Rehabilitation and Neurologic Repair in Parkinson's Disease

Abstract

Idiopathic Parkinson’s disease (PD) is a neurodegenerative disorder and the most common cause of the Parkinsonian syndrome: asymmetric bradykinesia, hypokinesia, and rigidity, sometimes combined with rest tremor and postural changes. Historically, PD treatment has primarily aimed to replace the loss of dopamine through pharmaceutical intervention, which may reduce physical symptoms and slow progression but rarely achieves complete control. More recently, multi-disciplinary neurorehabilitation treatments have been proposed to treat PD sequelae that reduce functional independence and lead to disability. This special issue explores current and future approaches to neurorehabilitation in PD. Papers were contributed in the areas of physical rehabilitation, neuropsychology, speech, deep brain stimulation and stem cell research. The Veteran’s Health Administration (VHA) Parkinson’s disease Research, Education, and Clinical Centers (PADRECC) have authored the body of work in this issue. The VHA system competitively awarded these regional centers of PD excellence to improve long-term functional outcomes for veterans. The PADRECC centers partner with affiliated academic medical centers to leverage expertise and resources in order to provide state-of the art treatments, deliver best medical practice education, and conduct innovative research. Diaz and Bronstein provide an overview of this landmark program including program mission and objectives, multidisciplinary services offered, the VHA and National Institute on Neurological Disorders and Stroke (NINDS) co-funded deep brain stimulation (DBS) surgical trial, the identification of PD quality care standards, and the research and development of new therapies including cell replacement. In a second study, Carne et al. examine the efficacy of PADRECC multidisciplinary treatment which includes visits with neurologists, physiatrists, and psychologists as well as functional diagnostic testing, rehabilitation therapies, home exercise programs, support groups, and disease and wellness education. Preliminary evidence from this single center study suggests that almost 70% of patients showed functional motor improvements during their first year of PADRECC multidisciplinary treatment. In patients with PD, the incidence of falls is greater than in the age-matched general population, affecting more than 68% of patients [1]. Seventy percent of falls in PD patients are due to intrinsic factors, and fear of falls is common, often leading to restricted ADLs [2]. Two papers in this issue are devoted to reducing falls. Robinson et al. identify risk factors for falling in PD appropriately grounded within the context of falling in the elderly. Pilot data are presented for tertiary interventions that might reduce specific risk factors. Practical treatment recommendations to reduce specific falling risk factors are proposed based on scientific review and best medical practice. Protas et al. conducted a randomized controlled trial to demonstrate the efficacy of gait training using supported treadmill for individuals with PD. Three hourly sessions over the course of 8 weeks produced significant reduction in falls, improved