Prospective study of specific rehabilitation in Parkinson's disease: Effectiveness on gait and balance of a group ambulatory hospitalization in extrapyramidal disorders

Abstract

Rehabilitation and physical activities on intensive specific stays is an increasingly rehabilitation modality in parkinsonian patients (Bregel, 2002, Carne, 2005, Stozek, 2016, Ridgel, 2016). Peer counselling appears to be a factor favoring compliance to the program care with the group constitution. The objective is to evaluate the feasibility and effectiveness of a specific care in a group of Parkinsonian patients in a rehabilitation center. Prospective observational study between May 2016 and February 2017 on a treatment in ambulatory hospitalization 3days/week over 4 weeks on groups of 4 to 6 patients with Parkinson's disease or related syndromes. The inclusion criteria were voluntary patients, referred by their neurologist, with a complaint about balance and/or gait and walking should be possible in 100 m with or without technical assistance. They should be no cognitive impairment for compliance to cure. The content of the sessions and the schedules were defined. Thirty patients (10 women, 20 men) with a mean age of 67.5 years old (± 10.3) with diseases since 4.65 years (from 1 to 18 years), mean UPDRS 19.6 were included. There was a significant improvement in gait and balance on all clinical parameters measured: speed at 10 m comfort (P = 0.007) and fast (P = 0.008), Time up and Go Test (P = 0.001), 6 minutes walking test (P = 0.003), unilateral balance on the most deficient side (P = 0.015). There is no evidence of improvement in upper-limb bradykinesia on the Box and Block Test and the Nine Hole Peg Test. Fatigue was noted at the end by 26 patients. A sequential specific program on an intensive 4-week stay in Parkinson's patients allows a significant improvement in balance and gait. This management can be done in a group of patients but requires in a framework a modification of the practices of the therapists more accustomed to the face-to-face care relationships. The 4 weeks of rehabilitation appear to be an acceptable compromise in view of fatigue. The prospects are the development of a home rehabilitation programs to promote the purchase of this improvement.