Parkinson’s disease: what solutions for effective rehabilitation?

Fisioterapista illustra risultati esercizio-terapia e report a paziente con diagnosi di malatti adi Parkinson
The role of measurable rehabilitation in the treatment plan for Parkinson's disease

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The treatment of Parkinson’s disease cannot be separated from the ‘pharmacological approach; but supplementing therapy with rehabilitation treatment can greatly optimize the management of the disease. Let’s see how.

The Parkinson’s disease

The chronic degenerative pathology of the central nervous system known by the names “Parkinson’s disease,” or, more simply, “Parkinson’s” (named after James Parkinson, the English physician who gave its first systematic description in 1817), in most cases makes its appearance between the ages of 55 and 65.

Symptoms include obvious motor slowing, often associated with tremor and muscle stiffness of varying intensity depending on the body districts affected from time to time.

038” is the specific exemption code for Parkinson’s Disease in Italy. Analysis of its distribution along our ASLs has enabled the National Parkinson Observatory to find that to date the disease affects, directly or indirectly, a total of half a million Italians:

“Today, there are about 230,000 sufferers in our country. If we also imagine that each patient is associated with at least one caregiver, it is easy to see that this is a phenomenon that affects about half a million people in Italy.” |Onp: Parkinson’s for Patients and Doctors

The Grisons Parkinson’s Disease Foundation then outlines how the incidence of the disease worldwide can be found in all ethnic groups, with different distribution according to age:

“The disease occurs worldwide and in all ethnic groups. It is found in both sexes, with perhaps a slight prevalence in men. The average age of onset is around 58-60 years, but about 5 percent of patients may have a juvenile onset between 21 and 40 years. Before age 20 it is extremely rare. Above 60 years of age it affects 1-2% of the population, while the percentage rises to 3-5% when the age is above 85.” | What is Parkinson’s disease?

Anatomopathologically, the origin of the disease is to be found in a process of neuronal degeneration with biochemical alteration effects at the level of important neurotransmitters: in particular, in the progression of Parkinson’s disease on the affected individual, a significant reduction in the amount of dopamine is commonly observed. It is precisely this reduction that determines the dopaminergic content of standard Parkinson’s drug treatment.

But what does the symptom picture of the affected person look like? Especially in its early stage, motor difficulties represent the main limitation in Parkinson’s disease.The symptom complex is variable and may include rest tremor, rigidity, bradykinesia (slowness of movements) and, in a more advanced stage, postural instability (loss of balance) and gait disturbances.

Parkinson’s disease: postural instability and gait disturbances

Balance disorder in Parkinson’s disease is a symptom that affects the stability of the entire axis of the body. Usually due to a reduction in straightening reflexes, this disorder implies that the subject is less and less able to spontaneously correct any imbalances, especially while walking or when wishing to change direction while walking.

Relevant Risk factor for falls, balance disturbance is among the effects of Parkinson’s that do not find immediate resolution through the standard drug therapy, unless it is appropriately supplemented by a motor rehabilitation pathway tailored to the symptomatological and etiological complex of the patient in question.

As for gait disturbance, on the other hand, in individuals affected by Parkinson’s it tends to be observed:

  • A camptocormic stance, that is, characterized by a forward hunched posture;
  • Poor range of motion, especially commuting, of the arms;
  • Reduced step length, often reduced to a few centimeters;
  • festination, or faster and shorter steps, as if the patient were chasing his or her center of gravity to avoid falling;
  • episodes of sudden motor freezing, known as “freezing“: these are times when the lower limbs do not respond to commands and the feet seem glued to the floor.

The continuation of one or more of these symptoms, associated with postural imbalances, not only results in total or partial inability to perform normal daily activities, but can unfortunately also be a cause of falls.

The role of the rehabilitation pathway in the treatment plan for Parkinson’s disease

Although the treatment of Parkinson’s disease cannot be separated from drug treatment, which is understood to be the foundational basis of the treatment plan, it is of crucial importance that rehabilitation treatment is also part of the management of the disease.

Motor rehabilitation, in particular, proves to be an indispensable adjunct for the patient, capable of improving his or her quality of life, positively conditioning the evolution of the disease and keeping the pharmacological dosage stable.

At an early stage of Parkinson’s disease, an exercise-therapy-based rehabilitation plan promotes overall muscle strengthening and an increase in both range of motion and degree of muscle relaxation. Through the exercise, the patient gains an awareness of his or her new psychophysical state: on this awareness, the subject can refound confidence in his or her posture.

With the progression of the disease, a course of cognitive neurorehabilitation that acts on the limitations related to all aspects of mobility, such as:

  • the way
  • the balance
  • coordination
  • posture
  • breathing
  • swallowing

In its two components (pharmacological and rehabilitative), a treatment plan intended for patients undergoing treatment for Parkinson’s disease thus has the main goal of supporting the frail individual and making him or her as autonomous as possible with respect to social, recreational, and work habits.

Parkinson’s rehabilitation: tools and technologies for personalized movement analysis

In any rehabilitation pathway aimed at restoring the psychomotor balance of the patient being treated for Parkinson’s disease, an essential role is played by movement professionals. Physiatrists, Physiotherapists, and Ph.D.s are at the forefront not only to study the specific rehabilitation plan for the individual undergoing treatment, but also to constantly recalibrate that plan, adapting it to the patient’s compensatory activations and postural improvements along the clinical course.

Once the rehabilitation pathway is established, the key to the success of the plan is. Make exercise therapy accessible and effective For both the patient and the practitioner: the former, in fact, needs to be supported and motivated at every stage of movement, while the latter needs to make accurate assessments and reliable measurements of exercise sessions.

Biofeedback technology represents an optimal solution for accurately analyzing movement. This is an instrumental mode based on self-regulation, through which the biometric data recorded by a sensor placed on a body segment is automatically reproduced in the form of auditory and/or visual feedback (feedback).

In particular, it is precisely through the real-time graphical representation of movement that the person in care becomes progressively autonomous and able to regulate his or her physical actions, both in terms of effort and correctness of performance. A self-adjustment that, at the same time, allows the movement professional to assess improvement parameters, compare data from multiple sessions, and estimate recovery times and the level of difficulty to be assigned to subsequent exercises.

In the case of Parkinson’s disease, CE Class 1/m medical devices such as Riablo from Euleria have wide application with respect to both neurological rehabilitation and partial or total restoration of motor function (including balance, core stability, and gait).

And it is precisely at the height of vestibular reeducation (related to balance) and fall prevention that tools like Riablo can make a difference in rehabilitation treatment for Parkinson’s; among Riablo’s exercise-therapy modules, the one devoted to balance on two legs, for example, is particularly detailed:

Reblo | Balance Test: Torso Tilt | Values
Riablo | Balance Test: Tilt Trunk | Graph

In addition to the 150 basic movements that allow rehabilitation of all body districts, with Riablo it is also possible to decide the time of single repetition, maintenance and rest, even within an a priori established joint range. These and many other functions associated with Riablo’s biofeedback technology have the ultimate goal of facilitating the patient along such a specific and delicate rehabilitation pathway as Parkinson’s disease.

Read also: Designing an exercise-therapy pathway with Riablo: new features and implementations of version 3.0

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