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Striding Out With Parkinson Disease: Evidence-Based Physical Therapy for Gait Disorders

M.E. Morris, PT, PhD, is Professor and Head, Melbourne School of Health Sciences, The University of Melbourne, Victoria, Melbourne 3010, Australia.
C.L. Martin, PT, PhD, is Senior Research Fellow, Centre for Health, Exercise and Sports Medicine, The University of Melbourne.
M.L. Schenkman, PT, PhD, FAPTA, is Professor and Director, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, and Associate Dean of Physical Therapy Education, School of Medicine, University of Colorado Denver, Aurora, Colorado.

Address all correspondence to Dr Morris at: m.morris{at}unimelb.edu.au.

Although Parkinson disease (PD) is common throughout the world, the evidence for physical therapy interventions that enable long-term improvement in walking is still emerging. This article critiques the major physical therapy approaches related to gait rehabilitation in people with PD: compensatory strategies, motor skill learning, management of secondary sequelae, and education to optimize physical activity and reduce falls. The emphasis of this review is on gait specifically, although balance and falls are of direct importance to gait and are addressed in that context. Although the researchers who have provided the evidence for these approaches grounded their studies on different theoretical paradigms, each approach is argued to have a valid place in the comprehensive management of PD generally and of gait in particular. The optimal mix of interventions for each individual varies according to the stage of disease progression and the patient's preferred form of exercise, capacity for learning, and age.

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