パーキンソン病の歩き方の理解と評価②

ひるけ (ATC)

歩き方の特徴や転ばないようにするにはどういう点を気を付ければ良いかなど､ペンシルバニア病院､ダン・アロンパーキンソンリハビリテーションセンターのHeather Cianci 先生からの教えをまとめました。

2026.06.24 公開

パーキンソン歩行評価

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ノートテキスト

ページ1:

Others
•Functional setting
- Stairs
Curbs
Ramps
Types of footwear
Gait during off medication
When able
-Falls: where, when, what activity ?
· On/off times?
• look for patterns (reproducible?)
• fear of falling (FOF)
↑ less activity
less Confidences & performance
Set small, realistic goals
to fear/ confidence
↓
(11)

ページ2:

-Balance: ·BESTest (36 items)
Obiomechanical
②Stability limits:
③postural responses
④anticipatory postural adjustments
⑤sensory orientation
dynamic balance during gait.
Cognitive effects
and
Identifies
Subtle
> Mini BESTest (14 items)
balance
deficits
-Brief BESTest (8 items)
Challenging
-Fullerton advanced balance scale.
Tasks (10 items) ①step up & over,
① step up & over, jumping
for early onset
P.P.
Multiple tests are better than just
one test to predict falls at 6 months."
"Test at least
every
6 months.

ページ3:

Anatomy of P.D.
Basal
ganglia
Cognitive
&
automatic
Substantia
nigra
Components of
motor skill
performance and
P.D.: Death of
1
Dopaminergic
heurons in
motor learning
(acquiring/retaining)
い
Lewy Bodies
(a-synuclein)
abnormal intraneuronal
proteins.
60~80% of cell death
before symptoms
death
Dopamine excitatory effect of the direct pathways.
and
Vinhibitory effect of the indirect pathways
=
Dopamine inhibition = motor control 2
(13)
motor planning
procedial learning 2
emotion I
cognition

ページ4:

• Cognitive Dysfunction
• executive function: planning
↓
-Sequencing
-cognitive flexibility
-problem-solving capacities
-initiation
-self-monitoring
· self-regulation
• visuospatial function
inhibition
• encoding, recall, and procedural memory
P.D.-mild cognitive impairment (MCI)
progressed
PD dementia
doesn't affect daily function much
te affects social and work function.
Tremor predominance as the initial presentation:
Postural
Instability
&
Gait
Disorder
(PIGD)
Ce lower risk for cognitive decline. ^ cognitive
14)
decline

ページ5:

Medical Management of Gait
Ope
Not the best
Medication
*Deep
Levodopa
gait velocity.
Brain
Stimulation
• postural responses.
(DBS) or dinamic postural control.
(In particular with Sub-thalamic nucleus DBS.)
・I anticipatory postural adjustments
J gait postural control
→ gait parameters.
Substantia nigra pars reticulata
&
Pedunculopontine Nucleus (PPN)
Can not solve all problems.
15

ページ6:

Rehab. Management of Gait.
Motor ex
Cognitive ex
These exs have to
long-term
exercise
gait & balance habits
needed.
be specific to
the patient's needs
and high level of
intensity.
16)

ページ7:

Freezing of Gait (FOG)
•Commonly occurs with:
-
direction changes
kitchen, bathrooms, etc...
small spaces
-crowds
- distraction
-
doorways
- turns
360° w/dual tusk is
one of the worst.
Brain cannot adjust speed/size of steps
quickly enough to changing environments.
te
movements.
they are going
to do are all
mixed together
and performed
Simultaneously.
(17)
So,
focus on one thing
to FOG
"

ページ8:

Festination
A
A
.
step cadence
Triggered with:
Retropulsion
How to prevent!
• Stand sideways
to
open doors
-
·
(not facing the door)
Sideways are
• power stance
(wide Bos)
reaching too for forward
flexed posture
"Hurry up"
reaching for the chair before turning to sit.
not focusing on quality of steps.
moving the rollator rather than the feet.
• Backward balance loss with step size
and I step cadence
·Triggered with:
-
reaching up
opening
Stepping
doors
$
back to get out of the
Sudden movement.
backing into a chair
Way
8