Affiliations: [a] Department of Neurology, University of California, San Francisco, CA, USA | [b] Parkinsons Disease Research, Education, & Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA | [x] Crawford Research Institute, Shepherd Center, 2020 Peachtree Road, NW, Atlanta, GA 30309, USA. Tel.: +1 404 367 1240; Fax: +1 404 350 3081; E-mail: ron_seal@shepherd.org | [y] Virginia Commonwealth University, Box 980661, 1223 East Marshall Street, Richmond, VA 23298-0661, USA. E-mail: dcifu@hsc.vcu.edu
Correspondence:
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Address for correspondence: Gary M. Abrams, MD, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA. Tel.: +1 415 221 4810 x3861; E-mail: abrams@itsa.ucsf.edu
Abstract: Abnormality in gait is a cardinal feature of Parkinson's disease. Walking is characterized by relatively preserved sequencing of trunk and limb movements, but diminished velocity, shortened stride length, increased base, and diminished double stance support time. The principle problem producing the gait abnormalities is dopamine deficiency, which is hypothesized to disrupt pallido-thalamic modulation of cortical motor regions that automatically regulate walking. Deep brain stimulation currently is directed at either the globus pallidum internus (GPi) or subthalamic nucleus (STN) and improves many of the abnormal characteristics of parkinsonian gait with efficacy similar to dopamine replacement. The optimal target for stimulation remains uncertain and is currently being addressed in a large VA cooperative study. Our studies show that unilateral stimulation of GPi or STN improves gait to a similar extent. Functional and quantitative gait analyses confirm sustained improvement in gait dynamics with bilateral stimulation for periods for more than several years. Parkinsonian gait is also improved with rehabilitation training, primarily using external visual or auditory cues. The combination of deep brain stimulation, pharmacotherapy, and rehabilitation training may result in more effective comprehensive approaches to the reduced mobility associated with Parkinson's disease.
Keywords: Parkinson's disease, gait, gait analysis, deep brain stimulation, rehabilitation
