Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson's Disease: A Retrospective and Observational Study

Abstract

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor (resting tremor, rigidity, bradykinesia, postural instability, and gait disturbances) and nonmotor symptoms (cognitive, neuropsychiatric, and autonomic problems). In recent years, several studies demonstrated that neurorehabilitation therapy is an effective treatment in addition to pharmacological personalized interventions in persons with PD (PwPD). The main aim of this study was to explore the short-term changes in functional, cognitive, and geriatric domains after a multidimensional rehabilitation program in PwPD (as primary condition) in mild–moderate (M-Ms) to severe (Ss) stages. Our second aim was to compare the effects of multidimensional rehabilitation in M-Ms versus Ss of PD. Twenty-four PwPD in M-Ms to Ss [age (mean ± SD) = 76.25 ± 9.42 years; male/female = 10/14; Hoehn and Yahr (median; IQR) = 4.00; 1.75] were included in a retrospective, observational study. Motor, cognitive, functional, and neuropsychiatric aspects were collected in admission (T0) and in discharge (T1). PwPD were involved in a person-tailored (to individual's needs), inpatient, intensive (5–7 days per week), multidisciplinary (combining cognitive, physical, occupational, and speech therapies), comprehensive, and rehabilitative program. According to Movement Disorders Society Unified Parkinson's Disease Rating Scale III cutoff, PwPD were classified in M-Ms or Ss (M-Ms ≤59; Ss >59); 87.50% of our sample reported significant reduction of functional disability at Barthel Index (p < 0.001). A significant improvement in Token test (p = 0.021), semantic fluency (p = 0.036), Rey's Figure-Copy (p < 0.001), and Raven's Colored Progressive Matrices (p = 0.004) was observed. The pain intensity perception (p < 0.001) and the risk of developing pressure ulcers (p < 0.001) as assessed, respectively, by the Numeric Rating Scale and by the Norton Scale were improved. With regard to the second aim, in M-Ms group, we found a positive correlation between the number of neuromotor sessions and the change in functional disability and language comprehension; in the Ss group, on the other hand, despite a higher number of hospitalization days, the total number of completed sessions was positively associated with the change in visuoconstructional abilities. Our findings suggest that an intensive, inpatient, and multidisciplinary rehabilitation program may improve functional abilities, some strategic cognitive functions, and geriatric aspects in PwPD with mild–moderate motor impairment.

Boxing vs Sensory Exercise for Parkinson’s Disease: A Double-Blinded Randomized Controlled Trial

“…Importantly, improvement in UPDRS-III scores from pre-to washout assessment for the sensory group is double the change needed to reach minimal clinical importance (greater than a 5-point change). 35,36 This is line with previous research utilizing similar exercise protocols involving slow and controlled moment (external focused exercise, 17 blindfolded balance training, 37 balance training HIBalance, 38 progressive modular rebalancing, 39 and Tai Chi exercises 40 ). The lasting improvements to disease severity post-sensory may have been due to the improved functioning of the remaining dopaminergic neurons as a result of the increased sensory stimulation passing through the basal ganglia during exercise.…”

Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson’s disease

“…Furthermore, utilization of PBFA as outcome measures in clinical trials for cognitive enhancement in PD could ensure patient-centered, clinically significant outcomes. Cognitive decline in PD need not be inevitable, as suggested in trials showing improvement in cognitive function with cognitive training ( Sammer et al, 2006 ; París et al, 2011 ; Edwards et al, 2013 ; Naismith et al, 2013 ; Pena et al, 2014 ), physical activity ( Tanaka et al, 2009 ; Cruise et al, 2011 ; McKee and Hackney, 2013 ; David et al, 2015 ; Picelli et al, 2016 ), and multi-disciplinary approaches ( Meloni et al, 2021 ), as well as the hope for disease-modifying pharmacological applications in the future. Having reliable tools for measuring cognitive functional improvements longitudinally, in addition to improvement in neuropsychological outcomes, is of utmost importance.…”

New Strategies to Improve the Quality of Life for Normal Aging versus Pathological Aging

“…Unfortunately, in advanced disease stages, the improvement of functional and motor results is irrelevant. Therefore, the intervention of multidisciplinary rehabilitation will have to be considered in early or moderate PD stages, in order to delay the progression of motor and non-motor disabilities, and hospitalizations and rehospitalizations will increase the financial costs [ 45 , 46 ].…”