MOTOR TRAINING IN THE THERAPY OF PARKINSONS-DISEASE

Motor training techniques may be a helpful adjunct to medical treatmen t in improving motor function in patients with Parkinson's disease. Ra tional physical therapy should be based on a detailed understanding of the underlying nature of the motor deficit in Parkinson's disease. Th e design of training techniques should take into account the known neu rophysiologic aspects of motor impairment in Parkinson's disease, such as the inability to initiate movement (akinesia), the inability to pe rform sequential movements, impairments in the pacing of rhythmic move ments, and impairments in the predictability of movements. Training te chniques are definitely necessary to prevent the sequelae, especially of the later stages of the disease, including contractures and muscle spasm. To increase voluntary motor activity, physiotherapeutic approac hes must take into account specific aspects of the motor control defic it in Parkinson's disease. For example, physical therapy should emphas ize large-amplitude movements and truncal activities and make use of c uing as a major facilitator in achieving rhythmic movement patterns. I n addition, the psychosocial integration of the patient may be improve d by physical exercises, particularly if these are provided in group t herapy sessions.