The Role of Sensory Cues in the Rehabilitation of Parkinsonian Patients: A Comparison of Two Physical Therapy Protocols Roberta Marchese, MD, Manuela Diverio, MD, Francesca Zucchi, MD, Carmelo Lentino, MD, and Giovanni Abbruzzese, MD Department of Neurological Sciences and Vision, Section of Neurology and Neurorehabilitation, University of Genoa, Genova, Italy Summary: We devised a single-blind study to assess the role of providing external sensory cues in the rehabilitation of pa- tients with idiopathic Parkinson’s disease (PD). Twenty stable, nondemented patients with PD entered a 6-week rehabilitation program and were randomly assigned to two balanced proto- cols which were differentiated by the use of external sensory cues (“non-cued” vs “cued”). Patients were evaluated by a neurologist, who was blind to group membership, with the Unified Parkinson’s Disease Rating Scale (UPDRS) at base- line, end of treatment, and after 6 weeks. Patient groups were comparable for age, disease duration, and severity. A signifi- cant reduction of UPDRS scores (activities of daily living and motor sections) was present after the rehabilitation phase in both groups. However, at follow up, while this clinical im- provement had largely faded in the “non-cued” group, mean UPDRS scores of the “cued” group were still significantly lower than baseline values. The incorporation of external sen- sory cues in the rehabilitation protocol can extend the short- term benefit of physical therapy in moderately disabled patients with PD, possibly as a result of the learning of new motor strategies. “Cued” physical therapy for PD should be targeted to compensate for the defective physiological mechanisms. Key Words: Parkinson’s disease—Physical therapy—External sensory cues—UPDRS—Motor learning. Physical therapy is widely used in association with pharmacologic treatment in the management of patients with Parkinson’s disease (PD), particularly in the ad- vanced stages of the disease. Conflicting results, how- ever, have been reported concerning the efficacy of physical therapy, and there is no general consensus on the specificity of rehabilitation programs most suitable for patients with PD. 1–7 Motor impairment in PD is a complex phenomenon but bradykinesia is generally re- garded as the fundamental deficit. 8 Several neurophysi- ological studies 9–15 have shown that internal cue produc- tion is defective in patients with PD, who are largely dependent on the use of external sensory information for their motor ability. However, the effect of sensory cueing in the rehabilitation of patients with PD has not been specifically investigated. We devised a single-blind study to compare the effects on motor impairment of two physical therapy programs with the aim of assessing the possible role of providing external sensory cues in the rehabilitation of patients with PD. METHODS Subjects Twenty patients (13 men and 7 women, aged 59–77 yrs) with idiopathic PD (according to the criteria of the UK Brain Bank for Parkinson’s Disease) 16 entered the study after informed consent. They were nondemented (Mini-Mental State Examination >26) and in a stable phase of the disease without clinical fluctuations (modi- fied Hoehn & Yahr stage: 1.5–3; disease duration, 28– 168 mos). Drug treatment was kept unchanged through- out the study. Physical Rehabilitation Program Patients were randomly assigned to two physical therapy protocols, including exercises for stimulation of postural control, active or assisted limb mobilization, ex- ercises for articulation and pendular movement in vari- ous positions (supine, quadrupedic, standing), and train- ing for walking. The two protocols were adequately Received June 25, 1999; revision received November 24, 1999. Ac- cepted April 3, 2000. Address correspondence and reprint requests to Prof. Giovanni Abbruzzese, Dipartimento di Scienze Neurologiche e della Visione, Via A. De Toni 5-16132, Genova, Italy. Movement Disorders Vol. 15, No. 5, 2000, pp. 879–883 © 2000 Movement Disorder Society 879