Movement Through Time: The Evolution of Treatment for People With Parkinson Disease

Background and Purpose: Parkinson disease (PD) is the fastest-growing neurological disorder worldwide, projected to affect approximately 25 million people by 2050. Despite effective pharmacologic management of motor symptoms, patients consistently identify walking, mobility, and balance as their greatest challenges. This Special Interest paper, based on the 2026 Anne Shumway-Cook Lectureship, summarizes a program of research aimed at building the evidence base for rehabilitation in PD and translating that evidence into improved real-world outcomes. Background and Purpose: Four interrelated themes are addressed: (1) the historical development of the evidence base, from 11 randomized controlled trials in 2001 to more than 240 today; (2) the capacity–performance gap and the importance of targeting real-world walking, not only clinic-based function; (3) complementary intervention approaches, including cognitive-behavioral strategies, closed-loop rhythmic auditory stimulation, and soft-robotic assistance for freezing of gait, that address psychological, neural, and biomechanical barriers to everyday mobility; and (4) a proposed secondary-prevention model of care that initiates rehabilitation at diagnosis and sustains it longitudinally. Recommendations for Clinical Practice: Taken together, this body of work argues for a fundamental restructuring of physical therapy for people with PD: from a reactive, late-stage response to a proactive, lifelong strategy that reduces disability, preserves independence, and improves healthspan.