Effect of different modes of therapy on vestibular and balance dysfunction in Parkinson's disease

Background: Patients with Parkinson's disease (PD) have difficulties in performing various motor tasks such as walking, writing and speaking, together with significant balance dysfunction. Despite gains made in the field of pharmacotherapy and deep brain stimulation, dopaminergic medications may produce a limited improvement in postural stability. Sustained improvement in motor skills can be achieved through physiotherapy. Aim of the work: To measure the effect of different modes of therapy in controlling vestibular and/or balance dysfunction in patients with PD. Methodology: This study was conducted on 20 patients suffering from definite PD, subdivided into two subgroups according to the mode of therapy they followed. Subgroup I received medical treatment and physiotherapy, while subgroup II received medical treatment only. The control group consisted of 10 age- and sex-matched normal subjects. All participants were evaluated using video-nystagmography (VNG), Computerized Dynamic Posturography (CDP) including sensory impairment, automatic motor and voluntary motor assessment. In addition, patients were evaluated using functional limitation tests and were asked to fill the Freezing of Gait (FOG) questionnaire. Results: This research documents vestibular as well as balance dysfunction in patients with PD. Central vestibular disorders were more common than peripheral ones. The most prevalent balance abnormality was encountered in the sensory organization subtest, though patients showed significant affection in other domains; namely, autonomic motor, voluntary motor and functional limitation. In general, patients receiving both medication and physiotherapy showed better vestibular and balance function than those receiving medication only, and approached the normal values in many test parameters. Conclusions: Since patients with PD receiving physiotherapy in conjunction with medical treatment showed better control of their vestibular and balance functions, efforts should be directed to start physiotherapy including vestibular rehabilitation as early as possible in order to improve balance, thus increasing independence in daily life activities.