Strategies for treatment of gait and posture associated deficits in movement disorders: the impact of deep brain stimulation.

Gait difficulties occur early in the course of Parkinson's disease (PD) as well as in generalized dystonia. Deep brain stimulation (DBS) is an effective treatment for patients with PD or dystonia. PD-associated slowness of gait improves dramatically after this procedure. Since not all gait problems can be treated with DBS, it is mandatory to assess the patient's symptoms precisely before an operation can be considered. In advanced stages of PD, postural deficits causing frequent falls are a major concern and will necessitate other strategies. In dystonia, walking may become possible only after this surgical intervention. After the implantation of DBS electrodes, rehabilitative treatment is necessary to (i) to establish new movement patterns, (ii) preserve an appropriate activity level, and (iii) treat specific disability, which resulted from secondary changes of the musculoskeletal system during pathological muscle tension in dystonia. An integrated multimodal approach, which has been adopted in our institution is presented.