Aquatic Therapy for Freezing of Gait in Parkinson's Disease Patients

Freezing of gait (FoG) is an often dramatic, disabling episodic gait pattern that is common in Parkinson's disease (PD). FoG highly impairs mobility, causes falls, and reduces quality of life. Given the limited effectiveness of both the dopaminergic therapy and the deep brain stimulation on this symptom, it represents a challenge in the field of rehabilitation. In the last years, some studies described the effectiveness of aquatic therapy on balance dysfunction in patients with PD, correlating it to the safe conditions offered by the aquatic environment and to the physical properties of water. Nevertheless, the issues concerning the feasibility and the effectiveness of aquatic therapy for the treatment of FoG have never been addressed before. The aquatic environment may act on the sensorial peripheral receptors, thus widely stimulating the proprioceptive system. PD patients show an altered processing of the proprioceptive information that could potentially underline FoG. The investigators aim at investigating the effects of aquatic therapy for the treatment of FoG in PD patients undergoing a Multidisciplinary Intensive Rehabilitation Treatment (MIRT), whose effectiveness on several motor and functional parameters has been already demonstrated.

Inclusion criteria

• Diagnosis of PD according to Gelb et al;
• Hoehn & Yahr (H&Y) stage 2.5-3;
• Presence of FOG confirmed in the patient assessment prior to participation in the study;
• Stable pharmacological treatment for the last 8 weeks and during the rehabilitation period;
• Mini Mental State Examination (MMSE) ≥ 24;

Exclusion criteria

• Cardiac, pulmonary, vestibular and orthopedic diseases;
• Urinary incontinence;
• Severe dyskinesias;
• Patients treated with deep brain stimulation;
• Visual deficits;
• Comorbilities other than PD determining reduction of motor autonomy