Occupational Therapy for Parkinsonian Patients: A Retrospective Study

Evidence-Based Physiotherapeutic Interventions Enhancing Hand Dexterity, Activities of Daily Living and Quality of Life of Parkinson's Disease Patients: A Systematic Review

OBJECTIVES

This systematic review primarily aims to identify the optimal physiotherapeutic intervention to improve hand dexterity in Parkinson's Disease (PD) patients. The secondary objectives were to identify the hand dexterity physiotherapeutic interventions available for PD patients, and to determine the quality of these interventions.

REVIEW METHODS

Eight electronic databases were systematically searched to identify relevant randomized controlled trial full-text articles using the established search strategy. The primary outcomes of interest were measurements for hand dexterity and activities of daily living (ADL).

RESULTS

A total of 11 studies comprising 647 participants with PD were included. Most studies had a high risk of performance bias and an unclear risk of selection bias. The intervention training period ranged from a single session to 12 weeks. Compared to their respective control group, eight out of 11 studies revealed significant results in hand dexterity, two out of three studies reported positive effects on ADL, four of seven studies showed significant improvements in upper limb motor performance, and two studies perceived positive benefits in terms of overall quality of life. Five out of 11 studies that recorded the occurrence of adverse events reported no adverse events post-intervention.

CONCLUSION

The dearth of evidence made it difficult to support any one intervention as the best intervention when compared to the other PD treatments in upper limb rehabilitation. Regardless, a home-based dexterity rehabilitation programme is still a promising approach to enhance dexterity-related functional abilities.

Altered Neurovascular Coupling for Multidisciplinary Intensive Rehabilitation in Parkinson's Disease

Effective rehabilitation in Parkinson's disease (PD) is related to brain reorganization with restoration of cortico-subcortical networks and compensation of frontoparietal networks; however, further neural rehabilitation evidence from a multidimensional perspective is needed. To investigate how multidisciplinary intensive rehabilitation treatment affects neurovascular coupling, 31 PD patients (20 female) before and after treatment and 30 healthy controls (17 female) underwent blood oxygenation level-dependent functional magnetic resonance imaging and arterial spin labeling scans. Cerebral blood flow (CBF) was used to measure perfusion, and fractional amplitude of low-frequency fluctuation (fALFF) was used to measure neural activity. The global CBF-fALFF correlation and regional CBF/fALFF ratio were calculated as neurovascular coupling. Dynamic causal modeling (DCM) was used to evaluate treatment-related alterations in the strength and directionality of information flow. Treatment reduced CBF-fALFF correlations. The altered CBF/fALFF exhibited increases in the left angular gyrus and the right inferior parietal gyrus and decreases in the bilateral thalamus and the right superior frontal gyrus. The CBF/fALFF alteration in right superior frontal gyrus showed correlations with motor improvement. Further, DCM indicated increases in connectivity from the superior frontal gyrus and decreases from the thalamus to the inferior parietal gyrus. The benefits of rehabilitation were reflected in the dual mechanism, with restoration of executive control occurring in the initial phase of motor learning and compensation of information integration occurring in the latter phase. These findings may yield multimodal insights into the role of rehabilitation in disease modification and identify the dorsolateral superior frontal gyrus as a potential target for noninvasive neuromodulation in PD.SIGNIFICANCE STATEMENT Although rehabilitation has been proposed as a promising supplemental treatment for PD as it results in brain reorganization, restoring cortico-subcortical networks and eliciting compensatory activation of frontoparietal networks, further multimodal evidence of the neural mechanisms underlying rehabilitation is needed. We measured the ratio of perfusion and neural activity derived from arterial spin labeling and blood oxygenation level-dependent fMRI data and found that benefits of rehabilitation seem to be related to the dual mechanism, restoring executive control in the initial phase of motor learning and compensating for information integration in the latter phase. We also identified the dorsolateral superior frontal gyrus as a potential target for noninvasive neuromodulation in PD patients.

Effects of Multimodal Rehabilitation on the Activities of Daily Living, Quality of Life, and Burden of Care for Patients with Parkinson's Disease: A Randomized Control Study

Background: Parkinson’s disease reduces patients’ function, activities of daily living, and quality of life, and increases their guardians’ burden of care. This study verified the effectiveness of a multimodal rehabilitation programme for patients with Parkinson’s disease. Trial design: This study was a multicentre parallel randomised controlled, single-blind, trial conducted in three hospitals in Korea. Methods: A central randomisation centre used computer generated tables to randomly allocate 60 of 75 patients with Parkinson’s disease who fulfilled the study requirements into experimental (n = 30; multimodal rehabilitation; consisting of daily living training, guardian education, home environment modification, fine muscle exercise, balance training, and training using auxiliary tools performed 50 min per session, twice a week, in 10 sessions) and control (n = 30; traditional rehabilitation; consisting of task-oriented training, joint exercise, and daily living training performed 50 min per session, twice a week, in 10 sessions) groups. Results: Multimodal rehabilitation for Parkinson’s disease significantly improved the activities of daily living (p < 0.01) and quality of life of patients (p < 0.001) and eased the guardians’ burden of care (p < 0.001). Conclusions: Multimodal rehabilitation is suggested to improve activities of daily living, quality of life of patients with Parkinson’s disease, and reduce the burden of care of their guardians.

The importance of a multidisciplinary approach to improve the life quality for patients with Parkinson's disease

Parkinson's disease is defined as a complex degenerative neurological disease with progressive evolution, which is part of motor system of the brain disorders, being the second degenerative disease as a frequency after Alzheimer's disease. It is characterized by tremor when muscles are at rest (rest tremor), increased muscle tone (stiffness), slow voluntary movements and difficulty maintaining balance (postural instability). Occupational therapy helps Parkinson's patients im-prove their ability to perform daily tasks. The intervention consists in assisting patients in deve-loping a self-care routine, taking into account the limitations of functional mobility, encoura-ging patients to maintain maximum function of daily activities for as long as possible, learning adaptive techniques to reduce tremor. Materials and methods. The devices used for this purpose are commercially available but they are quite expensive, which is why we wanted to make devi-ces made of material as cheap and affordable as possible. Some of the devices can be successfully made of material that every person has in their home. We also took into account the variant of making them without the need to use complicated tools and devices that are not available to pa-tients. Starting from these premises, we thought and made in our occupational therapy laborato-ry various devices designed to offer patients a variety of techniques and exercises and also a fle-xible work environment. On a pallet plate we fixed a series of elements such as zippers, snap button, hook-and-eye closure, systems that patients use on a regular basis. We also manufactu-red a device designed to help patients with household chores such as dish washing. The device is provided at one end with a washing sponge, its handle being a detergent tank. The size and sha-pe have been adapted to the needs of patients with Parkinson's disease. Results and discussions. In order to obtain the devices, cheap materials were used at the disposal of every person eager to make them. It started with simple objects that any patient uses for personal hygiene and more. The technique of making the devices was a very simple one, from the very beginning the steps that must be followed in order to make them were clearly established. Conclusions. Using the devices made during the physiotherapy sessions, significant improvements of the life quality for patients with Parkinson's disease were observed. Keywords: Parkinson, Occupational therapy, Devices, ADL