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Nonpharmacological,Nonsurgical Treatments for Freezing of Gait in Parkinson's Disease: A Systematic Review |
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| Authors: | Manuel Delgado-Alvarado MD PhD Massimo Marano MD Ana Santurtún MD PhD Ainhoa Urtiaga-Gallano PT Diana Tordesillas-Gutierrez PhD Jon Infante MD PhD |
| Affiliation: | 1. Neurology Department, Sierrallana Hospital, Torrelavega, Spain;2. Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy;3. Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain;4. Physical Therapy Faculty, Escuela Universitaria Gimbernat, Torrelavega, Spain;5. Biomedical Research Networking Center for Mental Health (CIBERSAM), Madrid, Spain Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Spain;6. Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain Centro de investigación en red de enfermedades neurodegenerativas (CIBERNED), Madrid, Spain |
| Abstract: | Freezing of gait is a disabling phenomenon that appears in a substantial number of Parkinson's disease (PD) patients as the disease evolves. It is considered to be one of the most relevant contributing factors to worsening of quality of life. Current pharmacological or surgical treatment options have limited efficacy. Thus, alternative nonpharmacological/nonsurgical approaches have emerged in recent years in an attempt to improve quality of life in PD. This systematic review summarizes studies of such therapies over the past 5 years. Thirty-five studies were evaluated by use of a qualitative evaluation, while the methodological quality was assessed using validated tools. According to our results, there appear to be two broad categories of nonpharmacological therapies: those that seek a long-lasting benefit and those that aim to achieve a transient effect to overcome the freezing of gait episode. Among the former, it is possible to differentiate between “passive” therapies, which include transcranial magnetic stimulation or transcranial direct current stimulation, and “active” therapies, which are based on different cognitive or physical training programs. Finally, “transient effect” therapies use different types of cues, such as visual, auditory, or proprioceptive stimuli, to attempt to shift the patient's habitual motor control to a goal-directed one. In conclusion, a broad spectrum of nonpharmacological/nonsurgical approaches for freezing of gait has emerged in recent years with promising results. © 2019 International Parkinson and Movement Disorder Society |
| Keywords: | freezing of gait Parkinson's disease physical therapy review treatment |