Basal ganglia and beyond: The interplay between motor and cognitive aspects in Parkinson's disease rehabilitation

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HighlightsRehabilitation is considered an effective treatment for the management of PD.In PD, the ability to learn and express habitual-automatic actions is impaired.The re-learning of habitual motor behaviours is the main goal of rehabilitation.Motor behaviours result from integration between motor and cognitive functions.Rehabilitation targeting cognitive and motor functions is the best strategy.Parkinson's disease (PD) is characterized by motor and cognitive dysfunctions, affecting the motor behaviour. We summarize evidence that the interplay between motor and cognitive approaches is crucial in PD rehabilitation. Rehabilitation is complementary to pharmacological therapy and effective in reducing the PD disturbances, probably acting by inducing neuroplastic effects.The motor behaviour results from a complex integration between cortical and subcortical areas, underlying the motor, cognitive and motivational aspects of movement. The close interplay amongst these areas makes possible to learn, control and express habitual-automatic actions, which are dysfunctional in PD.The physiopathology of PD could be considered the base for the development of effective rehabilitation treatments. As the volitional action control is spared in early-medium stages of disease, rehabilitative approaches engaging cognition permit to achieve motor benefits and appear to be the most effective for PD.We will point out data supporting the relevance of targeting both motor and cognitive aspects in PD rehabilitation. Finally, we will discuss the role of cognitive engagement in motor rehabilitation for PD.

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