Background
Although postural instability is one of the major symptoms of Parkinson’s disease (PD), dopaminergic treatment is ineffective for treating postural instability. Recent reports have shown that somatosensory deficit is associated with postural instability, and that somatosensory input improved postural instability. The purpose of this study is to evaluate the effects of lateral wedges for quiet standing postural control in people with PD.
Methods
Twenty-two patients who were diagnosed with PD were enrolled in this study. The participants stood on a force plate under two conditions (wedge and no wedge) with or without having their eyes open or closed. The center of pressure (COP) range and velocity were analyzed using a two-way repeated-measures analysis of variance.
Results
The range and velocity of COP in the anterioposterior and mediolateral (ML) directions were significantly improved after the patients stood on the lateral wedge with their eyes closed (p < 0.05). The range in ML direction and velocity in both directions of COP were significantly decreased when their eyes were open (p < 0.05).
Conclusions
Regardless of vision, standing on lateral wedges improved postural sway in people with PD.

Neurorehabilitation focuses on the maximal functional recovery of the patients suffered from various neurologic diseases. Comprehensive, functional, and interdisciplinary team approaches are essential and necessary to accomplish this goal. The most important theoretical basis of neurorehabilitation is the plasticity of brain. Even the mammalian CNS does have a considerable ability to readjust to functional loss. Two main form of plasticity are as follows. The first is sprouting, in which axon terminals form new branches and form connection with vacant synaptic sites. The second is the functional unmasking of the silent synapses that exist within the CNS. The local reorganization and remodelling is a feature of many parts of the brain throughout life, and the ability to constantly remodel connections is a vital part of the processes of plasticity and learning. Recently, the neural plasticity associated with rehabilitation and learning is increasingly being studied using functional neuroimaging methods such as positron emmission tomography(PET) and functional magnetic resonance imaging(fMRI). Researches identified intra- and interhemispheric reorganization of neural networks accompanied with functional recovery and rehabilitation after brain injury. Early timed referral of the patients to comprehensive rehabilitation team would be very helpful to promote successful functional recovery by maximizing the plasticity of brain.

Stroke remains a leading cause of death and disability. New rehabilitation therapies and approaches hold the promise of reducing the disability caused by stroke. Following stroke, the pattern of deficits and recovery, associated medical problems, and psychosocial factors vary among individuals, and it becomes critical to individualize rehabilitation program. Awareness of the pathophysiology and recovery patterns following stroke and attention to detail in medical and rehabilitative management enhance current functional outcome. The issues of when rehabilitation should begin, and what role rehabilitation should play acutely after stroke are changing rapidly. Based on studies demonstrating superior outcomes in programs that combine acute and rehabilitative care beginning immediately after stroke, many hospitals are developing practice protocols that require rehabilitation consultation and screening within 24 hours after stroke onset.

Many elderly persons admit the long-term care facilities due to progressive deterioration of physical or cognitive function constantly requiring medical, psychological, and ADL support. Pharmacotherapy may be required for treatment of medical illness or condition such as hypertension, diabetes, infection, fluid and electrolyte imbalance, malnutrition, or sore. Neurological diseases of chronic or terminal stage including dementia, movement disorder, or stroke may need the disease-specific intervention. Physical or cogntive rehabilitation is also needed for patients with physical disabilities and conitive impairment in the purpose of sustaining the quality of life. Besides many psychiatric problems become the cause of placement in long-term facilities, these may occur sometime during admission. So, psychiatirc approach must be essential. Because many elderly patients cannot manage daily activities to certain degree if not caregiver support, caregivers should be needed. Family members must be considered in the treatment program because they have enduring physical, psychological, psychosocial, and financial burden to gradual functional loss of patients. In long-term facilities, various intervention programs must be settled down for patients or family members through comprehesive approach and mutual interrelation of many staffs.