Abbruzzese Giovanni, Marchese Roberta, Avanzino Laura, Pelosin Elisa
Centre for Parkinson's Disease, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy; Unit of Rehabilitation and Functional Recovery, IRCCS S. Martino Hospital-IST, Genoa, Italy.
Centre for Parkinson's Disease, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy; Unit of Rehabilitation and Functional Recovery, IRCCS S. Martino Hospital-IST, Genoa, Italy.
Parkinsonism Relat Disord. 2016 Jan;22 Suppl 1:S60-4. doi: 10.1016/j.parkreldis.2015.09.005. Epub 2015 Sep 3.
Rehabilitation is considered as an adjuvant to pharmacological and surgical treatments for Parkinson's disease (PD) to maximize functional ability and minimize secondary complications. Originally, approaches were based on empirical experience, but growing evidence suggests that exercise-dependent plasticity constitutes the main mechanism underlying the effects of physiotherapy. Exercise increases synaptic strength and influences neurotransmission, thus potentiating functional circuitry in PD. In addition, exercise is a pivotal element of motor learning. PD patients retain a sufficient capacity of motor learning, though learning rates and performance are reduced in comparison to normal controls. Recent meta-analyses demonstrated that rehabilitation could induce short-lasting, but clinically important benefits, particularly for gait and balance. However, the interventions are largely heterogeneous (stretching, muscle strengthening, balance, postural exercises, occupational therapy, cueing, treadmill training), and there is still no consensus about the optimal approach. Innovative techniques have been recently proposed: virtual reality and exergaming, motor imagery and action observation, robot-assisted physiotherapy and non-conventional therapies (e.g.: dance, martial arts). The rehabilitative program for PD should be "goal-based" (targeted to practicing and learning specific activities in the core areas), but a number of practice variables (intensity, specificity, complexity) need to be identified and the program should tailored to the individual patients' characteristics.
康复被视为帕金森病（PD）药物和手术治疗的辅助手段，以最大限度地提高功能能力并减少继发并发症。最初，治疗方法基于经验，但越来越多的证据表明，运动依赖性可塑性是物理治疗效果的主要潜在机制。运动可增强突触强度并影响神经传递，从而增强PD患者的功能回路。此外，运动是运动学习的关键要素。PD患者保留了足够的运动学习能力，尽管与正常对照组相比，学习速度和表现有所下降。最近的荟萃分析表明，康复可以带来短期但具有临床意义的益处，特别是在步态和平衡方面。然而，干预措施在很大程度上是异质性的（伸展、肌肉强化、平衡、姿势练习、职业治疗、提示、跑步机训练），对于最佳方法仍未达成共识。最近提出了一些创新技术：虚拟现实和运动游戏、运动想象和动作观察、机器人辅助物理治疗以及非常规疗法（如舞蹈、武术）。PD的康复计划应是“基于目标的”（针对核心领域中特定活动的练习和学习），但需要确定一些练习变量（强度、特异性、复杂性），并且该计划应根据个体患者的特征进行调整。
