HUẤN LUYỆN DÁNG ĐI TÁC VỤ KÉP GIẢM RỐI LOẠN DÁNG ĐI TRONG PARKINSON: TỪ LÝ THUYẾT ĐẾN LÂM SÀNG

Nguyễn Minh Nhật

doi:10.59294/HIUJS.KHTT.2026.011

Từ khóa:

huấn luyện dáng đi tác vụ kép, parkinson, vật lý trị liệu

Tóm tắt

Đặt vấn đề: Huấn luyện dáng đi tác vụ kép (DTGT) có tiềm năng cải thiện rối loạn dáng đi ở bệnh nhân Parkinson nhưng chưa được đề cập đầy đủ trong các hướng dẫn lâm sàng. Mục tiêu nghiên cứu: Phân tích tác động của DTGT với gợi ý bên ngoài đối với các thông số dáng đi, chức năng nhận thức, thăng bằng, nguy cơ té ngã, hoạt động sinh hoạt hằng ngày (ADL) và chất lượng cuộc sống (QoL), qua đó đề xuất kế hoạch vật lý trị liệu dựa trên khoa học thần kinh. Phương pháp nghiên cứu: Tổng quan tường thuật phân tích thử nghiệm lâm sàng và tổng quan về huấn luyện dáng đi tác vụ kép trên bệnh nhân Parkinson. Kết quả: DTGT có thể cải thiện dáng đi, khả năng phối hợp vận động - nhận thức và chức năng điều hành trên bệnh nhân Parkinson, trong khi tác động lên té ngã, ADL và QoL còn chưa nhất quán. Gợi ý bên ngoài giúp cải thiện độ dài bước đi, khả năng khởi động và xoay chuyển khi đi. Ứng dụng kết quả vào lâm sàng dựa trên nguyên lý học vận động để lập kế hoạch DTGT với gợi ý thị giác cho một trường hợp Parkinson. Kết luận: Do thiếu bằng chứng dài hạn, DTGT nên được lồng ghép vào kế hoạch đa phương thức để tối ưu hóa kết quả huấn luyện dáng đi Parkinson.

Abstract

Background: Dual-task gait training (DTGT) is increasingly recognized as a physiotherapy strategy for Parkinson’s gait disturbances. Despite growing evidence, clinical practice guidelines remain lacking. This narrative review examines current evidence on DTGT and suggests physiotherapy planning informed by neuroscience principles. Method: A narrative review was conducted, focusing on effects of DTGT with and without external cueing on gait parameters, cognitive performance, balance, fall risk, activities of daily living (ADLs), and quality of life (QoL) among people with Parkinson’s disease. Results: DTGT can reallocate cognitive resources, engage executive networks, and reduce dual-task cost. Thus, it could improve gait parameters and cognitive-motor coordination within 4-8 weeks, with benefits sustained up to 3 months. Balance gains occurred under single-task conditions, while executive functions strengthened during dual-tasking. External cueing enhanced step length, initiation, and turning. However, evidence for falls, ADLs, and QoL was inconsistent. Findings are interpreted through motor learning principles and applied to physiotherapy practice for a Parkinson’s case. A tailored DTGT plan with visual cueing may reduce falls and enhance gait automaticity, while random practice, progressive difficulty, and “repetition without repetition” may support long-term retention and adaptability. Supervised sessions with patient feedback emphasize safety, autonomy, and transfer to real-world mobility. Conclusions: DTGT is safe, evidence-based, and clinically relevant for reducing Parkinson’s gait disturbances, though long-term outcomes require further studies. For optimal patient impact, it should be delivered through physiotherapy plans rooted in motor learning principles

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