QUALE RIABILITAZIONE NEL FUTURO PER LA MALATTIA DI PARKINSON?

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1 QUALE RIABILITAZIONE NEL FUTURO PER LA MALATTIA DI PARKINSON? DANIELE VOLPE Casa di Cura Villa Margherita Vicenza GVDR Padova

2 Evidence: Systematic Reviews Rapidly emerging research literature on physio exercise s for Parkinson s 39 trials 1827 patients Mild-moderate Hoehn & Yahr 1-3 Claire Tomlinson 2012

Falls Premotor Phase Early Phase Advanced Phase REM sleep

5 Disease onset of PD Resting tremor Rigidity Bradykinesia/Akinesia Postural instability Freezing of gait & Falls Premotor Phase Early Phase Advanced Phase REM sleep disorder Hyposmia Depression Autonomic dysfunction Mild cognitive impairment Dementia Psychosis

MOTOR LEARNING PROCESS Roma, 9-11 Ottobre 2013 Modern rehabilitation

learning process where old skills have to be re-acquired and new ones

cognitive training PHYSICAL THERAPY 7 Traditional rehabilitation

7 MOTOR LEARNING PROCESS Roma, 9-11 Ottobre 2013 Modern rehabilitation aims at physiological repair of neural damage and may be seen as a learning process where old skills have to be re-acquired and new ones have to be learned on the basis of practice, combining motor and cognitive training PHYSICAL THERAPY 7 Traditional rehabilitation focuses on compensation: behavior is changed to meet individual or environmental constraints

9 Connectedness of healthcare professionals involved in the treatment of patients with Parkinson's disease: a social networks study Michel Wensing, Martijn van der Eijk2, Jan Koetsenruijter1, Bastiaan R Bloem2, Marten Munneke1, 2 and Marjan Faber1 2011

Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial Munneke M, Nijkrake MJ, Keus SH, Kwakkel G, Berendse HW, Roos RA, Borm GF, Adang

10 Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial Munneke M, Nijkrake MJ, Keus SH, Kwakkel G, Berendse HW, Roos RA, Borm GF, Adang EM, Overeem S, Bloem BR; ParkinsonNet Trial Study Group Improving Community Healthcare for Patients with Parkinson's Disease: The Dutch Model S. H. J. Keus, 1 L. B. Oude Nijhuis, 2 M.J. Nijkrake, 3 B. R. Bloem, 2 and M. Munneke 1,4 2012

11 2012

12 Keus SH, Nijkrake MJ, Borm GF, Kwakkel G, Roos RA, Berendse HW, Adang EM, Overeem S, Bloem BR, Munneke M; ParkinsonNet Trial Study Group Nijkrake MJ, Keus SH, Overeem S, Oostendorp RA, Vlieland TP, Mulleners W, Hoogerwaard EM, Bloem BR, Munneke M. 2010

13 Moving from physician-centered care towards patient-centered care for Parkinson's disease patients van der Eijk M, Nijhuis FA, Faber MJ, Bloem BR 2011 Paziente Caregiver

14 MODELLO DI RIABILITAZIONE NEL FUTURO NEL PARKINSON AMBULATORIO NEUROLOGICO RIABILITAZIONE INTENDIVA COD 56 Paziente e Caregiver RIABILITAZIONE ESTENSIVA TEIIRRITORIO ASSOCIAZIONI PARKINSON INTERVENTO DOMICILIARE

15 LIFESTYLE PROBLEM PROBABLY DUE TO TRADITIONAL PHYSIOTHERAPY

16 REHABILITATIVE INTEFRVENTIONS THAT STIMULATE EMOTIONS AND MOTIVATION

17 2014

19 NEUROTRASMITTERS AND PARKINSON S DISEASE Courtesy of Ricciardi L 2008

20 Music and Parkinson s disease

23 2014 Amigdala is the neural substrate of emotional processing and it is also involved in music processing First neuroanatomical evidence on the association between the amigdala and music

25 Evidence for Dancing with Parkinson s Study N Dance style Dosage Outcomes Heiberger, L., C. Maurer, et al. (2011). "Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson's disease" 11 Modified version of Mark Morris Dance for Parkinson s disease 60 min/week for 8 months Rigidity scores improved No improvement in balance and movement efficiency Batson, G. (2010). "Feasibility of an Intensive Trial of Modern Dance for Adults with Parkinson Disease." 11 Contemporary dance 3 x 85min/week for 3 weeks Dynamic balance improved No improvement in movement efficiency Duncan, R. P. and G. M. Earhart (2012). "Randomized controlled trial of community-based dancing to modify disease progression in Parkinson disease." 62 Argentine tango compared to control (no intervention) 2 x 60 min/week for 12 months Walking velocity, balance, and endurance improved in tango group only. Hackney, M. E. and G. M. Earhart (2009). "Short duration, intensive tango dancing for Parkinson disease: an uncontrolled pilot study." 12 Argentine tango 5 x 90 min/week for 2 weeks Dynamic balance improved Movement efficiency and walking endurance didn t improve Courtesy Rebecca Twyerould

26 Evidence for Dancing (continued) Study N Dance genre Dosage Outcomes Hackney, M. E. and G. M. Earhart (2010). "Effects of dance on gait and balance in Parkinson's disease: a comparison of partnered and non partnered dance movement." Hackney, M. E., S. Kantorovich, et al. (2007). "Effects of ttango on functional mobility in Parkinson's disease: a preliminary study." Marchant, D., J. L. Sylvester, et al. (2010). "Effects of a short duration, high dose contact improvisation dance workshop on Parkinson disease: a pilot study." Volpe D et al. (2013). A comparison if Irish set dancing and exercises in Parkinson s disease: A phase II feasibility study:" 39 Argentine tango: Partnered compared to non partnered dance 19 Argentine tango and a Traditional exercise comparison group 11 Contact improvisation 24 Irish set dancing compared to control (conventional physiotherapy) 2 x 60min/week for 10 weeks 2 x 60 min/week for 13 weeks 5 x 90 min/week For 2 weeks 1 x 120 min/week for 24 weeks Dynamic balance, gait velocity and cadence improved equally in both groups Dynamic balance improved in tango group only. Both groups improved on UPDRS score. Dynamic balance, step length and score on UPDRS III improved. No improvement in movement efficiency and endurance Dynamic balance, mobility, FOG, walking endurance and quality of life improved for both dance groups more in Irish group. Courtesy Rebecca Twyerould

27 Irish Dancing for Parkinson s Disease Volpe et al. 2013

28 MOVE 4 PARKINSON DUBLIN August 2014

29 GRAZIE PER LA VOSTRA ATTENZIONE

Exercise as Medicine The Role of Rehabilitation Professionals in Helping to Treat Parkinson's Disease Rehabilitation Services

Exercise as Medicine The Role of Rehabilitation Professionals in Helping to Treat Parkinson's Disease Katie Parafinczuk PT, DPT, NCS Redwood City, CA Rehabilitation Services My Background Kathleen.n.parafinczuk@kp.org