Physical exercise combined with occupational therapy (OT) can lead to a global improvement in personal well-being.
OBJECTIVE:
To assess in PD patients: 1) if a rehabilitation program involving OT, Nordic walking (NW) and therapeutic touch (TT) yields motor/non-motor benefits; 2) if the time collocation of OT within the program influences results.
METHODS:
This is a pilot study on 17 PD patients undergoing a 10-week rehabilitation program consisting of OT, NW and TT. Patients were randomized to receive OT in the first [Group 1, n = 8] vs. last five weeks [Group 2, n = 9] of the program. Scales (MMSE, FAB, BDI, UPDRS II and III, PDQ39 and AES-S) and 6MWT, Gait speed and length were assessed at three time-points.
RESULTS:
Thirteen out of 17 patients were analyzed. 6MWT, Gait speed and length improved in time without between-group differences (p < 0.05) as did UPDRII, UPDRSIII, FAB and PDQ39 (p < 0.05). Baseline UPDRS II and III significantly determined Δ6MWT (adjusted R2 = 0.6738) and ΔGAIT speed (R2 = 0.6746) at multiple regression, while ΔGAIT length showed the best regression (adjusted R2 = 0.8247) with impact of age, gender and baseline PDQ39 (ADL and cognition dimensions).
CONCLUSIONS:
Multidisciplinary rehabilitation including OT can improve motor and non-motor conditions in PD patients. The OT time-collocation at beginning or end of the rehabilitation program does not significantly affect results.
Aarsland,D., Larsen,J. P., Lim,N. G., Janvin,C., Karlsen,K., Tandberg,E., & Cummings,J. L. (1999). Range of neuropsychiatric disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry, 67(4), 492–496.
2.
Abbruzzese,G., Marchese,R., Avanzino,L., & Pelosin,E. (2016). Rehabilitation for Parkinson’s disease: Current outlook and future challenges. Parkinsonism Relat Disord, 22(Suppl 1), S60–S64. doi: 10.1016/j.parkreldis.2015.09.005
3.
Alves Da Rocha,P., McClelland,J., & Morris,M. E. (2015). Complementary physical therapies for movement disorders in Parkinson’s disease: A systematic review. Eur J Phys Rehabil Med, 51(6), 693–704.
4.
Alwardat,M. (2018). Comments on: “Nordic walking for the management of people with Parkinson disease: A systematic review”. Pm r, 10(5), 560–561. doi: 10.1016/j.pmrj.2018.01.007
5.
Antonini,A., Abbruzzese,G., Ferini-Strambi,L., Tilley,B., Huang,J., Stebbins,G. T.,. . . … Group,M. -U. I. V. S. (2013). Validation of the Italian version of the movement disorder society–unified Parkinson’s disease rating scale. Neurol Sci, 34(5), 683–687. doi: 10.1007/s10072-012-1112-z
6.
Arbesman,M., Lieberman,D., & Metzler,C. A. (2014). Using evidence to promote the distinct value of occupational therapy. Am J Occup Ther, 68(4), 381–38510.5014/ajot.2014.684002
7.
Bang,D. H., & Shin,W. S. (2017). Effects of an intensive Nordic walking intervention on the balance function and walking ability of individuals with Parkinson’s disease: A randomized controlled pilot trial. Aging Clin Exp Res, 29(5), 993–999. doi: 10.1007/s40520-016-0648-9
8.
Beck,A. T., Ward,C. H., Mendelson,M., Mock,J., & Erbaugh,J. (1961). An inventory for measuring depression. Arch Gen Psychiatry, 4, 561–571.
9.
Carne,W., Cifu,D. X., Marcinko,P., Baron,M., Pickett,T., Qutubuddin,A.,. . . & Mutchler,B. (2005). Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinson’s disease. J Rehabil Res Dev, 42(6), 779–786.
10.
Clarke,C. E., Furmston,A., Morgan,E., Patel,S., Sackley,C., Walker,M.,. . . & Wheatley,K. (2009). Pilot randomised controlled trial of occupational therapy to optimise independence in Parkinson’s disease: The PD OT trial. J Neurol Neurosurg Psychiatry, 80(9), 976–978. doi: 10.1136/jnn2007.138586
11.
Cohen,J. (1988). Statistical power analysis or the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum.
12.
Cummings,J. L. (1992). Depression and Parkinson’s disease: A review. Am J Psychiatry, 149(4), 443–454. doi: 10.1176/aj149.4.443
13.
Cusso,M. E., Donald,K. J., & Khoo,T. K. (2016). The impact of physical activity on non-motor symptoms in Parkinson’s disease: A systematic review. Front Med (Lausanne), 3, 35–10.3389/fmed.2016.00035
14.
Dubois,B., Slachevsky,A., Litvan,I., & Pillon,B. (2000). The FAB: A frontal assessment battery at bedside. Neurology, 55(11), 1621–1626.
15.
Ellis,T., Katz,D. I., White,D. K., DePiero,T. J., Hohler,A. D., & Saint-Hilaire,M. (2008). Effectiveness of an inpatient multidisciplinary rehabilitation program for people with Parkinson disease. Phys Ther, 88(7), 812–819. doi: 10.2522/ptj.20070265
Folstein,M. F., Folstein,S. E., & McHugh,P. R. (1975). Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12(3), 189–198.
18.
Foster,E. R. (2014). Instrumental activities of daily living performance among people with Parkinson’s disease without dementia. Am J Occup Ther, 68(3), 353–362. doi: 10.5014/ajot.2014.010330
19.
Frazzitta,G., Maestri,R., Bertotti,G., Riboldazzi,G., Boveri,N., Perini,M.,. . . … Ghilardi,M. F. (2015). Intensive rehabilitation treatment in early Parkinson’s disease: A randomized pilot study with a -year follow-u. Neurorehabil Neural Repair, 29(2), 123–131. doi: 10.1177/1545968314542981
20.
Fritz,B., Rombach,S., Godau,J., Berg,D., Horstmann,T., & Grau,S. (2011). The influence of Nordic Walking training on sit-to-stand transfer in Parkinson patients. Gait Posture, 34(2), 234–238. doi: 10.1016/j.gaitpost.2011.05.004
21.
Goetz,C. G., Tilley,B. C., Shaftman,S. R., Stebbins,G. T., Fahn,S., Martinez-Martin,P.,. . . … Force,M. D. S. U. R. T. (2008). Movement disorder society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Mov Disord, 23(15), 2129–2170. doi: 10.1002/mds.22340
22.
Grimes,D., Gordon,J., Snelgrove,B., Lim-Carter,I., Fon,E., Martin,W.,. . . … Jog,M. (2012). Canadian Guidelines on Parkinson’s Disease.,(), S-S. Can J Neurol Sci, 39(4 Suppl 4), S1–S30.
23.
Herfurth,M., Godau,J., Kattner,B., Rombach,S., Grau,S., Maetzler,W., & Berg,D. (2015). Gait velocity and step length at baseline predict outcome of Nordic walking training in patients with Parkinson’s disease. Parkinsonism Relat Disord, 21(4), 413–416. doi: 10.1016/j.parkreldis.2015.01.016
24.
Herman,T., Giladi,N., & Hausdorff,J. M. (2009). Treadmill training for the treatment of gait disturbances in people with Parkinson’s disease: A mini-review. J Neural Transm (Vienna), 116(3), 307–318. doi: 10.1007/s00702-008-0139-z.
25.
Hesse,S., & Uhlenbrock,D. (2000). A mechanized gait trainer for restoration of gait. J Rehabil Res Dev, 37(6), 701–708.
26.
Leentjens,A. F., Dujardin,K., Marsh,L., Martinez-Martin,P., Richard,I. H., Starkstein,S. E.,. . . & Goetz,C. G. (2008). Apathy and anhedonia rating scales in Parkinson’s disease: Critique and recommendations. Mov Disord, 23(14), 2004–2014. doi: 10.1002/mds.22229
27.
Levin,B. E., Llabre,M. M., & Weiner,W. J. (1988). Parkinson’s disease and depression: Psychometric properties of the Beck Depression Inventory. J Neurol Neurosurg Psychiatry, 51(11), 1401–1404.
28.
Levy,R., & Dubois,B. (2006). Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex, 16(7), 916–928. doi: 10.1093/cercor/bhj043
29.
Marin,R. S. (1990). Differential diagnosis and classification of apathy. Am J Psychiatry, 147(1), 22–30. doi: 10.1176/aj147.1.22
30.
Marin,R. S. (1991). Apathy: A neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci, 3(3), 243–254. doi: 10.1176/jn3.3.243
31.
Marin,R. S., Biedrzycki,R. C., & Firinciogullari,S. (1991). Reliability and validity of the apathy evaluation scale. Psychiatry Res, 38(2), 143–162.
32.
Marinus,J., Ramaker,C., van Hilten,J. J., & Stiggelbout,A. M. (2002). Health related quality of life in Parkinson’s disease: A systematic review of disease specific instruments. J Neurol Neurosurg Psychiatry, 72(2), 241–248.
33.
Monroe,C. M. (2009). The effects of therapeutic touch on pain. J Holist Nurs, 27(2), 85–92. doi: 10.1177/0898010108327213
34.
Monteiro,E. P., Franzoni,L. T., Cubillos,D. M., de Oliveira Fagundes,A., Carvalho,A. R., Oliveira,H. B.,. . . … Peyre-Tartaruga,L. A. (2017). Effects of Nordic walking training on functional parameters in Parkinson’s disease: A randomized controlled clinical trial. Scand J Med Sci Sports, 27(1), 351–358. doi: 10.1111/sms.12652
35.
Morberg,B. M., Jensen,J., Bode,M., & Wermuth,L. (2014). The impact of high intensity physical training on motor and non-motor symptoms in patients with Parkinson’s disease (PIP): A preliminary study. NeuroRehabilitation, 35(2), 291–298. doi: 10.3233/nre-141119
36.
Newshan,G., & Schuller-Civitella,D. (2003). Large clinical study shows value of therapeutic touch program. Holist Nurs Pract, 17(4), 189–192.
37.
Parkinson,S., Saint-Hilaire,M., Sturkenboom,I. H., Graff,M. J., Hendriks,J. C., Veenhuizen,Y.,. . . … Adang,E. M. (2014). Viewpoint. Evidencing the value of activity-based occupational therapy Occupational therapy for Parkinson’s disease: Increasing awareness Efficacy of occupational therapy for patients with Parkinson’s disease: A randomised controlled trial Effectiveness of occupational therapy in Parkinson’s disease: Study protocol for a randomized controlled trial. In Ment Health Today (Vol. 13, pp. 21). England: 2014 Elsevier Ltd.
38.
Pedersen,K. F., Larsen,J. P., Alves,G., & Aarsland,D. (2009). Prevalence and clinical correlates of apathy in Parkinson’s disease: A community-based study. Parkinsonism Relat Disord, 15(4), 295–299. doi: 10.1016/j.parkreldis.2008.07.006
39.
Peto,V., Jenkinson,C., Fitzpatrick,R., & Greenhall,R. (1995). The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease. Qual Life Res, 4(3), 241–248.
40.
Picelli,A., Melotti,C., Origano,F., Waldner,A., Fiaschi,A., Santilli,V., & Smania,N. (2012). Robot-assisted gait training in patients with Parkinson disease: A randomized controlled trial. Neurorehabil Neural Repair, 26(4), 353–361. doi: 10.1177/1545968311424417
41.
Post,B., van der Eijk,M., Munneke,M., & Bloem,B. R. (2011). Multidisciplinary care for Parkinson’s disease: Not if, but how! In Postgrad Med J (Vol. 87, pp. 575–578). England.
42.
Preissner,K. (2014). Occupational therapy practice guidelines for adults with neurodegenerative disorders. In M. A. P. Bethesda (Ed.).
43.
R-Core-Team. (2017). A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.
44.
Radder,D. L. M., Sturkenboom,I. H., van Nimwegen,M., Keus,S. H., Bloem,B. R., & de Vries,N. M. (2017). Physical therapy and occupational therapy in Parkinson’s disease. Int J Neurosci, 127(10), 930–943. doi: 10.1080/00207454.2016.1275617
45.
Reuter,I., Mehnert,S., Leone,P., Kaps,M., Oechsner,M., & Engelhardt,M. (2011). Effects of a flexibility and relaxation programme, walking, and nordic walking on Parkinson’s disease. J Aging Res, 2011, 232473. doi: 10.4061/2011/232473
Senderovich,H., Ip,M. L., Berall,A., Karuza,J., Gordon,M., Binns,M.,. . . … DunalL. (2016). Therapeutic Touch((R)) in a geriatric Palliative Care Unit - A retrospective review. Complement Ther Clin Pract, 24, 134–138. doi: 10.1016/j.ctc2016.06.002
48.
Skorkowska-Telichowska,K., Kropielnicka,K., Bulinska,K., Pilch,U., Wozniewski,M., Szuba,A., & Jasinski,R. (2016). Nordic walking in the second half of life. Aging Clin Exp Res, 28(6), 1035–1046. doi: 10.1007/s40520-016-0531-8
49.
Starkstein,S. E. (2012). Apathy in Parkinson’s disease: Diagnostic and etiological dilemmas. Mov Disord, 27(2), 174–178. doi: 10.1002/mds.24061
50.
Starkstein,S. E., Merello,M., Jorge,R., Brockman,S., Bruce,D., & Power,B. (2009). The syndromal validity and nosological position of apathy in Parkinson’s disease. Mov Disord, 24(8), 1211–1216. doi: 10.1002/mds.22577
51.
Stewart,D. A. (2007). NICE guideline for Parkinson’s disease. In Age Ageing (Vol. 36, pp. 240–242). England.
52.
Sturkenboom,I. H., Graff,M. J., Hendriks,J. C., Veenhuizen,Y., Munneke,M., Bloem,B. R., & Nijhuis-van der Sanden,M. W. (2014). Efficacy of occupational therapy for patients with Parkinson’s disease: A randomised controlled trial. Lancet Neurol, 13(6), 557–566. doi: 10.1016/s1474-4422(14)70055-9
53.
Subramanian,I. (2017). Complementary and alternative medicine and exercise in nonmotor symptoms of Parkinson’s disease. Int Rev Neurobiol, 134, 1163–1188. doi: 10.1016/bs.irn.2017.05.037
54.
van der Marck,M. A., Kalf,J. G., Sturkenboom,I. H., Nijkrake,M. J., Munneke,M., & Bloem,B. R. (2009). Multidisciplinary care for patients with Parkinson’s disease. Parkinsonism Relat Disord, 15(Suppl 3), S219–S223. doi: 10.1016/s1353-8020(09)70819-3
55.
Warlop,T., Detrembleur,C., Buxes Lopez,M., Stoquart,G., Lejeune,T., & Jeanjean,A. (2017). Does Nordic Walking restore the temporal organization of gait variability in Parkinson’s disease?J Neuroeng Rehabil, 14(1), 17. doi: 10.1186/s12984-017-0226-1
