Mitigating gait decline in a woman with Parkinson’s disease : a case report

Abstract

Levodopa therapy is the standard pharmacological treatment for Parkinson’s disease (PD). However, after an initial period of significant benefit, the effects of levodopa begin to wear off. This results in a reduction in the effect duration and the development of motor complications. We describe the case of a 69-year-old woman presented with a 3-year history of lower back pain and progressive left leg weakness. One year prior to referral for neurological assessment, the patient first noted progressive leg weakness and insufficient strength to rise from a chair. The diagnosis of PD was made after excluding potential neurological disorders. The patient was initially started on oral levodopa, which improved her motor symptoms considerably during the first year. However, dose adjustment and combined pharmacological strategies failed to sufficiently control motor symptoms during the subsequent year. The patient experienced declines in gait ability, clumsiness in the left limbs, and difficulty in performing housework. The patient then sought chiropractic attention. Gait rehabilitation was the major goal in the treatment program for this patient, with the impression of motor complications of PD. The intervention consisted of spinal manipulation, intermittent motorized traction of the lumbar segments, and gait training programs. Following 3 months of the intervention, the patient demonstrated increased muscle strength and improved gait characteristics, as depicted by a gait cyclogram and vertical ground reaction force graphing. The current report illustrates that a multicomponent chiropractic approach may be used as an additional measure to mitigate gait decline in PD patients.