Clinical Framework for Motor Rehabilitation in Parkinsonism: Integrating Individualized and Syndrome-Specific Approaches

Abstract

This review presents a clinical framework for motor rehabilitation in patients with Parkinson’s disease and atypical parkinsonian syndromes. Its purpose is to provide practical, individualized rehabilitation strategies that consider both disease stage and the clinical characteristics of each syndrome. Motor symptoms such as bradykinesia, rigidity, postural instability, and gait disturbance are major contributors to disability and reduced independence in these populations. Although pharmacological treatment remains fundamental, rehabilitation is crucial for maintaining mobility and preventing falls. This review discusses stage-based approaches, including early education in self-management and compensatory movement strategies, as well as advanced interventions for patients with severe motor dysfunction. Syndrome-specific features are also addressed. For example, patients with progressive supranuclear palsy often exhibit early axial rigidity and postural extension, while those with multiple system atrophy may experience cerebellar ataxia or autonomic dysfunction. In corticobasal degeneration, motor planning deficits and sensory loss may resemble symptoms seen in cortical stroke. Additionally, the review emphasizes the importance of recognizing and managing dystonia, which can further impair motor function and safety. While the primary focus is on motor symptoms, the influence of non-motor features such as cognitive impairment and autonomic instability is also acknowledged in rehabilitation planning. Overall, this review aims to support clinical decision-making through a structured, patient-centered approach to motor rehabilitation in parkinsonism.