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Frameworks for Parkinson’s Disease Rehabilitation Addressing When, What, and How

  • Movement Disorders (T. Simuni, Section Editor)
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Abstract

Purpose of Review

This review summarizes the evidence on rehabilitation for people with Parkinson’s disease, including when to refer, what rehabilitation professionals should address, and how to deliver rehabilitation care.

Recent Findings

Clinical practice guidelines support physical therapy, occupational therapy, and speech-language pathology for Parkinson’s disease. However, integrating guidelines into practice may be difficult. Implementation studies take into account patient and clinician perspectives. Synthesizing guidelines with implementation research can improve local delivery.

Summary

There is moderate to strong evidence supporting physical therapy, occupational therapy, and speech-language pathology soon after diagnosis and in response to functional deficits. We propose a framework of three pathways for rehabilitation care: (1) consultative proactive rehabilitation soon after diagnosis for assessment, treatment of early deficits, and promotion meaningful activities; (2) restorative rehabilitation to promote functional improvements; and (3) skilled maintenance rehabilitation for long-term monitoring of exercise, meaningful activities, safety, contractures, skin integrity, positioning, swallowing, and communication.

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Funding

This work (MR) was supported in part by the Office of the Assistant Secretary of Defense for Health Affairs through the Neurotoxin Exposure Treatment Parkinson’s under Award No. W81XWH-19-PRP-EIRA). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

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Authors and Affiliations

  1. Shirley Ryan AbilityLab, Chicago, IL, USA

    Miriam R. Rafferty, Ella Nettnin, Jennifer G. Goldman & Jillian MacDonald

  2. Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Miriam R. Rafferty & Jennifer G. Goldman

  3. Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Miriam R. Rafferty

  4. Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jennifer G. Goldman

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  1. Miriam R. Rafferty
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Correspondence to Miriam R. Rafferty.

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Conflict of Interest

Dr. Rafferty reports grants from United States Department of Defense, during the conduct of the study. She reports grants from National Institute on Disability, Independent Living, and Rehabilitation Research; Parkinson’s Foundation; Academy of Neurologic Physical Therapy; Foundation for Physical Therapy; Agency for Healthcare Research and Quality; Davis Phinney Foundation, other from Parkinson’s Foundation, other from Academy of Neurologic Physical Therapy, outside the submitted work. Ella Nettnin has nothing to disclose. Dr. Goldman reports grants from NINDS, MJFF, Parkinson’s Foundation, other from Acadia, Aptinyx, Sunovion, Worldwide Med, grants from CHDI, Biotie, during the conduct of the study. Dr. MacDonald reports grants from Parkinson’s Foundation, grants from Academy of Neurologic Physical Therapy, grants from Department of Defense, outside the submitted work.

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Rafferty, M.R., Nettnin, E., Goldman, J.G. et al. Frameworks for Parkinson’s Disease Rehabilitation Addressing When, What, and How. Curr Neurol Neurosci Rep 21, 12 (2021). https://doi.org/10.1007/s11910-021-01096-0

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