Rehabilitation of parkinsonian syndromes

The “parkinsonian syndromes” encompass a number of different nosological entities that are classified together on the basis of the shared clinical features of bradykinesia and rigidity. Progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and vascular parkinsonism (VaP) are diseases that are included in this group of neurodegenerative disorders. However, if considered more broadly, “parkinsonian syndromes” includes any condition that leads to dysfunction of the basal ganglia causing progressive extrapyramidal bradykinesia, rigidity, and postural instability (Box 14.1). The strategies for rehabilitation amongst these disorders are similar, although they may differ in clinical features, rates of symptom progression, cognitive impairment, and age of onset. Any rehabilitation programs designed for patients with parkinsonism will need to take into account these differences and will be tailored to the patients’ needs, their constellation of symptoms, and their stage of disease. This chapter will focus on PSP, MSA, CBD, and VaP as these diseases cover the majority of patients with neurodegenerative parkinsonism and illustrate the prominent aspects of basal ganglia dysfunction and the associated rehabilitation principals. PSP is the second most common form of neurodegenerative parkinsonism and has a prevalence of approximately 5–7 per 100,000 people [1]. There are no diagnostic tests to confirm PSP, and the insidious onset of symptoms inevitably leads to a delay in establishing the clinical diagnosis, which may take some years. The disease can only be definitively diagnosed post-mortem when the characteristic pathological hallmarks of abnormal ‘tau’ protein accumulations in the basal ganglia, brainstem, and cortex are identified [2].