Intense Rehabilitation Can Help People at Earlier Disease Stages, Study Finds

An intensive and sweeping rehabilitation program, given in a hospital, led to significant short-term improvements in the functional and cognitive abilities of people with mild-to-moderate Parkinson’s disease in a recent study.

That study, “Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson’s Disease: A Retrospective and Observational Study,” was published in the journal Frontiers in Neurology.

Because people with Parkinson’s experience a wide range of motor and non-motor symptoms, individual response to therapies can differ — and no treatments to date can prevent or delay disease progression.

Recent studies have suggested that a multidisciplinary approach to care that involves daily rehabilitation aimed at supporting a person’s neurological abilities across disease symptoms — neurorehabilitation — might slow the loss of motor skills and aid cognition.

Researchers with the Don Carlo Gnocchi Foundation and Catholic University of Sacro Cuore, both in Milan, Italy, investigated this further by evaluating how such a program might help functional, cognitive, and age-related abilities in a group of Parkinson’s patients.

They examined records for 24 patients, whose Parkinson’s ranged from mild and moderate to severe, as assessed by the Movement Disorder Society Unified Parkinson’s Disease Rating Scale Part 3 (UPDRS-III), which measures motor skills ranging from speaking and walking abilities to tremor and rigidity.

These individuals stayed at the foundation’s hospital for about six weeks (a mean of 44.17 days), during which time they engaged in a series of individually tailored physical, cognitive, occupational, and speech therapies given by a multidisciplinary team at least twice a day, for five to seven days each week.

Ten patients with mild-to-moderate disability at baseline — the study’s start — showed significant short-term functional and cognitive improvements. Those with more severe impairment (14 patients) showed significant improvement only on visual-based memory tests.

Overall, functional abilities — measured using the Barthel Index, which assesses skills essential independence — improved for 87.5% of patients over the course of these sessions. Specific gains were recorded in activities such as dressing, bladder control, moving from a chair, walking, and climbing stairs.

Cognitively, most patients showed significant improvement in the areas of language comprehension, working memory, and abstract reasoning after their rehabilitation period.

People with more severe disability, however, only made significant gains in the Copy Rey’s Figure test (also called the Rey Complex Figure and the Rey–Osterrieth complex figure test), which uses visual cues to assess attention, planning, and working memory.

In fact, cognitive gains appeared to be most influenced by a patient’s starting disability, with those least disabled making the greatest gains. This suggested, the researchers wrote, “that the treatment, regardless of the intensity, is effective only according to cognitive functioning at baseline.”

Significant improvements were also seen in patients’ perception of pain and their risk of developing pressure ulcers. Daily doses of levodopa also declined over the sessions, although this drop was not statistically significant.

“Our findings strengthen the evidence about the efficacy of an inpatient multidisciplinary rehabilitation treatment” in Parkinson’s patients, the researchers concluded. But more research is needed “to identify at which level of motor impairment” such neurorehabilitation would be of most benefit, and to evaluate if sessions given for longer period of time — or “booster sessions” — show long-term benefit.

In this study, outcomes suggest that people with early to moderate disease gain most in terms of “slow progression of disability and to avoid longer hospitalization/rehospitalization and consequently higher financial costs,” they added.