University Grenoble Alpes, Grenoble, France.
INSERM U1216, Grenoble, France.
Curr Neurol Neurosci Rep. 2018 Apr 6;18(5):23. doi: 10.1007/s11910-018-0828-4.
Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies.
It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
姿势不稳和步态困难随着帕金森病（PD）的进展而不可避免地恶化，并变得对治疗有抗性，严重影响了患者的自主性和生活质量。我们回顾了晚期 PD 中平衡不稳、步态障碍和静态姿势改变的主要特征，以及现有的治疗策略。
改善晚期 PD 患者的步态和姿势障碍仍然非常困难。医学和手术干预措施往往不能令人满意地缓解这些轴性症状，实际上可能需要不同的治疗方法。运动和适应性身体活动方案有助于改善患者的病情。步态、平衡和姿势障碍通常被归为“姿势不稳和步态困难”这一类别。这可能导致患者管理效果不佳，因为数据表明，姿势、平衡和步态问题可能取决于不同的潜在机制。我们提倡从诊断的第一天起采取多学科方法。
