A multidisciplinary investigation of neurosurgical rehabilitation in bilateral parkinsonism.

Abstract

AbstractThis report concerns the authors' findings on the effect of thalamic surgery (particularly cryothalamectomy) in bilateral parkinsonism, not only from the viewpoint of neurosurgery but from that of several other disciplines, e.g., physical therapy, speech therapy, psychology, and vocational rehabilitation—in both the immediate postoperative and long‐range situations. The purpose of the investigation was to gain more knowledge concerning the treatment of parkinsonism and the pathophysiological mechanisms of the disease, and also the relationship between behavioral disturbances and alterations in the subcortical regions of the brain.Details are given in five chapters entitled respectively: Background, Patients and Procedures, Results, Discussion and Implications, and Significant Findings for the Rehabilitation Worker. The conclusions, outlined in the fifth chapter, are:Bilateral tremor and rigidity can be relieved by bilateral cryothalamectomy in most parkinsonian patients who are properly selected for surgery.Symptomatic relief is significantly related to improvement in self‐care ability, functional status and return to gainful employment.The work‐lives of preoperatively employed parkinsonian patients may be extended by surgical treatment combined with postoperative rehabilitation services. Preoperatively unemployed or disabled patients require more intensive postoperative treatment and vocational rehabilitation.Long‐range postoperative therapy can be of great assistance for patients with postoperative sequelae such as difficulties with balance and speech, and decreased activation.The preoperative psychological, neurological and vocational status of the parkinsonian patient is the single most important factor in predicting the overall outcome of thalamic surgery, particularly with reference to functional and vocational status. Therefore there should be greater emphasis on improvements in surgical techniques and in the criteria for selection of patients. Patients who undergo surgery early in the course of the disease have a greater chance for functional and vocational adequacy.The importance of follow‐up programs involving physical therapy and vocational counseling cannot be overestimated. Additional programs of education and communication should be started in cooperation with community agencies and with medical and rehabilitation centers so that they may become more aware that bilateral thalamic surgery is an effective approach to the rehabilitation of patients with parkinsonism.