Gait in Parkinson Disease: From Neurophysiology to Rehabilitation Overview
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Published:
Jun 17, 2025
Keywords:
gait, neurophysiology, Parkinson's Disease, Rehabilitation
Main Article Content
Abstract
Introduction: Parkinson's disease (PD) is a chronic and progressive neurodegenerative disorder, mostly happened in older adult, related to the degeneration of striatal dopaminergic neurons. Motor disorders in PD lead to gait disturbance, which worsen as the disease progresses. This literature review provides variety of gait disturbances possible in patients with PD. Understanding the mechanisms and factors associated with impaired walking activity of PD patients will form a solid foundation for selecting appropriate rehabilitation strategies, ultimately improving mobility, overcoming restriction of participation and life satisfaction for these patients.
Methods: Research was conducted using PubMed, Google Scholar, and the Cochrane Library to locate original articles, as well as systematic and narrative reviews, concerning the neurophysiology, pathophysiology, clinical features, and rehabilitation of gait in Parkinson disease
Result: PD Patients may experience a decrease in walking speed and stride length and increased axial rigidity. Early alterations in gait associated with PD include reduced arm swing amplitude, asymmetry between the extremities, and a decline in movement fluidity. In later stages, freezing of gait (FOG), festination, and turning en bloc can occur. These conditions will lead to increased dependency and affecting the patient's mobility and participation with further implication of immobility and isolation. Management of gait in Parkinson's disease (PD) consists of a combination of pharmacological and non-pharmacological treatment. A rehabilitation program designed for PD should cover the specific needs of each patient to optimize mobility and social participation.
Conclusion: Understanding the neurophysiology of walking and the neuropathology of PD, the effective rehabilitation strategies can be formulated to optimize mobility, efficiency and the independency in daily activities, especially related to gait and walking performance.
Methods: Research was conducted using PubMed, Google Scholar, and the Cochrane Library to locate original articles, as well as systematic and narrative reviews, concerning the neurophysiology, pathophysiology, clinical features, and rehabilitation of gait in Parkinson disease
Result: PD Patients may experience a decrease in walking speed and stride length and increased axial rigidity. Early alterations in gait associated with PD include reduced arm swing amplitude, asymmetry between the extremities, and a decline in movement fluidity. In later stages, freezing of gait (FOG), festination, and turning en bloc can occur. These conditions will lead to increased dependency and affecting the patient's mobility and participation with further implication of immobility and isolation. Management of gait in Parkinson's disease (PD) consists of a combination of pharmacological and non-pharmacological treatment. A rehabilitation program designed for PD should cover the specific needs of each patient to optimize mobility and social participation.
Conclusion: Understanding the neurophysiology of walking and the neuropathology of PD, the effective rehabilitation strategies can be formulated to optimize mobility, efficiency and the independency in daily activities, especially related to gait and walking performance.
Article Details
How to Cite
Arisanti, F., Asfara, A., & Yonathan, J. S. (2025). Gait in Parkinson Disease: From Neurophysiology to Rehabilitation Overview. Indonesian Journal of Physical Medicine and Rehabilitation, 14(1), 105 - 115. https://doi.org/10.36803/indojpmr.v14i1.433
Section
Literature Review
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20. Peterson DS, Horak FB. Neural Control of Walking in People with Parkinsonism. Physiology (Bethesda). 2016 Mar;31(2):95–107. https://doi.org/10.1152/physiol.00034.2015
21. Hong M, Earhart GM. Effects of medication on turning deficits in individuals with Parkinson’s disease. J Neurol Phys Ther. 2010 Mar;34(1):11–6. https://doi.org/10.1097/NPT.0b013e3181d070fe
22. Gilat M, Ginis P, Zoetewei D, De Vleeschhauwer J, Hulzinga F, D’Cruz N, et al. A systematic review on exercise and training-based interventions for freezing of gait in Parkinson’s disease. NPJ Park Dis. 2021 Sep;7(1):81. https://doi.org/10.1038/s41531-021-00224-4
23. Nonnekes J, Giladi N, Guha A, Fietzek UM, Bloem BR, Růžička E. Gait festination in parkinsonism: introduction of two phenotypes. J Neurol. 2019 Feb;266(2):426–30. https://doi.org/10.1007/s00415-018-9146-7
24. Nonnekes J, Goselink R, Weerdesteyn V, Bloem BR. The retropulsion test: a good evaluation of postural instability in Parkinson’s disease? J Parkinsons Dis. 2015;5(1):43–7. https://doi.org/10.3233/JPD-140514
25. Thanvi B, Lo N, Robinson T. Levodopa-induced dyskinesia in Parkinson’s disease: clinical features, pathogenesis, prevention and treatment. Postgrad Med J. 2007 Jun;83(980):384–8. https://doi.org/10.1136/pgmj.2006.054759
26. Yang Y, Wang Y, Zhou Y, Chen C, Xing D, Wang C. Validity of the Functional Gait Assessment in patients with Parkinson disease: construct, concurrent, and predictive validity. Phys Ther. 2014 Mar;94(3):392–400. https://doi.org/10.2522/ptj.20130019
27. Nonnekes J, Nieuwboer A. Towards Personalized Rehabilitation for Gait Impairments in Parkinson’s Disease. J Parkinsons Dis. 2018;8(s1):S101–6. https://doi.org/10.3233/JPD-181464
28. Biebl JT, Azqueta-Gavaldon M, Wania C, Zettl O, Woiczinski M, Bauer L, et al. Resistance Training Combined with Balance or Gait Training for Patients with Parkinson’s Disease: A Randomized Controlled Pilot Study. Parkinsons Dis. 2022;2022:9574516. https://doi.org/10.1155/2022/9574516
29. Ginis P, Nackaerts E, Nieuwboer A, Heremans E. Cueing for people with Parkinson’s disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives. Ann Phys Rehabil Med. 2018 Nov;61(6):407–13. https://doi.org/10.1016/j.rehab.2017.08.002
30. Tobar A, Jaramillo AP, Costa SC, Costa KT, Garcia SS. A Physical Rehabilitation Approach for Parkinson’s Disease: A Systematic Literature Review. Cureus. 2023 Sep;15(9):e44739. https://doi.org/10.7759/cureus.44739
31. Ni M, Hazzard JB, Signorile JF, Luca C. Exercise Guidelines for Gait Function in Parkinson’s Disease: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair. 2018 Oct;32(10):872–86. https://doi.org/10.1177/1545968318801558
32. Strouwen C, Molenaar EALM, Keus SHJ, Münks L, Munneke M, Vandenberghe W, et al. Protocol for a randomized comparison of integrated versus consecutive dual task practice in Parkinson’s disease: the DUALITY trial. BMC Neurol. 2014 Mar;14:61. https://doi.org/10.1186/1471-2377-14-61
33. Bryant MS, Rintala DH, Graham JE, Hou JG, Protas EJ. Determinants of use of a walking device in persons with Parkinson’s disease. Arch Phys Med Rehabil. 2014 Oct;95(10):1940–5. https://doi.org/10.1016/j.apmr.2014.06.002
2. Dorsey ER, Sherer T, Okun MS, Bloem BR. The Emerging Evidence of the Parkinson Pandemic. J Parkinsons Dis. 2018;8(s1):S3–8. https://doi.org/10.3233/JPD-181474
3. Dorsey ER, Constantinescu R, Thompson JP, Biglan KM, Holloway RG, Kieburtz K, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology. 2007 Jan;68(5):384–6. https://doi.org/10.1212/01.wnl.0000247740.47667.03
4. Kalia L V, Lang AE. Parkinson’s disease. Lancet (London, England). 2015 Aug;386(9996):896–912. https://doi.org/10.1016/S0140-6736(14)61393-3
5. DeMaagd G, Philip A. Parkinson’s Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis. P T. 2015 Aug;40(8):504–32.
6. Stoker TB, Greenland JC. Parkinson’s Disease: Pathogenesis and Clinical Aspects. Stoker TB, Greenland JC, editors. Parkinson’s Disease: Pathogenesis and Clinical Aspects. Brisbane (AU); 2018. https://doi.org/10.15586/codonpublications.parkinsonsdisease.2018
7. Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, et al. Gait impairments in Parkinson’s disease. Lancet Neurol. 2019 Jul;18(7):697–708. https://doi.org/10.1016/S1474-4422(19)30044-4
8. Pistacchi M, Gioulis M, Sanson F, De Giovannini E, Filippi G, Rossetto F, et al. Gait analysis and clinical correlations in early Parkinson’s disease. Funct Neurol. 2017;32(1):28–34. https://doi.org/10.11138/fneur/2017.32.1.028
9. Baron EI, Miller Koop M, Streicher MC, Rosenfeldt AB, Alberts JL. Altered kinematics of arm swing in Parkinson’s disease patients indicates declines in gait under dual-task conditions. Parkinsonism Relat Disord. 2018 Mar;48:61–7. https://doi.org/10.1016/j.parkreldis.2017.12.017
10. Albani G, Cimolin V, Fasano A, Trotti C, Galli M, Mauro A. “Masters and servants” in parkinsonian gait: a three-dimensional analysis of biomechanical changes sensitive to disease progression. Funct Neurol. 2014;29(2):99–105.
11. Rahimpour S, Gaztanaga W, Yadav AP, Chang SJ, Krucoff MO, Cajigas I, et al. Freezing of Gait in Parkinson’s Disease: Invasive and Noninvasive Neuromodulation. Neuromodulation. 2021 Jul;24(5):829–42. https://doi.org/10.1111/ner.13347
12. Walton CC, Shine JM, Hall JM, O’Callaghan C, Mowszowski L, Gilat M, et al. The major impact of freezing of gait on quality of life in Parkinson’s disease. J Neurol. 2015 Jan;262(1):108–15. https://doi.org/10.1007/s00415-014-7524-3
13. Klarner T, Zehr EP. Sherlock Holmes and the curious case of the human locomotor central pattern generator. J Neurophysiol. 2018 Jul;120(1):53–77. https://doi.org/10.1152/jn.00554.2017
14. Sheridan PL, Hausdorff JM. The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer’s disease. Dement Geriatr Cogn Disord. 2007;24(2):125–37. https://doi.org/10.1159/000105126
15. Takakusaki K. Functional Neuroanatomy for Posture and Gait Control. J Mov Disord. 2017 Jan;10(1):1–17. https://doi.org/10.14802/jmd.16062
16. Lanciego JL, Luquin N, Obeso JA. Functional neuroanatomy of the basal ganglia. Cold Spring Harb Perspect Med. 2012 Dec;2(12):a009621. https://doi.org/10.1101/cshperspect.a009621
17. Ropper AH, Samuels MA, Klein J. Adams and Victor’s Principles of Neurology 10th Edition [Internet]. McGraw-Hill Education; 2014. Available from: https://books.google.co.id/books?id=U3XhAgAAQBAJ
18. Jordan LM, Liu J, Hedlund PB, Akay T, Pearson KG. Descending command systems for the initiation of locomotion in mammals. Brain Res Rev. 2008 Jan;57(1):183–91. https://doi.org/10.1016/j.brainresrev.2007.07.019
19. Takakusaki K, Habaguchi T, Ohtinata-Sugimoto J, Saitoh K, Sakamoto T. Basal ganglia efferents to the brainstem centers controlling postural muscle tone and locomotion: a new concept for understanding motor disorders in basal ganglia dysfunction. Neuroscience. 2003;119(1):293–308. https://doi.org/10.1016/s0306-4522(03)00095-2
20. Peterson DS, Horak FB. Neural Control of Walking in People with Parkinsonism. Physiology (Bethesda). 2016 Mar;31(2):95–107. https://doi.org/10.1152/physiol.00034.2015
21. Hong M, Earhart GM. Effects of medication on turning deficits in individuals with Parkinson’s disease. J Neurol Phys Ther. 2010 Mar;34(1):11–6. https://doi.org/10.1097/NPT.0b013e3181d070fe
22. Gilat M, Ginis P, Zoetewei D, De Vleeschhauwer J, Hulzinga F, D’Cruz N, et al. A systematic review on exercise and training-based interventions for freezing of gait in Parkinson’s disease. NPJ Park Dis. 2021 Sep;7(1):81. https://doi.org/10.1038/s41531-021-00224-4
23. Nonnekes J, Giladi N, Guha A, Fietzek UM, Bloem BR, Růžička E. Gait festination in parkinsonism: introduction of two phenotypes. J Neurol. 2019 Feb;266(2):426–30. https://doi.org/10.1007/s00415-018-9146-7
24. Nonnekes J, Goselink R, Weerdesteyn V, Bloem BR. The retropulsion test: a good evaluation of postural instability in Parkinson’s disease? J Parkinsons Dis. 2015;5(1):43–7. https://doi.org/10.3233/JPD-140514
25. Thanvi B, Lo N, Robinson T. Levodopa-induced dyskinesia in Parkinson’s disease: clinical features, pathogenesis, prevention and treatment. Postgrad Med J. 2007 Jun;83(980):384–8. https://doi.org/10.1136/pgmj.2006.054759
26. Yang Y, Wang Y, Zhou Y, Chen C, Xing D, Wang C. Validity of the Functional Gait Assessment in patients with Parkinson disease: construct, concurrent, and predictive validity. Phys Ther. 2014 Mar;94(3):392–400. https://doi.org/10.2522/ptj.20130019
27. Nonnekes J, Nieuwboer A. Towards Personalized Rehabilitation for Gait Impairments in Parkinson’s Disease. J Parkinsons Dis. 2018;8(s1):S101–6. https://doi.org/10.3233/JPD-181464
28. Biebl JT, Azqueta-Gavaldon M, Wania C, Zettl O, Woiczinski M, Bauer L, et al. Resistance Training Combined with Balance or Gait Training for Patients with Parkinson’s Disease: A Randomized Controlled Pilot Study. Parkinsons Dis. 2022;2022:9574516. https://doi.org/10.1155/2022/9574516
29. Ginis P, Nackaerts E, Nieuwboer A, Heremans E. Cueing for people with Parkinson’s disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives. Ann Phys Rehabil Med. 2018 Nov;61(6):407–13. https://doi.org/10.1016/j.rehab.2017.08.002
30. Tobar A, Jaramillo AP, Costa SC, Costa KT, Garcia SS. A Physical Rehabilitation Approach for Parkinson’s Disease: A Systematic Literature Review. Cureus. 2023 Sep;15(9):e44739. https://doi.org/10.7759/cureus.44739
31. Ni M, Hazzard JB, Signorile JF, Luca C. Exercise Guidelines for Gait Function in Parkinson’s Disease: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair. 2018 Oct;32(10):872–86. https://doi.org/10.1177/1545968318801558
32. Strouwen C, Molenaar EALM, Keus SHJ, Münks L, Munneke M, Vandenberghe W, et al. Protocol for a randomized comparison of integrated versus consecutive dual task practice in Parkinson’s disease: the DUALITY trial. BMC Neurol. 2014 Mar;14:61. https://doi.org/10.1186/1471-2377-14-61
33. Bryant MS, Rintala DH, Graham JE, Hou JG, Protas EJ. Determinants of use of a walking device in persons with Parkinson’s disease. Arch Phys Med Rehabil. 2014 Oct;95(10):1940–5. https://doi.org/10.1016/j.apmr.2014.06.002