Pearls & Oy-sters: Marionette Walk in Parkinson Disease: A Rare Dyskinetic-Dystonic Gait Pattern Complication Improved by Visual Cueing

Abstract

We report a case of a 60-year-old patient with a 10-year history of Parkinson disease who developed a dyskinetic-dystonic gait pattern highly affecting his personal and social life. After multiple unsuccessful attempts to improve the clinical condition by adapting the pharmacologic treatment, the patient underwent gait rehabilitation based on the use of visual cueing. This approach induced a relevant improvement in the dyskinetic-dystonic gait. Our case contributes to the phenotypic description of motor fluctuations in advanced Parkinson disease and suggests an additional therapeutic option to mitigate their impact on motor performances.

Figure. Gait Analysis

(A) Pelvic rotation recorded at baseline during gait without visual cue. (B) Pelvic rotation recorded at baseline during gait under visual cue condition, showing a pattern closer to normal values (represented by the gray area). (C) Pelvic rotation recorded during gait without visual cue at the end of the rehabilitation training. In green: right foot stance phase; in red: left foot stance phase; gray areas: range of normal values. All panels show the degree of pelvic rotation (the X axis reports the percentage of the walking cycle, whereas the Y axis represents the degree of rotation).