Learning perspective on paradoxical kinesia (PK) in Parkinson's disease (PD)

MARÍA DE LOS ANGELES BACIGALUPE; JOSÉ LUIS DILLON; SILVANA PUJOL

MOVEMENT DISORDERS

WILEY-LISS, DIV JOHN WILEY & SONS INC

Lugar: New York; Año: 2010 vol. 25 p. 352 - 353

0885-3185

Objective: To draw attention to the phenomena known as paradoxical kinesia as a key factor to study and apply for patients´ rehabilitation. Background: Kinésie Paradoxale (PK) is the name that the French Neurologist M.A. Souques gave to a phenomena observed in PD patients: "Il consiste en ce fait que, certain malades, a` peine capable de marcher lentement et difficilement, deviennent, par moments, capables de courir" (Souques, 1921:559). Before him, Dr. J. Parkinson (1917/2002) had called "Shaking Palsy" to this neurological disease, name that reflects the paradox that PD presents. Methods: We conducted a bibliographical review and non-systematic observational study of PK in the "Taller de Parkinson (TdP)" (UNLP and Hospital Dr. A. Korn, Argentina). We also got data from the application of a quality of life scale (PDQ-39) which was answered by the patients who attend the TdP. Results: PK is contemporary described as a phenomena which is (1) not only a property of PD but also a motor system quality, (2) an unusual behavior elicited by urgent circumstances or a frequent phenomena in patients´ life, (3) elicited by auditory or visual stimuli, or a combination of them, and (4) based on some dopaminergic plasticity and/or cerebellar circuits. Also, PK could be related to perceptual deficits reported in PD. None of the bibliography revised propose our conception that PK can be used as a rehabilitation tool, which is the notion that has underlain the TdP from its creation in 2002. We have observed that the PD patients who attend the activities show subjective and objective improvements in their mobility. Following Vygotsky´s perspective on learning, the stimuli (balls, teachers, classmates, etc) help patients trespass a "zone of proximal development" and consciously or unconsciously use the possibility their movement system has to move better. Conclusions: We propose that PK underlies the possibility of the results. Furthermore, the combination of external stimuli and internal possibilities help patients reach some improvement that they couldn´t get by themselves without the intervention of appropriate stimuli. Systematic research is being conducted by us to improve our understanding and use of the phenomena.