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Parkinson's disease (also known as Parkinson disease, Parkinson's, idiopathic parkinsonism, primary parkinsonism, PD, hypokinetic rigid syndrome/HRS, or paralysis agitans) is a degenerative disorder of the central nervous system. The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain; the cause of this cell death is unknown. Early in the course of the disease, the most obvious symptoms are movement-related; these include tremors or shaking, rigidity, bradykinesia (slowness of movement), loss of postural control, difficulty with walking, and gait.〔Gleb DJ, Oliver E, Gilman S. (1999). Diagnostic criteria for Parkinson's disease. Arch Neurol. 56(1): 33-9.〕 Later, cognitive and behavioural problems may arise, with dementia commonly occurring in the advanced stages of the disease. Studies of rehabilitation in Parkinson's disease are scarce and are of low quality. ==Exercise== Regular physical exercise with or without physiotherapy can be beneficial to maintain and improve mobility, flexibility, strength, gait speed, and quality of life.〔 In terms of improving flexibility and range of motion for patients experiencing rigidity, generalized relaxation techniques such as gentle rocking have been found to decrease excessive muscle tension. Other effective techniques to promote relaxation include slow rotational movements of the extremities and trunk, rhythmic initiation, diaphragmatic breathing, and meditation techniques. Common changes in gait associated with the disease such as hypokinesia (slowness of movement), shuffling and decreased arm swing are addressed by a variety of strategies to improve functional mobility and safety. Goals with respect to gait during rehabilitation programs include improving gait speed, base of support, stride length, trunk and arm swing movement. Strategies include utilizing assistive equipment (pole walking and treadmill walking), verbal cueing (manual, visual and auditory), exercises (marching and PNF patterns) and varying environments (surfaces, inputs, open vs. closed). Strengthening exercises have led to improvements in strength and motor functions in patients with primary muscular weakness and weakness related to inactivity in cases of mild to moderate Parkinson’s disease.〔 Patients perform exercises when at their best, 45 minutes to one hour after medication. An 8 week resistance training study geared towards the lower legs found that patients with Parkinson's Disease gained abdominal strength, and improved in their stride length, walking velocity and postural angles.〔Scandalis TA, Bosak A, Berliner JC, Helman LL, Wells MR. (2001). Resistance Training and Gait Function in Patients with Parkinson's Disease. Am J Phys Med Rehabil. 80(1): 38-43.〕 Also, due to the forward flexed posture and respiratory dysfunctions in advanced Parkinson’s disease, deep diaphragmatic breathing exercises are beneficial for improving chest wall mobility and vital capacity. Exercise may correct constipation. Exercise training on a vibratory platform, also called whole body vibration (WBV) training, has been recently introduced as a training tool complementing standard physical rehabilitation programs for people with Parkinson’s disease. Compared to no intervention, single sessions of WBV have resulted in improved motor ability, as reflected by (Unified Parkinson's Disease Rating Scale ) (UPDRS) tremor and rigidity scores.〔Haas, C.T., Turbanski, S., Kessler, K., & Schmidtbleicher, D. (2006). The effects of random whole-body-vibration on motor symptoms in Parkinson's disease. ''NeuroRehabilitation, 21:'' 29–36.〕〔King, L.K., Almeida, Q.J., & Ahonen, H. (2009). Short-term effects of vibration therapy on motor impairments in Parkinson's disease. ''NeuroRehabilitation, 25:'' 297–306.〕 However, longer-term (3–5 weeks) WBV programs have not led to improved UPDRS motor scores compared to conventional exercises.〔Arias, P., Chouza, M., Vivas, J., & Cudeiro, J. (2009). Effect of whole body vibration in Parkinson's disease: a controlled study. ''Movement Disorders, 24:'' 891–898.〕〔Ebersbach, G., Edler, D., Kaufhold, O., & Wissel, J. (2008). Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease. ''Archives of Physical Medicine and Rehabilitation, 89:'' 399–403.〕 Furthermore, multiple sessions of WBV have failed to enhance mobility measures (i.e., the Timed Up and Go Test and (10-Meter Walking Test )) in people with Parkinson’s disease.〔〔 A recent review deemed that the evidence of the effects of WBV training on sensorimotor and functional performance remains inconclusive.〔Sitjà Rabert, M., Rigau Comas, D., Fort Vanmeerhaeghe, A., Santoyo Medina, C., Roqué, I., Figuls, M., Romero-Rodríguez, D., & Bonfill Cosp, X. (2012). Whole-body vibration training for patients with neurodegenerative disease. ''Cochrane Database of Systematic Reviews, 15(2):'' CD009097.〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Rehabilitation in Parkinson's disease」の詳細全文を読む スポンサード リンク
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