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Emerging therapies for gait disability and balance impairment: Promises and pitfalls

Authors

  • Walter Maetzler MD,

    1. Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany
    2. German Center for Neurodegenerative Diseases (DNZE), Tübingen, Germany
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  • Freek Nieuwhof,

    1. Department of Geriatric Medicine, Donders Institute for Brain, Cognition, and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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  • Sandra E. Hasmann,

    1. Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany
    2. German Center for Neurodegenerative Diseases (DNZE), Tübingen, Germany
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  • Bastiaan R. Bloem MD, PhD

    Corresponding author
    1. Department of Neurology and Parkinson Center, Donders Institute for Brain, Cognition, and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, Nijmegen, the Netherlands
    • Correspondence to: Dr. Bastiaan R. Bloem, Professor of Neurology, Medical Director, Parkinson Centre Nijmegen (ParC), Department of Neurology, 935, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands; b.bloem@neuro.umcn.nl

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  • Funding agencies: The present research is part of the European Union project SENSE-PARK, funded under the Seventh Framework Programme, Cooperation-ICT (grant agreement no. 288557). Sandra E. Hasmann was supported by an Interdisciplinary Center for Clinical Research (IZKF) grant from the University of Tubingen. Bastiaan R. Bloem was supported by a research grant from the Stichting Internationaal Parkinson Fonds.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Therapeutic management of gait and balance impairment during aging and neurodegeneration has long been a neglected topic. This has changed considerably during recent years, for several reasons: (1) an increasing recognition that gait and balance deficits are among the most relevant determinants of an impaired quality of life and increased mortality for affected individuals; (2) the arrival of new technology, which has allowed for new insights into the anatomy and functional (dis)integrity of gait and balance circuits; and (3) based in part on these improved insights, the development of new, more specific treatment strategies in the field of pharmacotherapy, deep brain surgery, and physiotherapy. The initial experience with these emerging treatments is encouraging, although much work remains to be done. The objective of this narrative review is to discuss several promising developments in the field of gait and balance treatment. We also address several pitfalls that can potentially hinder a fast and efficient continuation of this vital progress. Important issues that should be considered in future research include a clear differentiation between gait and balance as two distinctive targets for treatment and recognition of compensatory mechanisms as a separate target for therapeutic intervention. © 2013 International Parkinson and Movement Disorder Society

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