Parkinson’s disease is a neurodegenerative disease with a slow but progressive evolution, which mainly involves functions such as control of movement and balance.

The disease is present all over the world and in all ethnic groups, about 5% of the population shows the first symptoms between 21 and 40 years, above 60 years affects 1-2% of the population, while the percentage rises to 3-5% for the age group over 85.

It occurs when the production of dopamine in the brain drops consistently due to the degeneration of neurons in a deep area of ​​the brain called “black substance”.

Motor disorders, especially in the initial phase, represent the main limitation in Parkinson’s disease: tremor at rest, rigidity, bradykinesia (slowness of movement) and, in one more advanced phase, postural instability (loss of balance) and walking disorders.

Disorders of balance and walking

Balance disorder in Parkinson’s disease is a symptom that involves “the axis of the body” and is due to a reduction in straightening reflexes, so the subject is not able to spontaneously correct any imbalances.

It is highlighted especially when the person walks or changes direction during the journey.

Equilibrium disorders are a significant risk factor for falls on the ground and do not respond to dopaminergic drug therapy, therefore motor rehabilitation becomes an important intervention for the disturbance management.

As far as the walking disorder is concerned, it is observed that the posture of many patients tends to hunch forward, the pendular movements of the arms are reduced, and the length of the steps is reduced up to a few centimeters.

Furthermore, the phenomenon of “festination” is often presented, ie the patient takes faster and shorter steps, as if he were chasing his center of gravity to avoid the fall, up to to no longer be able to move your feet.

From the intermediate stages of the disease episodes of sudden motor blockage can occur, generally called “freezing” of the march, moments in which the legs do not respond to commands and feet they seem to be glued to the floor.

Motor rehabilitation in Parkinson’s

Although the treatment of Parkinson’s disease cannot prescind from a pharmacological approach, it is of fundamental importance that rehabilitative treatment is also included in the management of the disease.

Motor rehabilitation, in particular, is an essential complement for the patient to improve the quality of life and has proved to be particularly effective in slowing the evolution of the disease and in reducing the need to increase drug dosage.

It favors a global reinforcement of the musculature, an increase in the amplitude of the movements and the degree of muscular relaxation, with the main objective of allowing the patient to reach the greater degree of autonomy possible.

In the initial phase patients are advised to practice as much physical activity as possible, with the progression of the disease a neurorehabilitation aimed at improving mobility-related problems becomes indispensable, to balance, coordination, posture, breathing and walking to reduce the risk of falling.

The rehabilitation program generally includes the following exercises:

• Exercises of stretching and mobilization , with the aim of preventing musculotendineous retractions on individual joints and the onset of painful pathologies bones, and to correct flawed postural attitudes.
• Functional exercises , for improving the ability to change position (lying, sitting, standing) and to perform everyday life gesture
  
• Balance exercises
• Coordination exercises , for improving the fluidity and accuracy of movements

Motor rehabilitation should have a daily frequency and the exercises should be performed both in the clinic and at home, to maintain the results achieved, since the main objective is to to maintain patient autonomy.

Biofeedback in motor rehabilitation of Parkinson’s

The biofeedback technique (which translated literally means biological feedback) consists in giving the patient real-time feedback concerning physiological / motor functions of the patient himself, increasing awareness of one’s functional efficiency.

A particularly effective technique in the case of Parkinson’s disease as it acts on cortical plasticity, allowing reconstruction of damaged neural networks and favoring the correct restoration of motor patterns.

The University of Chieti conducted a pilot study on Parkinsonian patients (with frequent falls and axial dystonia) subjected to an 8-week rehabilitation protocol focused on sensorimotor improvement.

The protocol also included the execution, at least twice a week, of biofeedback rehabilitation exercises performed using Riablo.

The study highlighted improvements in static and dynamic balance, promoting better overall motor performance, and improvements in processes related to motor control.