Giladi N, Balash Y
Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
J Neural Transm Suppl. 2006(70):327-32. doi: 10.1007/978-3-211-45295-0_49.
Gait is affected in all stages of Parkinson's disease (PD) and is one of the hallmarks for disease progression. The fear of getting into the wheel chair is one of the first thoughts many patients ask about when the diagnosis of PD is given. At the early stages of the disease gait disturbances are present and can be measured but in most patients it does not cause significant functional disturbances. In contrast, as the disease progress, gait disturbances and postural control abnormalities are becoming major causes for lost of mobility and falls. These unfortunate consequences should be forecasted at the early stages of the disease and a preventive approach should be taken. Treatment of gait disturbances at the early stages of the disease is mainly to encourage patients to exercise and walk daily and by drugs in those with disabling symptoms. At the advanced stages, treatment should be aggressive in order to keep the patient walking safely. Drugs, physiotherapy and functional neurosurgery should be used wisely for best outcomes and least side effects. When time comes and the risk of falls is very significant, walking aids should be suggested and if no other option is left, wheel chair is a very reasonable option to maintain mobility out of home, preserving quality of life and avoiding falls with all it severe consequences.
帕金森病（PD）的各个阶段都会影响步态，且步态是疾病进展的标志之一。许多患者在被诊断为帕金森病时，首先想到的问题之一就是害怕坐上轮椅。在疾病早期，步态紊乱就已存在且可以测量，但大多数患者的步态紊乱并未导致明显的功能障碍。相反，随着疾病进展，步态紊乱和姿势控制异常成为导致行动能力丧失和跌倒的主要原因。这些不幸后果应在疾病早期就被预测到，并应采取预防措施。疾病早期步态紊乱的治疗主要是鼓励患者每天锻炼和行走，对有致残症状的患者则使用药物治疗。在疾病晚期，治疗应积极主动，以使患者能够安全行走。药物、物理治疗和功能性神经外科手术应明智使用，以达到最佳效果并减少副作用。当跌倒风险非常高时，应建议使用助行器，如果没有其他选择，轮椅是维持户外行动能力、保持生活质量并避免跌倒及其严重后果的非常合理的选择。
