Motor training in the therapy of Parkinson's disease

Motor training techniques may be a helpful adjunct to medical treatment in improving motor function in patients with Parkinson's disease. Rational physical therapy should be based on a detailed understanding of the underlying nature of the motor deficit in Parkinson's disease. The design of training techniques should take into account the known neurophysiologic aspects of motor impairment in Parkinson's disease, such as the inability to initiate movement (akinesia), the inability to perform sequential movements, impairments in the pacing of rhythmic movements, and impairments in the predictability of movements. Training techniques 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 approaches must take into account specific aspects of the motor control deficit in Parkinson's disease. For example, physical therapy should emphasize large-amplitude movements and truncal activities and make use of cuing as a major facilitator in achieving rhythmic movement patterns. In addition, the psychosocial integration of the patient may be improved by physical exercises, particularly if these are provided in group therapy sessions.