SCC - Parkinson Rehabilitation Program
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1 SCC - Parkinson Rehabilitation Program Introduction At the Spine Care Centre we don t treat Parkinson s Disease, we treat PEOPLE with Parkinson s Disease. Our goal is to assure that, in addition to improving the clinical symptoms of the disease controlled by the treating Neurologist, we improve the quality of our patients lives. We accomplish this goal by listening to our patients and developing a targeted rehabilitation plan that serves the unique needs of each individual. Spine Care Centre Team is introducing a Hi-Tech Program in the rehabilitation of individuals with Parkinson s disease. Our breakthroughs in evidence-based interventions allow our patients to go beyond the clinical setting, providing them with the opportunity to participate in important life roles in the home, work, volunteer and community environments. Our Medical Team has the expertise to develop the rehabilitation strategies people living with Parkinson s Disease need. Patients with Parkinson s Disease may face the following challenges: Walking difficulties & Decreased balance and coordination Weakness & Postural problems Tremors Involuntary movements Difficulty with handwriting Diminished oral and motor skills Decreased speech intelligibility and volume Swallowing difficulties Cognitive impairments Anxiety & Depression 1 P a g e
2 There is growing evidence that individuals with mild to moderate Parkinson s disease can benefit from treatment that targets flexibility, strengthening and cardiovascular conditioning. Physical activity is an important part of a healthy lifestyle for everyone. These treatments can improve balance, walking and overall functional ability. In addition, therapy may slow down the progression of the disease. Moderate to vigorous exercise/activity should begin immediately upon diagnosis and continue throughout the course of the disease. Such activity is difficult for such patient and aborted progressively; SCC Advanced Parkinson Program is Electro-Mechanical without Effort and can improve the patient s condition very quickly. Evidence also supports that regular aerobic exercise prevents development of cognitive impairment in healthy elderly individuals and this can hold true in Parkinson s disease as well. What does Parkinson s disease rehabilitation involve? Our clinicians bring a comprehensive, multidisciplinary approach to the patient care management of Parkinson s disease. Patient-centred care is coordinated among physical therapy and rehabilitation therapy with the use over very advanced Machinery in collaboration with her/his Neurologist. After a thorough evaluation and development of a plan of care, treatment may consist of: a. Flexibility/stretching and strengthening exercises b. Fitness (aerobic) activities c. Strategies to improve mobility: walking, freezing, standing up from chairs, reduce risk of falls d. Strategies to improve self-care activities e. Stress management f. Instruction in cognitive strategies 2 P a g e
3 How Our Approach Differs From Traditional Physical Therapy Physical Therapy is widely used to improve motor symptoms in PD; however, NSSF and insurance companies only cover a limited amount of PT per year, resulting in a short-term model of treatment for a lifelong, progressive neurodegenerative disease. In fact, many studies have shown that, although 20 weeks of traditional physical therapy was effective in improving the motor symptoms of PD, this benefit was lost following three months of no therapy. Our advanced program associates many machines to manipulate the spine (Spine decompressor - rotator), improve the Parkinson Posture (Ceragem), Muscle stretching (Motion Lab- Stretching), and global nerve and muscle stimulators to improve muscle strength (EMA), and increase nerve strength and stimulation (EMS). Other Machines will improve the coordination and Parkinson gait (ML-coordination). In case of Dysphagia and swallowing difficulties, we use special stimulators on the neck to improve the contraction of the suprahyoid muscles which will improve the deglutition of our patient. In order to provide an affordable long-term rehabilitation to people with PD in Lebanon, we have developed a model to provide continuous rehabilitation throughout the entire time course of the disease. High-intensity exercise designed to improve the symptoms of PD, has been shown to be superior to the low-intensity approach of Physiotherapy. Our approach is very intense and very effective. We expect patient to work and he/she should expect results! Since all people with PD do not display the symptoms of the disease equally and the prominence of each symptom varies over the course of the disease, we integrate the scientifically established modes of exercise based on the predominate symptom(s) of each patient to provide personalized rehabilitation. An additional benefit of exercise for PD is the increase of proteins in the brain that enhance learning and cognition. Since cognitive deficits limit the ability of exercise to improve gait and balance, patients perform motor and cognitive rehabilitation simultaneously to enhance the effects of both therapies. 3 P a g e
4 How long will Parkinson s disease rehabilitation take? The plan of care is developed specifically to the individual's needs and goals defined by the patient and evaluating therapist. We will work with the treating physician to optimize our care. Therapy may be two to three times a week to achieve our goal and could last for life on once weekly as Maintenance Program depending on patient s needs. Research & Follow up It is well established that exercise training directed towards a specific symptom of PD is an effective, complementary intervention to the traditional medical management of PD symptoms. Specifically, targeted exercise is effective in improving the targeted deficit. Furthermore, comprehensive exercise programs combining several scientifically proven modes of exercise have been shown to result in clinically meaningful benefits, as measured by the Unified Parkinson s Disease Rating Scale UPDRS. Although substantial evidence supports the use of symptom-specific exercise programs for PD, this intervention has not been implemented on a wide scale. Substantial obstacles prevent many PD patients from receiving symptom-specific exercise training. First, targeted training for gait and balance can only be safely performed in the presence of an exercise professional. Second, effective cognitive rehabilitation requires errorless learning during complex cognitive tasks. This can only take place under close supervision. Since insurance companies and NSSF cover a limited amount of physical rehabilitation each year, targeted training requires a monetary investment that the majority of patients are unable to make. Since properly structured comprehensive exercise programs have been proven to be safe and effective in improving symptoms in people living with PD, the primary barrier to people with PD receiving longterm rehabilitation is that therapy administered by Hi-Tech machinery and highly trained Therapists is cost-prohibitive in the eyes of the insurance industry. PREPARED by: Fadi ZEIN EL ABIDINE, Medical advisor at SCC Medical & Therapeutic Team at SCC 4 P a g e
5 References 1. Exploring the effect of electrical muscle stimulation as a novel treatment of intractable tremor in Parkinson's disease. Jitkritsadakul O1, Thanawattano C2, Anan C1, Bhidayasiri R3. J Neurol Sci Nov 15;358(1-2): doi: /j.jns Epub 2015 Aug Neuromuscular Electrical Stimulation Versus Traditional Therapy in Patients with Parkinson s Disease and Oropharyngeal Dysphagia: Effects on Quality of Life B. J. Heijnen,corresponding author1,5 R. Speyer,2 L. W. J. Baijens,3 and H. C. A. Bogaardt. Dysphagia Sep; 27(3): Nagaya M, Kachi T, Yamada T, Igata A. Videofluorographic study of swallowing in Parkinson s disease. Dysphagia. 1998;13: doi: /PL [PubMed] [Cross Ref] 4. Wintzen AR, Bradrising UA, Roos RAC, Vielvoye J, Liauw L, Pauwels EKJ. Dysphagia in ambulant patients with Parkinson s disease: common, not dangerous. Can J Neurol Sci. 1994;21: [PubMed] 5. Ali GN, Wallace KL, Schwartz R, Decarle DJ, Zagami AS, Cook IJ. Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson s disease. J Gastroenterol. 1996;110: doi: /gast.1996.v110.pm [PubMed] [Cross Ref] 6. Nagaya M, Kachi T, Yamada T. Effect of swallowing training on swallowing disorders in Parkinson s disease. Scand J Rehabil Med. 2000;32: doi: / [PubMed] [Cross Ref] 7. Ertekin C, Tarlaci S, Aydogdu I, Kiylioglu N, Yuceyar N, Turman AB, Secil Y, Esmeli F. Electrophysiological evaluation of pharyngeal phase of swallowing in patients with Parkinson s disease. Mov Disord. 2002;17: doi: /mds [PubMed] [Cross Ref] 8. Johnston BT, Li Q, Castell JA, Castell DO. Swallowing and esophageal function in Parkinson s disease. Am J Gastroenterol. 1995;90: [PubMed] 9. Kirshner HS. Causes of neurogenic dysphagia. Dysphagia. 1989;3: doi: /BF [PubMed] [Cross Ref] 10. Mari F, Matei M, Ceravolo MG, Pisani A, Montesi A, Provinciali L. Predictive value of clinical indices in detecting aspiration in patients with neurological disorders. J Neurol Neurosurg Psychiatry. 1997;63: doi: /jnnp [PMC free article] [PubMed] [Cross Ref] 11. Martin L, Cometti G, Pousson M, Morlon B. Effect of electrical stimulation on the contractile characteristics of the triceps surae muscle. Eur J Appl Physiol. 1993;67: doi: /BF [PubMed] [Cross Ref] 12. Gustafsson B, Tibblin L. Dysphagia, an unrecognized handicap. Dysphagia. 1991;16: doi: /BF [PubMed] [Cross Ref] 13. Plowman-Prine EK, Sapienza CM, Okun MS, Pollock SL, Jacobson C, Wu SS, et al. The relationship between quality of life and swallowing in Parkinson s disease. Mov Disord. 2009;24(9): doi: /mds [PMC free article] [PubMed] [Cross Ref] 5 P a g e
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