger H-P, et al. Predictors of freezing in Parkinson’s disease: a survey of 6,620 patients. Mov Disord. 2007;22:953–6.

    Article  PubMed  Google Scholar 

  75. Vercruysse S, Devos H, Munks L, Spildooren J, Vandenbossche J, Vandenberghe W, et al. Explaining freezing of gait in Parkinson’s disease: motor and cognitive determinants. Mov Disord. 2012;27:1644–51.

    Article  PubMed  Google Scholar 

  76. Factor SA, Scullin MK, Sollinger AB, Land JO, Wood-Siverio C, Zanders L, et al. Freezing of gait subtypes have different cognitive correlates in Parkinson’s disease. Parkinsonism Relat Disord. 2014;20:1359–64.

    Article  CAS  PubMed  Google Scholar 

  77. Walton CC, Shine JM, Hall JM, O’Callaghan C, Mowszowski L, Gilat M, et al. The major impact of freezing of gait on quality of life in Parkinson’s disease. J Neurol. 2015;262:108–15.

    Article  CAS  PubMed  Google Scholar 

  78. Henderson EJ, Lord SR, Brodie MA, Gaunt DM, Lawrence AD, Close JC, et al. Rivastigmine for gait stability in patients with Parkinson’s disease (ReSPonD): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol. 2016;15:249–58.

    Article  CAS  PubMed  Google Scholar 

  79. Ferraye MU, Debû B, Pollak P. Deep brain stimulation effect on freezing of gait. Mov Disord. 2008;23:S489–94.

    Article  PubMed  Google Scholar 

  80. Ferraye MU, Ardouin C, Lhommée E, Fraix V, Krack P, Chabardès S, et al. Levodopa-resistant freezing of gait and executive dysfunction in Parkinson’s disease. Eur Neurol. 2013;69:281–8.

    Article  CAS  PubMed  Google Scholar 

  81. Espay AJ, Fasano A, van Nuenen BFL, Payne MM, Snijders AH, Bloem BR. “On” state freezing of gait in Parkinson disease: a paradoxical levodopa-induced complication. Neurology. 2012;78:454–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Smulders K, Dale ML, Carlson-Kuhta P, Nutt JG, Horak FB. Pharmacological treatment in Parkinson's disease: Effects on gait. Parkinsonism Relat Disord. 2016;31:3–13.

  83. Rascol O. The pharmacological therapeutic management of levodopa-induced dyskinesias in patients with Parkinson’s disease. J Neurol. 2000;247(Suppl 2):II51–7.

    PubMed  Google Scholar 

  84. Ikeda K, Hirayama T, Takazawa T, Kawabe K, Iwasaki Y. Transdermal patch of rotigotine attenuates freezing of gait in patients with Parkinson’s disease: an open-label comparative study of three non-ergot dopamine receptor agonists. Intern Med (Tokyo). 2016;55:2765–9.

    Article  CAS  Google Scholar 

  85. Chung KA, Lobb BM, Nutt JG, et al. Effects of a central cholinesterase inhibitor on reducing falls in Parkinson disease. Neurology. 2010;75:1263–9.

  86. Rascol O, Brooks DJ, Melamed E, Oertel W, Poewe W, Stocchi F, Tolosa E; LARGO study group. Rasagiline as an adjunct to levodopa in patients with Parkinson's disease and motor fluctuations (LARGO, Lasting effect in Adjunct therapy with Rasagiline Given Once daily, study): a randomised, double-blind, parallel-group trial. Lancet. 2005;365(9463):947–54.

  87. Espay AJ, Dwivedi AK, Payne M, Gaines L, Vaughan JE, Maddux BN, et al. Methylphenidate for gait impairment in Parkinson disease: a randomized clinical trial. Neurology. 2011;76:1256–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Moreau C, Delval A, Defebvre L, Dujardin K, Duhamel A, Petyt G, et al. Methylphenidate for gait hypokinesia and freezing in patients with Parkinson’s disease undergoing subthalamic stimulation: a multicentre, parallel, randomised, placebo-controlled trial. Lancet Neurol. 2012;11:589–96.

    Article  CAS  PubMed  Google Scholar 

  89. Malkani R, Zadikoff C, Melen O, Videnovic A, Borushko E, Simuni T. Amantadine for freezing of gait in patients with Parkinson disease. Clin Neuropharmacol. 2012;35:266–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Lee JY, Oh S, Kim JM, Kim JS, Oh E, Kim H-T, et al. Intravenous amantadine on freezing of gait in Parkinson’s disease: a randomized controlled trial. J Neurol. 2013;260:3030–8.

    Article  CAS  PubMed  Google Scholar 

  91. Chan HF, Kukkle PL, Merello M, Lim SY, Poon YY, Moro E. Amantadine improves gait in PD patients with STN stimulation. Parkinsonism Relat Disord. 2013;19(3):316–9.

  92. Vaamonde Gamo J, Cabello JP, Gallardo Alcañiz MJ, Flores Barragan JM, Carrasco García de León S, Ibañez Alonso RE. Freezing of gait unresponsive to dopaminergic stimulation in patients with severe parkinsonism. Neurologia. 2010;25:27–31.

    Article  CAS  PubMed  Google Scholar 

  93. Devos D; French DUODOPA Study Group. Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson’s disease. Mov Disord. 2009 May 15;24(7):993–1000.

  94. Fukada K, Endo T, Yokoe M, Hamasaki T, Hazama T, Sakoda S. L-threo-3,4-dihydroxyphenylserine (L-DOPS) co-administered with entacapone improves freezing of gait in Parkinson’s disease. Med Hypotheses. 2013;80(2):209–12.

  95. Chang FCF, Tsui DS, Mahant N, Wolfe N, Kim SD, Ha AD, et al. 24 h levodopa-carbidopa intestinal gel may reduce falls and “unresponsive” freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord. 2015;21:317–20.

    Article  PubMed  Google Scholar 

  96. Ferraye MU, Debu B, Fraix V, Xie-Brustolin J, Chabardes S, Krack P, et al. Effects of subthalamic nucleus stimulation and levodopa on freezing of gait in Parkinson disease. Neurology. 2008;70:1431–7.

    Article  CAS  PubMed  Google Scholar 

  97. Giladi N. Medical treatment of freezing of gait. Mov Disord. 2008;23(Suppl 2):S482–8.

    Article  PubMed  Google Scholar 

  98. Sensi M, Preda F, Trevisani L, Contini E, Gragnaniello D, Capone JG, et al. Emerging issues on selection criteria of levodopa carbidopa infusion therapy: considerations on outcome of 28 consecutive patients. J Neural Transm (Vienna). 2014;121:633–42.

    Article  CAS  Google Scholar 

  99. Cossu G, Ricchi V, Pilleri M, Mancini F, Murgia D, Ricchieri G, et al. Levodopa-carbidopa intrajejunal gel in advanced Parkinson disease with “on” freezing of gait. Neurol Sci. 2015;36:1683–6.

    Article  PubMed  Google Scholar 

  100. Rascol O, Perez-Lloret S, Ferreira JJ. New treatments for levodopa-induced motor complications. Mov Disord. 2015;30:1451–60.

    Article  CAS  PubMed  Google Scholar 

  101. Stolze H, Klebe S, Poepping M, Lorenz D, Herzog J, Hamel W, et al. Effects of bilateral subthalamic nucleus stimulation on parkinsonian gait. Neurology. 2001;57:144–6.

    Article  CAS  PubMed  Google Scholar 

  102. Bakker M, Esselink RAJ, Munneke M, Limousin-Dowsey P, Speelman HD, Bloem BR. Effects of stereotactic neurosurgery on postural instability and gait in Parkinson’s disease. Mov Disord. 2004;19:1092–9.

    Article  PubMed  Google Scholar 

  103. Schlenstedt C, Shalash A, Muthuraman M, Falk D, Witt K, Deuschl G. Effect of high-frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson’s disease: a systematic review and meta-analysis. Eur J Neurol. 2017;24:18–26.

    Article  CAS  PubMed  Google Scholar 

  104. Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ, et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009;301:63–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Moreau C, Defebvre L, Destee A, Bleuse S, Clement F, Blatt JL, et al. STN-DBS frequency effects on freezing of gait in advanced Parkinson disease. Neurology. 2008;71:80–4.

    Article  CAS  PubMed  Google Scholar 

  106. Brozova H, Barnaure I, Alterman RL, Tagliati M. STN-DBS frequency effects on freezing of gait in advanced Parkinson disease. Neurology. 2009;72:770. author reply 770-771

    Article  PubMed  Google Scholar 

  107. Ricchi V, Zibetti M, Angrisano S, Merola A, Arduino N, Artusi CA, et al. Transient effects of 80 Hz stimulation on gait in STN DBS treated PD patients: a 15 months follow-up study. Brain Stimul. 2012;5:388–92.

    Article  PubMed  Google Scholar 

  108. Xie T, Vigil J, MacCracken E, Gasparaitis A, Young J, Kang W, et al. Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD. Neurology. 2015;84:415–20.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Sidiropoulos C, Walsh R, Meaney C, Poon YY, Fallis M, Moro E. Low-frequency subthalamic nucleus deep brain stimulation for axial symptoms in advanced Parkinson’s disease. J Neurol. 2013;260:2306–11.

    Article  CAS  PubMed  Google Scholar 

  110. Khoo HM, Kishima H, Hosomi K, Maruo T, Tani N, Oshino S, et al. Low-frequency subthalamic nucleus stimulation in Parkinson’s disease: a randomized clinical trial: 60-HZ STN-DBS in Parkinson’s disease. Mov Disord. 2014;29:270–4.

    Article  PubMed  Google Scholar 

  111. Khoo HM, Kishima H, Oshino S, Yoshimine T. Reply to: Low-frequency subthalamic nucleus stimulation in Parkinson’s disease: a randomized clinical trial. Mov Disord. 2014;29:1569–70.

    Article  PubMed  Google Scholar 

  112. Phibbs FT, Arbogast PG, Davis TL. 60-Hz frequency effect on gait in Parkinson’s disease with subthalamic nucleus deep brain stimulation: 60 Hz STN DBS effect on gait in Parkinson’s disease. Neuromodulation. 2014;17:717–20.

    Article  PubMed  Google Scholar 

  113. Vallabhajosula S, Haq IU, Hwynn N, Oyama G, Okun M, Tillman MD, et al. Low-frequency versus high-frequency subthalamic nucleus deep brain stimulation on postural control and gait in Parkinson’s disease: a quantitative study. Brain Stimul. 2015;8:64–75.

    Article  PubMed  Google Scholar 

  114. Baizabal-Carvallo JF, Alonso-Juarez M. Low-frequency deep brain stimulation for movement disorders. Parkinsonism Relat Disord. 2016;31:14–22.

    Article  PubMed  Google Scholar 

  115. di Biase L, Fasano A. Low-frequency deep brain stimulation for Parkinson’s disease: great expectation or false hope? Mov Disord. 2016;31:962–7.

    Article  PubMed  CAS  Google Scholar 

  116. Chastan N, Westby GWM, Yelnik J, Bardinet E, Do MC, Agid Y, et al. Effects of nigral stimulation on locomotion and postural stability in patients with Parkinson’s disease. Brain. 2008;132:172–84.

    Article  PubMed  Google Scholar 

  117. Weiss D, Walach M, Meisner C, Fritz M, Scholten M, Breit S, et al. Nigral stimulation for resistant axial motor impairment in Parkinson’s disease? A randomized controlled trial. Brain J Neurol. 2013;136:2098–108.

    Article  Google Scholar 

  118. Fasano A, Herzog J, Seifert E, Stolze H, Falk D, Reese R, et al. Modulation of gait coordination by subthalamic stimulation improves freezing of gait. Mov Disord. 2011;26:844–51.

    Article  PubMed  Google Scholar 

  119. Mazzone P, Lozano A, Stanzione P, Galati S, Scarnati E, Peppe A, et al. Implantation of human pedunculopontine nucleus: a safe and clinically relevant target in Parkinson’s disease. Neuroreport. 2005;16:1877–81.

    Article  PubMed  Google Scholar 

  120. Plaha P, Gill SS. Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson’s disease. Neuroreport. 2005;16:1883–7.

    Article  PubMed  Google Scholar 

  121. Stefani A, Lozano AM, Peppe A, Stanzione P, Galati S, Tropepi D, et al. Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson’s disease. Brain. 2007;130:1596–607.

    Article  PubMed  Google Scholar 

  122. Ferraye MU, Debu B, Fraix V, Goetz L, Ardouin C, Yelnik J, et al. Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson’s disease. Brain. 2010;133:205–14.

    Article  CAS  PubMed  Google Scholar 

  123. Moro E, Hamani C, Poon Y-Y, Al-Khairallah T, Dostrovsky JO, Hutchison WD, et al. Unilateral pedunculopontine stimulation improves falls in Parkinson’s disease. Brain. 2010;133:215–24.

    Article  PubMed  Google Scholar 

  124. •• Thevathasan W, Debu B, Aziz T, Bloem BR, Blahak C, Butson C, et al. Pedunculopontine nucleus deep brain stimulation in Parkinson’s disease: a clinical review. Mov Disord. 2018;33:10–20. Conclusions of the Movement Disorders Society working group on PPN stimulation. Although the outcome is very variable between patients, published data suggest that freezing of gait and falls refractory to medication can be improved by low frequency stimulation of the PPN.

    Article  PubMed  Google Scholar 

  125. Welter M-L, Demain A, Ewenczyk C, Czernecki V, Lau B, El Helou A, et al. PPNa-DBS for gait and balance disorders in Parkinson’s disease: a double-blind, randomised study. J Neurol. 2015;262:1515–25.

    Article  PubMed  Google Scholar 

  126. • de Andrade EM, Ghilardi MG, Cury RG, Barbosa ER, Fuentes R, Teixeira MJ, et al. Spinal cord stimulation for Parkinson’s disease: a systematic review. Neurosurg Rev. 2016;39:27–35. This is a meta-analysis based on the few (8) available studies of spinal cord stimulation for PD.

    Article  PubMed  Google Scholar 

  127. Hassan S, Amer S, Alwaki A, Elborno A. A patient with Parkinson’s disease benefits from spinal cord stimulation. J Clin Neurosci. 2013;20:1155–6.

    Article  PubMed  Google Scholar 

  128. Pinto de Souza C, Hamani C, Oliveira Souza C, Lopez Contreras WO, dos Santos Ghilardi MG, Cury RG, et al. Spinal cord stimulation improves gait in patients with Parkinson’s disease previously treated with deep brain stimulation: spinal cord stimulation in PD. Mov Disord. 2017;32:278–82.

    Article  PubMed  Google Scholar 

  129. Fénelon G, Goujon C, Gurruchaga J-M, Cesaro P, Jarraya B, Palfi S, et al. Spinal cord stimulation for chronic pain improved motor function in a patient with Parkinson’s disease. Parkinsonism Relat Disord. 2012;18:213–4.

    Article  PubMed  Google Scholar 

  130. Landi A, Trezza A, Pirillo D, Vimercati A, Antonini A, Sganzerla EP. Spinal cord stimulation for the treatment of sensory symptoms in advanced Parkinson’s disease: SCS in advanced Parkinson’s diseases. Neuromodulation. 2013;16:276–9.

    Article  PubMed  Google Scholar 

  131. Nishioka K, Nakajima M. Beneficial therapeutic effects of spinal cord stimulation in advanced cases of Parkinson’s disease with intractable chronic pain: a case series. Neuromodulation. 2015;18:751–3.

    Article  PubMed  Google Scholar 

  132. Akiyama H, Nukui S, Akamatu M, Hasegawa Y, Nishikido O, Inoue S. Effectiveness of spinal cord stimulation for painful camptocormia with Pisa syndrome in Parkinson’s disease: a case report. BMC Neurol [Internet]. 2017 [cited 2018 Jan 8];17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543441/.

  133. Agari T, Date I. Spinal cord stimulation for the treatment of abnormal posture and gait disorder in patients with Parkinson’s disease. Neurol Med Chir (Tokyo). 2012;52:470–4.

    Article  Google Scholar 

  134. Thevathasan W, Mazzone P, Jha A, Djamshidian A, Dileone M, Di Lazzaro V, et al. Spinal cord stimulation failed to relieve akinesia or restore locomotion in Parkinson disease. Neurology. 2010;74:1325–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  135. • Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev. 2013;CD002817. A comprehensive review of randomized controlled trials of physiotherapy intervention in PD. The effectiveness of intervention was assessed for gait and balance issues.

  136. •• Mak MK, Wong-Yu IS, Shen X, Chung CL. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol. 2017;13:689–703. This paper discusses long term benefits of exercise programs on gait and balance issues in PD. The authors make recommendation of clinical practice.

    Article  PubMed  Google Scholar 

  137. de Dreu MJ, van der Wilk ASD, Poppe E, Kwakkel G, van Wegen EEH. Rehabilitation, exercise therapy and music in patients with Parkinson’s disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. Parkinsonism Relat Disord. 2012;18(Suppl 1):S114–9.

    Article  PubMed  Google Scholar 

  138. Alves Da Rocha P, McClelland J, Morris ME. Complementary physical therapies for movement disorders in Parkinson’s disease: a systematic review. Eur J Phys Rehabil Med. 2015;51:693–704.

    CAS  PubMed  Google Scholar 

  139. dos Santos Delabary M, Komeroski IG, Monteiro EP, Costa RR, Haas AN. Effects of dance practice on functional mobility, motor symptoms and quality of life in people with Parkinson’s disease: a systematic review with meta-analysis. Aging Clin Exp Res [Internet]. 2017 [cited 2017 Dec 19]; Available from: http://link.springer.com/10.1007/s40520-017-0836-2.

  140. Janssen S, Soneji M, Nonnekes J, Bloem BR. A painted staircase illusion to alleviate freezing of gait in Parkinson’s disease. J Neurol. 2016;263:1661–2.

    Article  PubMed  Google Scholar 

  141. Janssen S, Bolte B, Nonnekes J, Bittner M, Bloem BR, Heida T, et al. Usability of three-dimensional augmented visual cues delivered by smart glasses on (freezing of) gait in Parkinson’s disease. Front Neurol. 2017;8:279.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Ginis P, Heremans E, Ferrari A, Dockx K, Canning CG, Nieuwboer A. Prolonged walking with a wearable system providing intelligent auditory input in people with Parkinson’s disease. Front Neurol. 2017;8:128.

    Article  PubMed  PubMed Central  Google Scholar 

  143. Barthel C, Nonnekes J, van Helvert M, Haan R, Janssen A, Delval A, et al. The laser shoes: a new ambulatory device to alleviate freezing of gait in Parkinson disease. Neurology. 2017;

  144. Ferraye MU, Fraix V, Pollak P, Bloem BR, Debû B. The laser-shoe: a new form of continuous ambulatory cueing for patients with Parkinson’s disease. Parkinsonism Relat Disord. 2016;29:127–8.

    Article  PubMed  Google Scholar 

  145. Castrioto A, Piscicelli C, Pérennou D, Krack P, Debû B. The pathogenesis of Pisa syndrome in Parkinson’s disease: Pisa syndrome in Parkinson’s disease. Mov Disord. 2014;29:1100–7.

    Article  PubMed  Google Scholar 

  146. • Barone P, Santangelo G, Amboni M, Pellecchia MT, Vitale C. Pisa syndrome in Parkinson’s disease and parkinsonism: clinical features, pathophysiology, and treatment. Lancet Neurol. 2016;15:1063–74. This paper discusses the different pathophysiological hypotheses of Pisa The authors examined the effects of STN DBS on camptocormia. Multifactorial analysis revealed the link between duration of camptocormia and DBS benefit.

    Article  PubMed  Google Scholar 

  147. Fasano A, Di Matteo A, Vitale C, Squintani G, Ferigo L, Bombieri F, et al. Reversible Pisa syndrome in patients with Parkinson’s disease on rasagiline therapy. Mov Disord. 2011;26:2578–80.

    Article  PubMed  Google Scholar 

  148. Doherty KM, van de Warrenburg BP, Peralta MC, Silveira-Moriyama L, Azulay J-P, Gershanik OS, et al. Postural deformities in Parkinson’s disease. Lancet Neurol. 2011;10:538–49.

    Article  PubMed  Google Scholar 

  149. Bonanni L, Thomas A, Varanese S, Scorrano V, Onofrj M. Botulinum toxin treatment of lateral axial dystonia in parkinsonism. Mov Disord. 2007;22:2097–103.

    Article  PubMed  Google Scholar 

  150. Bloch F, Houeto JL, du Montcel ST, Bonneville F, Etchepare F, Welter ML, et al. Parkinson’s disease with camptocormia. J Neurol Neurosurg Psychiatry. 2006;77:1223–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  151. Margraf NG, Wrede A, Rohr A, Schulz-Schaeffer WJ, Raethjen J, Eymess A, et al. Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord. 2010;25:542–51.

    Article  PubMed  Google Scholar 

  152. Wrede A, Margraf NG, Goebel HH, Deuschl G, Schulz-Schaeffer WJ. Myofibrillar disorganization characterizes myopathy of camptocormia in Parkinson’s disease. Acta Neuropathol (Berl). 2012;123:419–32.

    Article  CAS  Google Scholar 

  153. • Srivanitchapoom P, Hallett M. Camptocormia in Parkinson’s disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry. 2016;87:75–85. A review of the clinical manifestations, pathophysiological hypotheses, and pharmacological and non-pharmacological approaches to camptocormia management.

    PubMed  Google Scholar 

  154. Vorovenci RJ, Biundo R, Antonini A. Therapy-resistant symptoms in Parkinson’s disease. J Neural Transm. 2016;123:19–30.

    Article  PubMed  CAS  Google Scholar 

  155. Ye X, Lou D, Ding X, Xie C, Gao J, Lou Y, et al. A clinical study of the coronal plane deformity in Parkinson disease. Eur Spine J. 2017;26:1862–70.

    Article  PubMed  Google Scholar 

  156. Abe K, Uchida Y, Notani M. Camptocormia in Parkinson’s disease. Park Dis [Internet]. 2010 [cited 2018 Jan 9];2010. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951140/.

  157. Tiple D, Fabbrini G, Colosimo C, Ottaviani D, Camerota F, Defazio G, et al. Camptocormia in Parkinson disease: an epidemiological and clinical study. J Neurol Neurosurg Psychiatry. 2009;80:145–8.

    Article  CAS  PubMed  Google Scholar 

  158. Tinazzi M, Geroin C, Gandolfi M, Smania N, Tamburin S, Morgante F, et al. Pisa syndrome in Parkinson’s disease: an integrated approach from pathophysiology to management: Pisa syndrome in Parkinson’s disease. Mov Disord. 2016;31:1785–95.

    Article  PubMed  Google Scholar 

  159. Doherty KM, Davagnanam I, Molloy S, Silveira-Moriyama L, Lees AJ. Pisa syndrome in Parkinson’s disease: a mobile or fixed deformity? J Neurol Neurosurg Psychiatry. 2013;84:1400–3.

    Article  PubMed  PubMed Central  Google Scholar 

  160. Su PC, Tseng H-M, Liou H-H. Postural asymmetries following unilateral subthalomotomy for advanced Parkinson’s disease. Mov Disord. 2002;17:191–4.

    Article  PubMed  Google Scholar 

  161. van de Warrenburg BPC, Bhatia KP, Quinn NP. Pisa syndrome after unilateral pallidotomy in Parkinson’s disease: an unrecognised, delayed adverse event? J Neurol Neurosurg Psychiatry. 2007;78:329–30.

    Article  PubMed  PubMed Central  Google Scholar 

  162. Finsterer J, Strobl W. Presentation, etiology, diagnosis, and management of camptocormia. Eur Neurol. 2010;64:1–8.

    Article  PubMed  Google Scholar 

  163. Pezzoli G, Zini M. Levodopa in Parkinson’s disease: from the past to the future. Expert Opin Pharmacother. 2010;11:627–35.

    Article  CAS  PubMed  Google Scholar 

  164. Mensikova K, Kaiserova M, Vastik M, Kurcova S, Kanovsky P. Treatment of camptocormia with continuous subcutaneous infusions of apomorphine: 1-year prospective pilot study. J Neural Transm (Vienna). 2015;122:835–9.

    Article  CAS  Google Scholar 

  165. Azher SN, Jankovic J. Camptocormia pathogenesis, classification, and response to therapy. Neurology. 2005;65:355–9.

    Article  PubMed  Google Scholar 

  166. von Coelln R, Raible A, Gasser T, Asmus F. Ultrasound-guided injection of the iliopsoas muscle with botulinum toxin in camptocormia: botulinum toxin in camptocormia. Mov Disord. 2008;23:889–92.

    Article  Google Scholar 

  167. Wijemanne S, Jimenez-Shahed J. Improvement in dystonic camptocormia following botulinum toxin injection to the external oblique muscle. Parkinsonism Relat Disord. 2014;20:1106–7.

    Article  PubMed  Google Scholar 

  168. Furusawa Y, Mukai Y, Kawazoe T, Sano T, Nakamura H, Sakamoto C, et al. Long-term effect of repeated lidocaine injections into the external oblique for upper camptocormia in Parkinson’s disease. Parkinsonism Relat Disord. 2013;19:350–4.

    Article  PubMed  Google Scholar 

  169. •• Schulz-Schaeffer WJ, Margraf NG, Munser S, Wrede A, Buhmann C, Deuschl G, et al. Effect of neurostimulation on camptocormia in Parkinson’s disease depends on symptom duration. Mov Disord. 2015;30:368–72. The authors examined the effects of STN DBS on camptocormia. Multifactorial analysis revealed the link between duration of camptocormia and DBS benefit.

    Article  PubMed  PubMed Central  Google Scholar 

  170. Capecci M, Serpicelli C, Fiorentini L, Censi G, Ferretti M, Orni C, et al. Postural rehabilitation and Kinesio taping for axial postural disorders in Parkinson’s disease. Arch Phys Med Rehabil. 2014;95:1067–75.

    Article  PubMed  Google Scholar 

  171. Cannas A, Solla P, Floris G, Tacconi P, Serra A, Piga M, et al. Reversible Pisa syndrome in patients with Parkinson’s disease on dopaminergic therapy. J Neurol. 2009;256:390–5.

    Article  PubMed  Google Scholar 

  172. Umemura A, Oka Y, Ohkita K, Yamawaki T, Yamada K. Effect of subthalamic deep brain stimulation on postural abnormality in Parkinson disease. J Neurosurg. 2010;112:1283–8.

    Article  PubMed  Google Scholar 

  173. Shih LC, Vanderhorst VG, Lozano AM, Hamani C, Moro E. Improvement of Pisa syndrome with contralateral pedunculopontine stimulation. Mov Disord. 2013;28:555–6.

    Article  PubMed  PubMed Central  Google Scholar 

  174. Bartolo M, Serrao M, Tassorelli C, Don R, Ranavolo A, Draicchio F, et al. Four-week trunk-specific rehabilitation treatment improves lateral trunk flexion in Parkinson’s disease: trunk-specific rehabilitation treatment in PD. Mov Disord. 2010;25:325–31.

    Article  PubMed  Google Scholar 

  175. Sørensen J, Sørensen JB, Skovgaard T, Bredahl T, Puggaard L. Exercise on prescription: changes in physical activity and health-related quality of life in five Danish programmes. Eur J Pub Health. 2011;21:56–62.

    Article  Google Scholar 

  176. Chakravarthy MV, Joyner MJ, Booth FW. An obligation for primary care physicians to prescribe physical activity to sedentary patients to reduce the risk of chronic health conditions. Mayo Clin Proc. 2002;77:165–73.

    Article  PubMed  Google Scholar 

  177. Francardo V, Schmitz Y, Sulzer D, Cenci MA. Neuroprotection and neurorestoration as experimental therapeutics for Parkinson’s disease. Exp Neurol. 2017;298:137–47.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Grenoble Alpes, Grenoble, France

    Bettina Debû & Elena Moro

  2. INSERM U1216, Grenoble, France

    Bettina Debû, Clecio De Oliveira Godeiro, Jarbas Correa Lino & Elena Moro

  3. Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France

    Clecio De Oliveira Godeiro, Jarbas Correa Lino & Elena Moro

  4. Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil

    Clecio De Oliveira Godeiro

  5. Division of Neurology, CHU Amiens, Amiens, France

    Jarbas Correa Lino

Authors
  1. Bettina Debû
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clecio De Oliveira Godeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jarbas Correa Lino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elena Moro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bettina Debû.

Ethics declarations

Conflict of Interest

Bettina Debû, Clecio De Oliveira Godeiro, and Jarbas Correa Lino declare no conflict of interest.

Elena Moro has received personal fees from Medtronic and Bial, and grants from Merz and Amadys.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Movement Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Debû, B., De Oliveira Godeiro, C., Lino, J.C. et al. Managing Gait, Balance, and Posture in Parkinson’s Disease. Curr Neurol Neurosci Rep 18, 23 (2018). https://doi.org/10.1007/s11910-018-0828-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-018-0828-4

Keywords

Search

Navigation