J Neurol Neurosurg Psychiatry 75:1682-1687 doi:10.1136/jnnp.2003.016550
  • Paper

Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease

  1. M Jöbges,
  2. G Heuschkel,
  3. C Pretzel,
  4. C Illhardt,
  5. C Renner,
  6. H Hummelsheim
  1. Neurologisches Rahabilitationszentrum Leipzig, University of Laipzig, 04828 Bennewitz, Germany
  1. Correspondence to:
 Dr M Jöbges
 NRZ Leipzig, Muldentalweg 1, 04828 Bennewitz, Germany;
  • Received 9 April 2003
  • Accepted 22 March 2004


Background: Postural instability (PI) is a common and serious problem in Parkinson’s disease (PD). Dopaminergic medication is of negligible use and a positive effect of deep brain stimulation on this issue has not been reported.

Objective: To develop a method of repetitive training of compensatory steps to enhance protective postural responses by using training strategies based on recent neurophysiological research.

Methods: Fourteen patients with PD took part in a multiple baseline design study and were trained for 14 days in an ambulant setting consisting of two daily sessions.

Results: After training, the length of compensatory steps increased and the step initiation shortened. In a gait analysis, the cadence and the step length increased, gait velocity improved, and the period of double support shortened. The “mobility” subscore of a quality of life questionnaire (PDQ-39) also improved. All these changes were significant (p < 0.05). These effects were stable for two months without additional training.

Conclusion: The repetitive training of compensatory steps is an effective approach in the treatment of PI and should be applied if PI is evident clinically or in a patient’s history.


  • Competing interests: none declared

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