Progressive Supranuclear Palsy: Disease Profile and Rehabilitation Strategies

Progressive supranuclear palsy (PSP) is the most common parkinsonian disorder after Parkinson disease (PD).1–3 Postural instability with frequent falls and difficulty moving the eyes in the vertical direction are the main symptoms of PSP.4,5 However, because the initial clinical features often resemble PD,6–8 many patients are referred for rehabilitation services with the wrong diagnosis. There is no cure or effective medication to manage PSP, and the progression of the symptoms is much faster than in PD.1,2 It is important that physical therapists be aware of the particularities of this disease to ensure that patients are referred to movement disorder specialists for the correct diagnosis. Despite the demand for rehabilitation in this population, there is no evidence in the literature to support its effectiveness. Studies with controlled methods are necessary to provide guidance to physical therapists in the management of this disease. The purposes of this update are to highlight the characteristics of this disease and to evaluate rehabilitation strategies.Progressive supranuclear palsy was first described as a distinct clinical entity in 1964.9 The syndrome was identified by Steele et al at a meeting of the American Neurological Association where they reported that a group of 9 patients with a progressive brain disorder did not conform to any classifications of diseases already known. Common symptoms included ophthalmoplegia, pseudobulbar palsy, dysarthria, dystonic rigidity of the neck and upper trunk, and dementia. Neuropathological alterations involved neuronal loss and neurofibrillary tangles in the basal ganglia, brain stem, and cerebellum. The disease was named progressive supranuclear palsy , referring to the progressive degeneration of the brain structures localized superior to the oculomotor nuclei, causing palsy and eventual paralysis of ocular movements. Another term also used in the literature, but not as often, …