Management of Walking and Mobility in Individuals with Frontal Parietal Atrophy
For individuals with frontal parietal atrophy, a comprehensive mobility management program should include balance training, structured exercise therapy, and appropriate assistive devices to improve walking ability and reduce fall risk.
Assessment of Mobility and Fall Risk
- Initial assessment should include validated mobility screening tools such as the Timed Up and Go (TUG) test (>12 seconds indicates fall risk) or the 4-Stage Balance Test (inability to hold tandem stand for 10 seconds indicates fall risk) 1
- Three key screening questions should be asked: 1) Have you fallen in the past year? 2) Do you feel unsteady when standing or walking? 3) Are you worried about falling? A positive response to any question warrants further assessment 1
- Evaluate gait abnormalities, which are common in individuals with frontal-parietal atrophy due to impaired motor planning, executive function, and balance control 1, 2
- Assess both voluntary and reactive balance control, as both are affected in neurological conditions with frontal-parietal involvement 1
Exercise Interventions
Balance training should be offered as a primary intervention for individuals with balance disorders related to frontal-parietal atrophy 1
Effective balance interventions include:
Aerobic exercise training should be considered as it may improve mobility by maintaining fronto-parietal network connectivity 3
Assistive Devices and Environmental Modifications
- Individuals should be prescribed and fitted with appropriate assistive devices (canes, walkers) if needed to improve balance and mobility 1
- Environmental assessment and modification should address factors that contribute to fall risk, using the P-SCHEME framework: Pain, Shoes, Cognitive impairment, Hypotension, Eyesight, Medications, and Environmental factors 1
- For individuals with severe mobility impairment, wheelchair mobility may be necessary, especially for longer distances 1
Specialized Therapeutic Approaches
- Physical therapy referral is strongly recommended for individuals who show positive results on mobility screening tests 1
- Task-specific training should focus on functional activities that are progressively more challenging 1
- Circuit class therapy can be an effective method for improving mobility, involving group treatment with exercises focused on repetitive practice of functional tasks 1
- For individuals with ataxic components to their gait (common in frontal-parietal atrophy), postural training and task-oriented therapy are recommended 1
Medication Management
- Review and potentially deprescribe medications that may contribute to gait instability, particularly centrally acting medications 1
- If pain is contributing to mobility limitations and there are no contraindications, analgesics such as acetaminophen or ibuprofen can be used 1
Monitoring and Follow-up
- Regular reassessment of mobility function is essential, as frontal-parietal atrophy is often progressive 1, 2
- Quality of life assessment should be incorporated into ongoing care, as mobility limitations significantly impact health-related quality of life 1
- Functional performance should be evaluated with objective tests in both symptomatic and asymptomatic phases of mobility decline 1
Special Considerations
- Dual-task walking (walking while performing a cognitive task) is particularly challenging for individuals with frontal-parietal atrophy and may require specific training 2, 4
- Recognize that frontal-parietal atrophy may be part of various conditions including neurodegenerative diseases, vascular cognitive impairment, or other neurological disorders, which may require additional specific management approaches 1, 5
- Individuals with frontal-parietal atrophy often show inefficient brain activation patterns during walking, which contributes to their mobility difficulties 2, 4, 6