Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study

Objective: Freezing of gait is a frequently disabling symptom in Parkinson's disease, poorly responding to dopaminergic treatment. We investigated the short-term effectiveness of a rehabilitation protocol in parkinsonian patients with freezing of gait. Design: Prospective, uncontrolled pilot study with open label design. Setting: Outpatient service for rehabilitation of neurological disorders. Subjects: Twelve patients (8 male, 4 female; aged 59-78 years; Hoehn-Yahr stage: 2-3; mean disease duration: 14.29 +/- SD 4.1 years). Interventions: Patients attended three (45 min) sessions every week, over a six-week period, of physical therapy focused to improve balance, postural control and walking, and to learn new strategies for overcoming freezing of gait. Main outcome measures: Patients were evaluated before (T0), at the end (T1), and one month after (T2) rehabilitation by means of clinical rating scales (Unified Parkinson Disease Rating Scale - Motor Section; Freezing of Gait Questionnaire; Parkinson Disease Quality of Life Score) and gait parameters (number of strides, stride length and velocity) during a standardized walking test. Results: The scores of Freezing of Gait Questionnaire and of Parkinson Disease Quality of Life Questionnaire (but not of the Unified Parkinson Disease Rating Scale - Motor Section) were significantly improved after treatment (T1). Gait parameters were significantly improved at T1 and T2. Conclusions: We showed the potential short-term efficacy of a rehabilitative approach to freezing of gait in Parkinson's disease. The positive outcome was documented by clinical rating scales and objective gait evaluation. The rapid reversibility of the clinical benefit suggests that further studies are needed to better define the optimal frequency and duration of treatment.