Referral to rehabilitation in Parkinson's disease: who, when and to what end?

Abstract

The current state of evidence in non-pharmacological treatments amounts to an impending paradigm shift in neurology where physicians should be alerted that some rehabilitation interventions are already supported in current therapeutic guidelines. This manuscript aims to overview the best scientific data supporting referral to rehabilitation services in order to help physicians make the best use of the existing evidence for non-pharmacological treatments in the different stages of Parkinson´s disease.Keywords: Parkinson's disease, non-pharmacological treatments, physical therapy, speech therapy, rehabilitation.resUMo O atual nível de evidência para tratamentos não farmacológicos sugere uma mudança de paradigma na área da neurologia, a qual passa por alertar os médicos neurologistas de que algumas intervenções na área da reabilitação estão já fundamentadas em linhas de orientação terapêutica. Este trabalho tem o objetivo de rever a melhor evidencia cientifica para a definição de critérios de encaminhamento para serviços de reabilitação, procurando auxiliar os médicos neurologistas a obter o melhor beneficio da evidência cientifica atual para tratamentos não farmacológicos nos diferentes estadios da doença de Parkinson.Palavras-chave: doença de Parkinson, tratamentos não farmacológicos, fisioterapia, fonoaudiologia, reabilitação.Parkinson's disease (PD) is a complex heterogeneous neurodegenerative disorder. While many pharmacological treatments in PD have proven beneficial, some motor and nonmotor problems associated with disease progression are not always most comprehensively addressed by a purely pharmacological approach, such as freezing of gait or postural instability The current gold standard drug for symptomatic treatment of motor symptoms of PD, levodopa, has limitations in its use 1,2 which has justified the need for adjunctive treatment for dopaminergic-responsive symptoms and new treatments for non dopaminergic-related symptoms.Current PD guidelines already recognize the potential role of some rehabilitation interventions as a mean to improve patients' functionality and to help patients and their families to cope with the disability and functional limitations due to PD 3-6 . As for example, the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology recently proposed a set of quality measures for neurology practice 7 that consider PD rehabilitative therapy options as a quality measure for PD care, recommending it to be addressed by clinicians in clinical practice.In contrast to these findings, current referral rates to rehabilitation interventions in PD are clearly low 8 . As reported by Nijkrake and colleagues 8 , only 63% of the PD patients were referred to physical therapy for problems with gait, posture, transfers and balance. For problems with speech, voice, eating and drooling, only 14% of the patients were referred to speech therapy. For problems related to arm and hand activities, gait, transfers, balance, posture, leisure activities, personal care and domestic/...

Implementation of a Community-Based Exercise Program for Parkinson Patients: Using Boxing as an Example

“…Additionally, we included participants that self-enrolled through the Parkinson Association, possibly creating a bias in the types of patients that participated. Referrals from other sources (e.g., physicians, physiotherapist, advocacy institutions) can be guided by specific referral criteria that promote integration of patients subgroups that may better benefit [33]. Notably, even though participation of individuals with cognitive impairment in exercise programs is often perceived as not feasible [44], it remains important to determine if they can participate with additional resources (e.g., volunteers or caregiver support).…”

Cross-cultural adaptation of the Activities of Daily Living Questionnaire-Brazil in Parkinson’s disease

“…The objectives of rehabilitation interventions are to improve patients' functionality as well as to help individuals and their families cope with the functional limitations of PD 7 . Therefore, the ADL assessment is relevant to the rehabilitation process and should be based on valid and reliable measures.…”

Impacto da capsaicina (pimenta vermelha) na deglutição de indivíduos com Doença de Parkinson

“…Porém, a melhora pode ser observada através de intervenções e adaptações simples e acompanhamento multidisciplinar durante todos os estágios da doença quanto aos problemas de deglutição. 17 Vale ressaltar que nenhuma das técnicas terapêuticas nãofarmacológicas existentes quando aplicadas isoladamente ou associadas são completamente eficazes no manejo dos sintomas da doença de Parkinson. Porque a fisiopatologia da doença é complexa e consequentemente sua sintomatologia é variada.…”