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Background and Purpose. Impaired balance, gait disturbances, and frequent falls are common problems in people with progressive supranuclear palsy (PSP). This case report describes the use of a modified body weight support treadmill training program to reduce falls and improve the balance and gait of a patient with PSP. Case Description. The patient was a 62-year-old man diagnosed with PSP. His major problems were impaired balance and frequent, abrupt falls. Methods. Physical therapy included walk training, balance perturbation, and step training using body weight support with a treadmill. Training sessions lasted 1 1 ⁄2 hours and occurred 3 days a week for 8 weeks. Fall incidence, balance, and gait were assessed before, during, and after the program. Outcomes. The patient reported fewer falls during and after training. Balance and gait improved after training. Discussion. This case report is the first to report fall reduction, improved gait, and improved balance following physical therapy for a person with PSP. [Suteerawattananon M, MacNeill B, Protas EJ. Supported treadmill training for gait and balance in a patient with progressive supranuclear palsy. Phys Ther. 2002;82:485-495 A fter idiopathic Parkinson disease (PD), progressive supranuclear palsy (PSP) is the most common degenerative form of parkinsonism, although it is still a relatively rare neurologic disorder. 1 Pathologically, PSP is characterized by severe degeneration of the brain stem (eg, red nuclei, substantia nigra), diencephalon (eg, thalamic nuclei, subthalamic nuclei), cerebellum (eg, dentate nuclei), and other cortical areas. The incidence of PSP has been reported to be about 3 to 4 per million per year. [2][3][4] Most patients have difficulty with balance, turning, getting up, and sitting down as well as facial hypomimia, hypophonia, slowness of movement, gait disturbance, sleep disturbances, unexplained and abrupt falls, visual and ocular disturbances, slurred speech, dysphagia, and changes in personality. 5 Unlike the shuffling, festinating gait seen with PD, patients with PSP display a cavalier gait (described as a swaggering gait) with usual stride lengths and arm swing.In advanced stages, patients frequently have postural instability, a downward gaze, a frozen appearance with a worried stare, and reduced neck extension. Patients tend to lean and fall backward. The frequent and unexplained falls are a result of akinesia associated with axial rigidity, vertical supranuclear gaze palsy, and impaired postural reflexes. Eventually, patients develop anarthria and become immobile and helpless. Dementia is often present, but is mostly mild. Forgetfulness, an apathetic appearance, and slow thinking are frequently seen in clients with PSP. 6 Management of PSP by antiparkinsonian medications has remained disappointing. Dopaminergic medications reduce the bradykinesia and rigidity in about one third of the patients, but the benefit diminishes after a few years. 7,8 Partial therapeutic responses also have been obtained by using dopamine agonists suc...

The purpose of this study was to conduct a preliminary evaluation of the test-retest reliability of timed functional tests, the Physical Performance Test, and the Physical Activity Rating scale in individuals in Stage 2 or 3 of Parkinson's disease ( PD) . Eleven patients were recruited. Participants performed ve functional timed tests including bed mobility, chair transfers, ve chair stands, gait velocity and 360 degree turns. Participants also completed the Physical Performance Test ( PPT) and were interviewed using the Physical Activity Rating Scale. The same procedures were retested the next day. Test-retest reliability was established with intraclass correlation coef cients ( ICCs) and ranged from a low of .50 ( for bed mobility) to a high of .99 ( for gait velocity) . Two of the timed measures ( gait velocity and 360 degree turn) had excellent reliability and two had good reliability ( chair transfers and chair stands) . Bed mobility had low reliability in this patient population. The Physical Performance Test ( PPT) and Physical Activity Rating scale were reliable with Spearman correlation coef cients of .92 and .75, respectively. Timed functional tests and a self-assessed rating scale were reliable when applied to individuals with PD. These measures will enable the clinician to use appropriate tools to evaluate patients with PD.

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