[...]... Voluntary and involuntary adaptation of gait in Parkinson’s disease Gait Posture 7: 53–63 Handbook of Clinical Neurology, Vol 84 (3rd series) Parkinson’s disease and related disorders, Part II W C Koller, E Melamed, Editors # 2007 Elsevier B V All rights reserved Chapter 31 Neuroprotection in Parkinson’s disease: clinical trials FABRIZIO STOCCHI* Department of Neurology, IRCCS San Raffaele Pisana,... typical shortening of stride length in PD may in fact be accentuated when walking on a treadmill (Zijlstra et al., 1998) 30.1.3 Long-term effects of physical therapy The exact duration of the effects of programs of physical exercise in PD remains unknown Most studies on physical therapy in PD have been open and had follow-up periods of less than 8 weeks, making the longterm persistence of beneficial effects... rigorous assessment of the acute impact of the device on freezing episodes, walking speed and stride length Finally, regardless of the acute effects observed at the clinic, the potential effects of chronic use of these devices should also be considered, particularly with the use of walkers An assistive device must not necessarily be used indefinitely One may consider the temporary use of an assistive device... plate section 561 571 Section 5 Treatment of Parkinson’s disease Handbook of Clinical Neurology, Vol 84 (3rd series) Parkinson’s disease and related disorders, Part II W C Koller, E Melamed, Editors # 2007 Elsevier B V All rights reserved Chapter 30 Physical therapy in Parkinson’s disease JEAN-MICHEL GRACIES*, WINONA TSE, MARA LUGASSY AND JUDITH FRANK Department of Neurology, Mount Sinai Medical Center,... It is often noted that during an episode of freezing, the more the patient worries about the functional end-goal of walking (freeing the elevator entry for other people to come out, moving out of a crowded store through  11 a narrow exit, entering the doctor’s office), the more difficult the task becomes, particularly as others look on The emotional stress associated with the social function of walking... improvements occur regardless of whether the patient is on or off medication at the time of training (McIntosh et al., 1997) The effects of auditory cueing by metronome on gait may depend on the frequency used for the metronome beat, which may have to be 5 slightly faster than the baseline walking cadence to be efficacious PD patients using such rhythmic cues set at rates of 107.5 and 115% of their baseline walking... recommendations consisting of strict programs of daily home exercises in the mild to moderate stages of the disease and the teaching – to the patient and then to the care-giver – of compensation strategies in the late stages Acknowledgments We are grateful to Jerri Chen and Jonathan Alis for their excellent work in illustrating some of the exercises recommended in this chapter We also thank Sheree Loftus Fader,... the therapeutic focus may shift from the teaching of exercises to the teaching of compensation strategies allowing preservation of as much functional independence as possible These strategies include adaptation of the home environment, both to lessen the effects of motor impairment and to optimize safety 30.1 Physical exercises in mild to moderate stages of Parkinson’s disease Most studies investigating... that rural living, well-water consumption and exposure to pesticides increase the risk of developing PD, whereas there is a decreased risk of PD associated with smoking and coffee consumption (Koller et al., 1990) None of these factors, however, explain the large majority of cases who appear to have a sporadic form of the disease Indeed, twin studies suggest that genetic factors probably play a dominant... Postmortem studies in the substantia nigra of PD patients demonstrate increased levels of iron (which promotes oxidative stress) and decreased levels of glutathione (the major brain antioxidant) (Jenner and Olanow, 1998) Further, there is evidence of oxidative damage to carbohydrates, lipids, proteins and DNA in the SNpc of PD patients Additionally, the oxidative metabolism of levodopa and/or dopamine can generate . Disorders Clinic, Division of Neurology, University of Toronto, Toronto, Ontario, Canada M. Leehey Department of Neurology, University of Colorado School of Medicine,. Rabey Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel A. Rajput Division of Neurology, Department of Medicine, University of Saskatchewan,