Neuromotor and Occupational Rehabilitation Therapy in Parkinson's Disease
Mandalà Giorgio1*, La Mantia Valentina1, Passantino Giuseppina1, Terrasi Micol1, Sofia Mandalà1 and Pietro Cataldo2
1UOC Rehabilitation Medicine, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
2Department of Psychology, educational science and human movement, University of Palermo, Italy
*Corresponding author: Mandalà Giorgio, UOC Rehabilitation Medicine, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
Citation: Giorgio M, Valentina LM, Giuseppina P, Micol T, Mandala S, et al. (2024) Neuromotor and Occupational Rehabilitation Therapy in Parkinson's Disease. Adv Clin Med Res. 5(2):1-4.
Received: December 28, 2023 | Published: March 1, 2024
Copyright© 2024 by Giorgio M. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Parkinson's disease involves a gradual and progressive loss of motor, communication, swallowing and cognitive functions with a variable rate and speed of progression. Rehabilitation therapy has proven effective in maintaining functions and autonomy for longer and in some cases also in improving these skills. Given the impairment and slowing down of numerous functions of the central nervous system, rehabilitation must be a process integrated by multi-professionalism and interdisciplinary within an individual rehabilitation project.
Neuromotor and occupational rehabilitation are planned for motor and ADL autonomy, speech therapy rehabilitation for verbal communication skills and swallowing, neuropsychological rehabilitation for higher cortical functions and cognitive decline. Social and work rehabilitation will also be necessary to facilitate reintegration.
Neuromotor Rehabilitation and Occupational Therapy: It’s used for recovery of motor skills that are deficient or lost due to illness and disuse, but also stabilization of basic skills for maintaining autonomy in Activities of daily living. Speech therapy rehabilitation: It’s used for recovery of communication skills, dysarthria, hypo\dysphonia and dysprosody, but also maintenance of nutritional and swallowing ability safely in bradyphagia.
Neuropsychological rehabilitation: It’s used for treatment of braid psychism and executive function disorders due to deafferentation of the frontal lobes, but also increase in cognitive reserve for the reduction of the functional incidence of cognitive disability at the onset of the first dementia-related signs. Social and work rehabilitation. Usede for Family and work reintegration, psychological support for the patient and family, commitment to socialization activities.
CI Tomlinson's meta-analysis1 collects numerous studies demonstrating the effectiveness of physiotherapy in slowing the progression of disability in PD. The type of motor treatment used is not indicated or comprehensively described in the studies. But the effectiveness of "Motor Therapy" is still demonstrated with strong evidence In the initial, advanced and evolved stages. In particular, evidence of effectiveness after rehabilitation is demonstrated in 9 outcome tests:
- Increased walking speed,
- Increase in distance traveled in the 2\6 M.w.t.
- Improvement of the freezing score in the G.Q.
- No improvement in cadence
- Reduction of time in the up & go test
- Increased breadth in the functional reach test
- Increased score on the Berg balance scale
- Reduction of falls (as an absolute value and in the individual patient)
- Increase in motor score and ADL s.s. UPDRS
GM Petzinger2 says that it was not possible to demonstrate the greater or lesser effectiveness of a type of treatment given the heterogeneity of the studies that evaluated interventions of:
- Non-specific physiotherapy
- Exercises for the limbs
- Treadmill training
- Sensory cueing interventions
- Martial arts
The short follow-up of the analyzed studies of 3-6 months should be noted. A. Amara3, demonstrates that neuromotor rehabilitation and the improvement of Physical performance also has favorable effects on non-motor symptoms and in particular autonomic dysfunctions, sleep disorders and cognitive decline.
Restorative Rehabilitation: Is useful in the initial stages of the disease, approximately the first 8 years from diagnosis, until cognitive abilities transform and decline into parkinson\dementia. Substitutive Rehabilitation: Is necessary n the advanced and advanced stages of the disease when one must be satisfied with maintaining basic and vital skills with a satisfactory perceived quality of life.
In the Restorative Rehabilitation: Overcome rehabilitation of the musculoskeletal motor periphery, except for the treatment of hypokinesia and rigidity. Maintaining a good general performance in the gym, respecting the previous level of physical activity.
Transposition of discoveries in the field of neuroscience. Possibility of recovering lost motor skills through their new learning. Treatment techniques that exploit the discovery of the motor image (motor imagery in the premotor areas of the frontal lobe as the start of neurobiological activation of the action (the brain knows the action, not the single movement) and use the re-enactment of the movement and action) and mirror neurons (action observation). Treatment techniques such as mirror therapies which exploit mirrors with different assumptions than the previous ones.
Treatment techniques that exploit the plastic possibilities of sensorimotor learning of the CNS. Recent discoveries on the mechanisms of comparison that generate and regulate learning (Dendre); and the importance of perceptual associations in motor learning (Synesthesia).
It exploits the Comparison of Actions (C.T.A.) and perceptual association, as a strategy for motor recovery through learning. With the exercises, perceptive hypotheses are proposed that allow us to grasp the similarities and differences between the current performance and the previous perceptual memory of the normal performance for the purposes of new learning.
The C.T.A. it is necessary to relearn the adequate performance of current performances, no longer functional to achieving the aim of the action. Comparing the perceptions deriving from the pathological performance with the perceptual memory (Kinesthetic, tactile, Proprioceptive), of past and significant experiences and actions. The hands lose information and motor capacity. Perception is crucial for movement and vice versa.
Examples of Neurocognitive Rehabilitation Exercises
Comparison exercises on the board
Compression sponges of different consistency
The perceptive hypothesis created with the help of the physiotherapist thanks to the multisensory integration of tactile, proprioceptive and kinesthetic information, with the exclusion of sight, must be verified at the end of the exercise and compared in terms of similarities and differences to generate a new motor learning.