Exercice program and rehabilitation of motor disorders in Parkinson's disease.

As long as motor disorders are controlled by DOPAtherapy, exercise programs and rehabilitation would not appear to be essential for patients suffering from Parkinson's disease. Such measures do become necessary however when s econdary occurrence of motor decline develops. Physical medicine and rehabi litation have not been really involved in Parkinson's disease and few artic les have assessed the value of these programs. In fact controlled randomize d studies have faced two kinds of methodological difficulties those due to rehabilitation practices, and those due to Parkinson's disease specificity especially similarities between groups for Hoehn and Yahr stage at study on set and unchanged drug treatment during the period of the clinical trial As sessment has had to rely on scales laking into account the main Parkinson i mpairments (e.g. walking ability, postural control skill), their intensity and also their fluctuation such as on-off effects The Unified Parkinson's D isease Rating Scale (UPDRS) looks well-adapted but has been only recently f or such studies. Many exercise programs, aiming at improving coordination, sway balance, transfer and gait have been proposed in the literature; rhyth mic visual or auditory cueing seem quite effective. Only four controlled st udies with satisfactory methodology are available. They could lead to the c onclusion that physiotherapy would be effective more by reducing daily life disability than by improving Parkinson symptoms such as bradykinesia or tr emor To be effectively performed at home, these exercises would have to be taught early in the course of the disease and during an on phase, physiothe rapists giving special attention to postural control and prevention of fall s. In another controlled randomized study occupational therapists successfu lly trained patients in everyday activities. For the most severely impaired patients, rehabilitation and home adaptations are the only means to achiev e an less dependent status. Multidisciplinary outpatient departments provid ing physical medicine and rehabilitation facilities in addition to neurolog ical care would appear to be the best solution for helping Parkinson's dise ase patients rope with their impairments and disabilities.