Progressive Supranuclear Palsy: Clinical Features and Rehabilitation Approach

Introduction

Progressive Supranuclear Palsy (PSP) is a rare, progressive neurodegenerative disorder that primarily affects movement, balance, vision, and cognition. It commonly presents in late adulthood and often mimics Parkinson’s disease in early stages, leading to delayed diagnosis. Early rehabilitation plays a crucial role in maintaining function and safety.

Definition

Progressive Supranuclear Palsy is a chronic neurological condition characterized by degeneration of brain cells in the brainstem and basal ganglia, leading to impaired postural control, eye movement abnormalities, and motor dysfunction.

Etiology

The exact cause of PSP is unknown, but it is associated with abnormal accumulation of tau protein in the brain. This tau pathology results in neuronal damage and impaired neural signaling. PSP is generally considered a sporadic disorder rather than inherited.

Clinical Features

Clinical manifestations gradually worsen and vary among individuals. Key features include:

• Early postural instability with frequent falls, especially backward
• Difficulty with voluntary eye movements, particularly vertical gaze
• Slowed movements and muscle stiffness
• Speech and swallowing difficulties
• Facial masking and decreased emotional expression
• Cognitive impairment affecting executive functions

Complications

• Recurrent falls and fractures
• Severe gait and balance impairment
• Speech impairment and communication difficulties
• Progressive loss of independence
• Dysphagia leading to aspiration pneumonia
• Reduced quality of life

Risk Factors

• Increasing age 
• Male predominance
• Environmental or occupational exposure
• Neurodegenerative susceptibility related to tau protein abnormalities

Physiotherapy Management

Physiotherapy focuses on maximizing mobility, safety, and functional independence:

• Balance and postural stability training
• Strengthening exercises for axial and limb muscles
• Gait training using visual and auditory cues
• Stretching to decrease rigidity and prevent contractures
• Fall prevention strategies and environmental modification
• Respiratory exercises to maintain chest mobility
• Education of caregivers on safe mobility and transfers

Therapy programs are individualized and adapted as the disease progresses.

Conclusion

Progressive Supranuclear Palsy is a disabling neurodegenerative condition with no definitive cure. Early recognition and a structured physiotherapy rehabilitation program are essential to slow functional decline, decrease complications, and enhance quality of life. A multidisciplinary approach is key to optimal long-term management.