Exploring Contemporary Perspectives on Rehabilitation Approaches for Parkinson's Disease: A Review of Evidence
Parkinson’s disease (PD) is a progressive neurodegenerative condition primarily impacting motor function due to the gradual loss of dopamine-producing brain cells, particularly in the substantia nigra. Rehabilitation serves as a complementary strategy alongside pharmacological and surgical treatments to enhance functional abilities and mitigate secondary complications. Numerous studies have examined various rehabilitation approaches for PD, with emerging evidence suggesting that exercise-induced plasticity plays a key role, influencing synaptic strength and neurotransmission to bolster functional circuitry.
Exercise is fundamental to motor learning, although individuals with PD exhibit reduced learning rates and performance compared to the general population, as noted by recent findings. Meta-analyses have shown that rehabilitation interventions yield short-term yet clinically significant improvements, particularly in gait and balance. However, these interventions encompass a wide range of techniques, including stretching, muscle strengthening, balance exercises, postural training, occupational therapy, cueing, and treadmill sessions, leading to a lack of consensus on the optimal approach.
Innovative methods such as virtual reality, exergaming, motor imagery, action observation, robot-assisted therapy, and unconventional practices like dance and martial arts have garnered attention. A goal-based rehabilitative program tailored to individual patient characteristics and targeting specific activities in core areas is recommended. Aerobic exercise, music therapy, dance, virtual reality, and non-invasive brain stimulation have shown promise in improving motor function, with some supporting evidence for telerehabilitation, expiratory muscle strengthening exercises, and Lee Silverman Voice Treatment.
Below, I outline the various rehabilitation approaches for patients with Parkinson’s disease? and their respective evidence as per the European Parkinson Rehabilitation Guidelines.
Strong recommendation for using conventional physiotherapy to improve:
? ? ? ? Walking speed
? ? ? ? Muscle strength?
? ? ? ? Movement functions (UPDRS III)
Weak recommendation for using conventional physiotherapy to improve:
? ? ? ? Functional mobility (TUG)
? ? ? ? Balance capacity (BBS, FR)
Weak recommendation against using conventional physiotherapy to improve:
? ? ? ? Stride/step length
? ? ? ? Cadence
? ? ? ? Walking distance
? ? ? ? Freezing of gait (FOG-Q)
? ? ? ? Timed turn
? ? ? ? Balance performance (FES, ABC)
? ? ? ? Falls
? ? ? ? Activity levels
? ? ? ? quality of life (PDQ-39, EQ-5D)
2. GRADE-based recommendations for treadmill training
Strong recommendation for using treadmill training to improve:
? Walking speed
? Stride length
Weak recommendation for using treadmill training to improve:
?? Walking distance
?? Balance capacity (BBS)
Weak recommendation against using treadmill training to improve:
? Cadence
? Gait-related functional mobility (climbing stairs or an 8.8cm step)
? Knee extensors muscle strength (torque)
? Movement functions (UPDRS III)
3. GRADE-based recommendations for dance therapy
Strong recommendation for using dance to improve:
? ? Functional mobility (TUG - tango only)
? ? Balance capacity (BBS, Mini-BESTest)
Weak recommendation against using dance to improve:
? Walking speed
? Stride length
? ? Walking distance
? ? Freezing of gait (FOG-Q)
? ? Quality of life (PDQ-39)
? ? Movement functions (UPDRS III)
Strong recommendation for using Tai Chi to improve:
? Movement functions (UPDRS III)
Weak recommendation for using Tai Chi to improve:
? Number of falls
? Balance capacity (BBS)
? Walking speed
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? Stride length
? Walking distance
? Functional mobility (TUG)
? Muscle strength (torque)
? Standing-related balance capacity (Functional Reach)
4. GRADE-based recommendations for whole-body vibration
Strong recommendation against using WBV because of safety considerations
5. GRADE-based recommendations for massage of trigger points
Weak recommendation for using massage of trigger points to reduce pain and postural abnormalities
6.Dual-task training?
????????No GRADE-based recommendation is available
7.Reducing respiratory impairments
???????No GRADE-based recommendations are available
8. Action observation and mental imagery
??????No GRADE-based recommendations are available
9. Cueing and attentional strategies
Strong recommendation for Cueing and attentional strategies to improve:
? ? ? ? walking speed
Weak recommendation for using cueing for gait to improve:
? ? step length
? ? Gait-related balance capacity (DGI)
? ? movement functions (UPDRS III; UPDRS posture & gait score)
? ? freezing of gait (FOG-Q)
Weak recommendation for using cueing during transfers to improve:
? ? functional mobility (timed sit-to-stand)
Weak recommendation against using cueing for gait to improve:
? ? stride length
? ? cadence
? ? functional mobility (TUG)
? ? Standing-related balance capacity (Functional Reach)
? ? balance performance (FES, ABC)
? ? quality of life (PDQ-39)
10.?Strategies for complex motor sequences
GRADE-based recommendations for strategies for complex motor sequences
Strong recommendation for using strategies for complex motor sequences to improve:
? ? functional mobility (PAS and PAS chair transfers)
Weak recommendation for using strategies for complex motor sequences to improve:
? ? stride length
? ? patient-based treatment effect
Weak recommendation against using strategies for complex motor sequences to improve:
? ? walking speed
? ? step length
? ? cadence
? ? movement functions (UPDRS III)
?
The table contains the graded recommendation for the physiotherapy intervention for Parkinson's rehabilitation:
Physical rehabilitation is integral to the care of Parkinson's patients, with various approaches currently employed. Despite available evidence, determining the optimal approach remains challenging. Comprehensive assessment of Parkinson's symptoms is strongly advised, enabling tailored interventions targeting specific abnormalities. Different approaches have demonstrated efficacy in addressing various aspects of Parkinson's symptoms, including balance, gait, tremors, and postural instability.
To date, numerous rehabilitation programs have been implemented in Parkinson's patients, yet the evidence remains limited. Determining the superiority of one approach over others remains challenging. Well-designed randomized controlled trials with substantial participant cohorts are essential to establish robust evidence for rehabilitation in Parkinson's disease. Additionally, identifying key practice variables such as intensity, specificity, and complexity is crucial for informing future interventions.
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