Evidence Based Approach Rehabilitation for Patients with Parkinson's Disease Across Continuum of Disability
Understanding disability in Parkinson’s disease
Living with Parkinson's disease affects every aspect of the life of a patient and creates challenges when new symptoms emerge. Patients with Parkinson's disease can experience the following symptoms as a neurodegenerative disease:
· Walking difficulties
· Decreased balance and coordination
· Postural problems
· Involuntary movements
· Difficulty with handwriting
· Diminished oral and motor skills
· Decreased speech intelligibility and volume
· Swallowing difficulties
· Cognitive impairments
Evidence-Based Rehab of patients with Parkinson’s disease
Recent evidence suggests that music-based movement therapy may be a promising treatment to improve gait and gait-related activities in Parkinson's disease patients, because it normally combines cognitive movement strategies, cueing techniques, balance exercises and physical activity while focusing on the enjoyment of moving on music instead of the current mobility limitations of the patient.
Evidence-based approaches to rehabilitation are known to improve physical performance, strength, balance, gait, and health-related quality of life among people with Parkinson’s disease. People with Parkinson’s disease are most often not seen earlier in the course of the disease when rehabilitation could play a key role in secondary preventive care. Secondary prevention would implicate addressing early Parkinson’s disease signs and symptoms, most preferably immediately upon diagnosis, to optimize the condition of the central nervous system as well as other peripheral systems such as the cardiovascular and respiratory systems in order to maximize function and slow advancement of disability. Even earlier intervention should be considered, as we think that rehabilitation may ultimately serve a role in primary prevention of Parkinson’s disease. Primary prevention would entail treating those without current neurologic signs and symptoms in order to prevent Parkinson’s disease from ever developing.
Ultimately, there is a need to redefine the role of rehabilitation in Parkinson’s disease to include the provision of primary, secondary, and third prevention approaches. Across this spectrum from primary through tertiary care, the application of multidisciplinary approaches is required to optimize the health, function, and quality of life of individuals at risk for, or who already have, Parkinson disease. Only then will the full potential of rehabilitation in the management of Parkinson’s disease be realized.
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