Cognitive Rehabilitation for Individuals With Parkinson's Disease: Developing and Piloting an External Aids Treatment Program

Abstract

Purpose Cognitive deficits are common in Parkinson's disease (PD) and can have a detrimental effect on daily activities. To date, most cognitive treatments have had an impairment-based focus with primary outcome measures of formal neuropsychological test scores. Few, if any, studies have focused on functional improvement or patient-centered goals. Method Three individuals with idiopathic PD participated in an 8-week pilot treatment program to train for the use of compensatory external aids to achieve personalized goals. Goal attainment scaling was the primary outcome measure, which was independently judged by multiple raters at baseline, postintervention, and 1 month posttreatment and analyzed via T -score analysis. Descriptive measures, including self-report and spouse-report rating scales of cognitive functioning, were employed. Results All 3 participants improved in the majority of their laboratory and home goals posttreatment, as measured by goal attainment scaling, and maintained gains for the majority of goals 1 month posttreatment. Conclusions This is the 1st known study to implement an external aids treatment program with patient-centered goals for individuals with cognitive deficits from PD. Positive outcomes were likely influenced by 3 factors: (a) a theoretically motivated focus on external aids; (b) a well-documented, systematic approach to instruction; and (c) the personalization of goals. Supplemental Material https://doi.org/10.23641/asha.10093493

Suitability of Goal Attainment Scaling in Older Adult Populations with Neurodegenerative Disease Experiencing Cognitive Impairment: A Systematic Review and Meta-Analysis

“…Four reports (40%) did not describe how many goals each participant set [14,45,47,50], and one report (10%) did not describe who was involved in goal setting and scaling [45]. Four studies (40%) did not use blinded assessors at GAS follow-up [44][45][46][47], and two studies (20%) did not report if GAS assessors were blinded at follow-up [48,49]. This increases risk of bias, as assessors may be influenced by knowledge of the participants' baseline GAS scores.…”

“…This increases risk of bias, as assessors may be influenced by knowledge of the participants’ baseline GAS scores. A moderate-high risk of bias was introduced due to small sample sizes in four studies (40%) [45, 46, 49, 50]. While these were appropriately weighted in the meta-analysis, these studies inevitably had a higher risk of bias than studies with a larger sample size [51].…”

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“…All models should be considered along with individual differences, such as contextual and environmental factors described in biopsychosocial models [122]. Cultural differences and personal factors, such as level of resilience, will also color the clinical picture [123,124]. Additionally, comorbidities are frequent in PD and have been demonstrated to predict mortality [125] and for by distinct neurotransmitter involvement.…”

Effectiveness of Nintendo Wii on Balance in People with Parkinson’s Disease: A Systematic Review

“…PD refers to a neurological disorder involving motor dysfunctions, stiffness, tremor, rigidity, bradykinesia, and postural and gait instability [ 4 ]. Spencer et al [ 5 ] narrate that the disease has serious adverse effects on patients, curtailing their mobility, and limiting their daily life by increasing some risks, such as frequent falls.…”