[Exercices 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 secondary occurrence of motor decline develops. Physical medicine and rehabilitation have not been really involved in Parkinson's disease and few articles have assessed the value of these programs. In fact, controlled randomized 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 onset and unchanged drug treatment during the period of the clinical trial. Assessment has had to rely on scales taking into account the main Parkinson impairments (e.g. walking ability, postural control, skill), their intensity and also their fluctuation such as on-off effects. The Unified Parkinson's Disease Rating Scale (UPDRS) looks well-adapted but has been only recently for such studies. Many exercise programs, aiming at improving coordination, sway balance, transfer and gait have been proposed in the literature; rhythmic visual or auditory cueing seem quite effective. Only four controlled studies with satisfactory methodology are available. They could lead to the conclusion that physiotherapy would be effective more by reducing daily life disability than by improving Parkinson symptoms such as bradykinesia or tremor. 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, physiotherapists giving special attention to postural control and prevention of falls. In another controlled randomized study occupational therapists successfully trained patients in everyday activities. For the most severely impaired patients, rehabilitation and home adaptations are the only means to achieve an less dependent status. Multidisciplinary outpatient departments providing physical medicine and rehabilitation facilities in addition to neurological care would appear to be the best solution for helping Parkinson's disease patients cope with their impairments and disabilities.