Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open-label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ-8). Twenty-two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in "best on" state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ-8 (QoL). The improvement in PDQ-8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa-based continuous dopaminergic stimulation is beneficial for NMS and health-related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias.

This paper uses autoethnography to reassess the concept “experience” and the lack of theoretical frameworks within experiential education for delimiting experience within the practices and research around experiential, adventure, and outdoor education. Although a pivotal and essential part of practice, theoretical understandings of experience have been missing in experiential education scholarship. Experience is clearly a complex, constructed “reality.” Jagger (cited in Lauritzen, 1997, p. 83) has pointed out that an appeal to experience is “fraught with methodological difficulties.” What exactly is experience? Whose experience is heard? Like other disciplines, for example the studies of religions and psychology, experiential education has no rigorous definitions, characterizations, typologies, or conceptualizations of the focus of its study and practice—a type of experience. Drawing upon critiques from Indigenous, feminist, postcolonial, and black Americans and Canadians, and integrating with an autoethnographic approach, this paper provides a critique of the existing use of “experience” and sketches an initial approach for developing theoretical understandings of the central phenomenon of experiential, adventure, and outdoor education.

In this pilot study, we found indications that LCIG therapy has a substantial antidyskinetic effect and could be an alternative also for PD patients with dyskinesias as a major symptom. However, further studies with blinded evaluation and larger numbers of patients are warranted to confirm the findings.

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