Rehabilitation interventions for improving balance in Parkinson's disease: a narrative review

Francesco Lena, PhD, Nicola Modugno, Giulio Greco, Monica Torre, Simone Cesarano, Marco Santilli, Auwal Abdullahi, Giuseppe Giovannico, and Mohammad Etoom Introduction: Postural instability is one of the latest clinical manifestations of Parkinson disease. Because of the limited therapeutic effect of pharmacological therapies, a favorable consideration has now become toward rehabilitation interventions. Thus, this study aimed to synthesize literature evidence to summarize the effects of rehabilitation interventions for improving balance in Parkinson disease. Materials and Methods:We conducted a narrative reviewof randomizedcontrolled clinical trials comparing the effects of interventions, control interventions, and no interventions on balance-related outcomes. A comprehensive search using the MEDLINE database was conducted fromJanuary 2000 to September 2021. This reviewincluded the following causes of balance-related impairments: inability to control body weight in the base of support, impaired attention and focus on balance, postural deformities, proprioceptive deficiency, sensory-motor integration, and coordination disorders, including visual and auditory-motor coordination. Results: Twenty randomized-controlled clinical trialswere included in the review.Various balance-related outcomeswere included. The included studies focused on the effectiveness of different rehabilitation interventions, including physical therapy, virtual reality and telerehabilitation, treadmill training, hydrotherapy, action observation training, balance and cues training interventions, and cognitive rehabilitation. Conclusions: The results suggest that most of the included rehabilitation interventions have promising therapeutic effects in improving balance in Parkinson disease.