Tottori J. Clin. Res. 8(2), 171-175, 2017

Reduced incidence of falling in a Parkinson’s disease patient prone to falling
after one-year outpatient rehabilitation
Shogo Usui*, Makoto Sawada, Yasuji Imai, Tatsunori Murakami, Tamotsu Kato, Kenta Nakashima
1) Department of Rehabilitation, NHO Tottori Medical Center*Correspondence: 876 Mitsu, Tottori, 689-0203
Abstract
For patients with Parkinson’s disease (PD), gait disturbance and falls are leading factors in limiting daily activities.
A PD treatment guideline indicates that frequency of falls decreases through therapeutic exercise. In this case study,
therapeutic exercises and a home exercise program were provided for gait disturbance and frozen gait as part ofoutpatient rehabilitation intervention. This intervention resulted in improving the patient’ ability to ambulate and reduced
the frequency of falls. It also reduced her fear of gait, resulting in increased participation in housekeeping activities andrange of daily life. It is necessary to provide individualized programs based on the symptoms of each patient, and it isimportant to provide interventions suitable for each patient, including implementation of home exercise programs andfollow-up to confirm the patient’s adherence to the home exercise programs. Tottori J. Clin. Res. 8(2), 171-175, 2017
Key Words: Parkinson’s disease (PD), rehabilitation, frozen gait, home exercise program, Cue exercise	 

I. Introduction
For patients with PD, gait disturbance and falls are
the leading factors in limiting their daily lives. The
effects of these factors include direct ones such as
fractures and secondary ones such as decrease inphysical functions and social isolation for fear of goingout. Recently, the prevalence of PD is increasing due tothe aging of the population, and it is important to address
gait disturbance and falls among patients with PD.
The PD treatment guideline indicates thattherapeutic exercises would reduce the frequency of falls.
Here, we report on a patient with PD who improved gait
ability and reduced frequency of falls through outpatient
rehabilitation interventions. The patient also overcame
the fear of walking, improved participation inhousekeeping activities, and expanded the range of dailylife.
.
II. Case
Age: Late 60s.
Gender: Female.
Chief complaint: Difficulty walking (frozen gait).
Past medical history: The patient has been receiving drug
therapy for chronic rheumatoid arthritis for the past 25years to the present. The patient was diagnosed withlumbar disc herniation eight years ago and spinal canalstenosis six years ago. The patient underwent spinal
fusion due to lumbar spine scoliosis four years ago.

Present medical history: The patient has had resting
tremors for the past 15 years. The patient was diagnosed
with PD for the tremors 13 years ago despite the absenceof other symptoms. The patient began drug therapy at
our hospital 10 years ago. At that time, in addition toobvious tremors, muscular rigidity and postural reflex
disturbance were only very mild, and bradykinesia wasinsignificant. Hoehn and Yahr (H&Y) stage was rated asI. Five years ago, wearing-off began to affect the patient,leaving her unable to move at all when the drug effects
diminished. Frozen gait also appeared from this point intime. Three years ago, dysphagia and dysarthria became
significant. One year ago, frozen gait exacerbated andfalls became frequent, virtually confining the patient athome. She would fall about once a month. Outpatient
rehabilitation started in order to improve her ability toambulate
Medications: Stalevo Combination Tablets 100 mg,
selegiline HCl 2.5 mg, Mirapex-LA 1.5 mg, Neupro
patch 9 mg, clonazepam 0.5 mg.
III. Physical Therapy Evaluation (Table 1)
Body height, 148.0 cm; body weight, 42.0 kg.
Blood pressure, 113/80 mmHg; pulse rate, 96 bpm.
General impression: The patient was outgoing, and hadstrong motivation for rehabilitation.
H&Y stage: III.
Neurological findings: Under anti-PD medications,