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Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement

Goldman, Jennifer G; Volpe, Daniele; Ellis, Terry D; Hirsch, Mark A; Johnson, Julia; Wood, Julia; Aragon, Ana; Biundo, Roberta; Di Rocco, Alessandro; Kasman, Glenn S; Iansek, Robert; Miyasaki, Janis; McConvey, Victor M; Munneke, Marten; Pinto, Serge; St Clair, Karen A; Toledo, Santiago; York, Michele K; Todaro, Ronnie; Yarab, Nicole; Wallock, Kristin
BACKGROUND:Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE:The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS:The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS:The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS:Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.
PMID: 38277303
ISSN: 1877-718x
CID: 5625422

Art therapy as a comprehensive complementary treatment for Parkinson's disease

Ettinger, Tom; Berberian, Marygrace; Acosta, Ikuko; Cucca, Alberto; Feigin, Andrew; Genovese, Danilo; Pollen, Travis; Rieders, Julianne; Kilachand, Rohita; Gomez, Clara; Kaimal, Girija; Biagioni, Milton; Di Rocco, Alessandro; Ghilardi, Felice M; Rizzo, John-Ross
INTRODUCTION/UNASSIGNED:Parkinson's disease (PD) is the second most prevalent neurodegenerative disease. Complementary and alternative therapies are increasingly utilized to address its complex multisystem symptomatology. Art therapy involves motoric action and visuospatial processing while promoting broad biopsychosocial wellness. The process involves hedonic absorption, which provides an escape from otherwise persistent and cumulative PD symptoms, refreshing internal resources. It involves the expression in nonverbal form of multilayered psychological and somatic phenomena; once these are externalized in a symbolic arts medium, they can be explored, understood, integrated, and reorganized through verbal dialogue, effecting relief and positive change. METHODS/UNASSIGNED:42 participants with mild to moderate PD were treated with 20 sessions of group art therapy. They were assessed before and after therapy with a novel arts-based instrument developed to match the treatment modality for maximum sensitivity. The House-Tree-Person PD Scale (HTP-PDS) assesses motoric and visuospatial processing-core PD symptoms-as well as cognition (thought and logic), affect/mood, motivation, self (including body-image, self-image, and self- efficacy), interpersonal functioning, creativity, and overall level of functioning. It was hypothesized that art therapy will ameliorate core PD symptoms and that this will correlate with improvements in all other variables. RESULTS/UNASSIGNED:HTP-PDS scores across all symptoms and variables improved significantly, though causality among variables was indeterminate. DISCUSSION/UNASSIGNED:Art therapy is a clinically efficacious complementary treatment for PD. Further research is warranted to disentangle causal pathways among the aforementioned variables, and additionally, to isolate and examine the multiple, discrete healing mechanisms believed to operate simultaneously in art therapy.
PMCID:10215005
PMID: 37250693
ISSN: 1662-5161
CID: 5526392

Art therapy for Parkinson's disease

Cucca, Alberto; Di Rocco, Alessandro; Acosta, Ikuko; Beheshti, Mahya; Berberian, Marygrace; Bertisch, Hilary C; Droby, Amgad; Ettinger, Tom; Hudson, Todd E; Inglese, Matilde; Jung, Yoon J; Mania, Daniella F; Quartarone, Angelo; Rizzo, John-Ross; Sharma, Kush; Feigin, Andrew; Biagioni, Milton C; Ghilardi, M Felice
OBJECTIVE:To explore the potential rehabilitative effect of art therapy and its underlying mechanisms in Parkinson's disease (PD). METHODS:Observational study of eighteen patients with PD, followed in a prospective, open-label, exploratory trial. Before and after twenty sessions of art therapy, PD patients were assessed with the UPDRS, Pegboard Test, Timed Up and Go Test (TUG), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale and PROMIS-Self-Efficacy, Montreal Cognitive Assessment, Rey-Osterrieth Complex Figure Test (RCFT), Benton Visual Recognition Test (BVRT), Navon Test, Visual Search, and Stop Signal Task. Eye movements were recorded during the BVRT. Resting-state functional MRI (rs-fMRI) was also performed to assess functional connectivity (FC) changes within the dorsal attention (DAN), executive control (ECN), fronto-occipital (FOC), salience (SAL), primary and secondary visual (V1, V2) brain networks. We also tested fourteen age-matched healthy controls at baseline. RESULTS:At baseline, PD patients showed abnormal visual-cognitive functions and eye movements. Analyses of rs-fMRI showed increased functional connectivity within DAN and ECN in patients compared to controls. Following art therapy, performance improved on Navon test, eye tracking, and UPDRS scores. Rs-fMRI analysis revealed significantly increased FC levels in brain regions within V1 and V2 networks. INTERPRETATION/CONCLUSIONS:Art therapy improves overall visual-cognitive skills and visual exploration strategies as well as general motor function in patients with PD. The changes in brain connectivity highlight a functional reorganization of visual networks.
PMID: 33526323
ISSN: 1873-5126
CID: 4776032

Barriers to Vaccination Among People with Parkinson's Disease and Implications for COVID-19

Phanhdone, Tiffany; Drummond, Patrick; Meisel, Talia; Friede, Naomi; Di Rocco, Alessandro; Chodosh, Joshua; Fleisher, Jori
BACKGROUND:Patients with Parkinson's disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. OBJECTIVE:To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. METHODS:Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. RESULTS:Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. CONCLUSION/CONCLUSIONS:Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.
PMID: 33935103
ISSN: 1877-718x
CID: 4865872

Art Therapy for Parkinson's disease: preliminary findings from the ExplorARTPD Study [Meeting Abstract]

Cucca, A.; Di Rocco, A.; Acosta, I.; Berberian, M.; Bertish, H.; Inglese, M.; Mania, D.; Quartarone, A.; Rizzo, J.; Ghilardi, M.; Feigin, A.; Biagioni, M.
ISI:000663065900410
ISSN: 1351-5101
CID: 4989352

Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study

Fleisher, Jori E; Sweeney, Meghan M; Oyler, Sarah; Meisel, Talia; Friede, Naomi; Di Rocco, Alessandro; Chodosh, Joshua
Background/UNASSIGNED:care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL. Methods/UNASSIGNED:Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including history, examination, medication reconciliation, psychosocial evaluation, pharmacologic and nonpharmacologic management, and service referrals. Disease severity, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS), and QoL using the Neuro-QoL were measured at visits 1 and 4. Results/UNASSIGNED:= 0.19-0.95). Conclusions/UNASSIGNED:Homebound individuals with advanced PD receiving interdisciplinary home visits experienced no significant decline in QoL over 1 year, despite disease progression. Our findings highlight the disease severity and impaired QoL of the advanced, homebound PD population, and the potential for novel approaches to foster continuity of care.
PMCID:7508339
PMID: 32983607
ISSN: 2163-0402
CID: 4616432

Visual-Spatial Dysfunction in Parkinson's Disease: an Exploratory Multimodal Biomarker Study [Meeting Abstract]

Cucca, Alberto; Droby, Amgad; Beheshti, Mahya; Acosta, Ikuko; Mania, Daniella; Sharma, Kush; Berberian, Marygrace; Bertish, Hilary C.; Hudson, Todd; Di Rocco, Alessandro; Ghilardi, Maria Felice; Inglese, Matilde; Rizzo, John-Ross; Biagioni, Milton; Feigin, Andrew
ISI:000536058006120
ISSN: 0028-3878
CID: 4561632

NEURAL CORRELATES OF VISUOSPATIAL DYSFUNCTION IN PARKINSON'S DISEASE: A MULTIMODAL BIOMARKER STUDY [Meeting Abstract]

Cucca, A.; Mania, D.; Sharma, K.; Acosta, I.; Berberian, M.; Beheshti, M.; Biagioni, M.; Droby, A.; Di Rocco, A.; Ghilardi, M. F.; Inglese, M.; Rizzo, J. R.; Feigin, A.
ISI:000614411700126
ISSN: 1353-8020
CID: 4790882

Effects of rTMS and intensive rehabilitation in Parkinson's Disease on learning and retention

Marchesi, Giorgia; Albanese, Giulia Aurora; Ferrazzoli, Davide; George, Shaina; Ricci, Serena; Tatti, Elisa; Di Rocco, Alessandro; Quartarone, Angelo; Frazzitta, Giuseppe; Ghilardi, M Felice
Movement is accompanied by modulation of oscillatory activity in different ranges over the sensorimotor areas. This increase is more evident in normal subjects and less in patients with Parkinson's Disease (PD), a disorder associated with deficits in the formation of new motor skills. Here, we investigated whether such EEG changes improved in a group of PD patients, after two different treatments and whether this relates to performance. Subjects underwent either a session of 5 Hz repetitive Transcranial Magnetic Stimulation (rTMS) over the right posterior parietal cortex or a 4-week Multidisciplinary Intensive Rehabilitation Treatment (MIRT). We used a reaching task with visuo-motor adaptation to a rotated display in incremental 10° steps up to 60°. Retention of the learned rotation was tested before and after either intervention over two consecutive days. High-density EEG was recorded throughout the testing. We found that patients adapted their movements to the rotated display similarly to controls, although retention was poorer. Both rTMS and MIRT lead to improvement in retention of the learned rotation. Mean beta modulation levels changed significantly after MIRT and not after rTMS. These results suggest that rTMS produced local improvement reflected in enhanced short-term skill retention; on the other hand, MIRT determined changes across the contralateral sensorimotor area, reflected in beta EEG changes.
PMID: 31374802
ISSN: 1945-7901
CID: 4032392

Outcomes of intradetrusor botulinum toxin injection in patients with Parkinson's disease [Meeting Abstract]

Vurture, G; Peyronnet, B; Feigin, A; Biaginoi, M; Gilbert, R; Rosenblum, N; Frucht, S; DiRocco, A; Nitti, V; Brucker, B
Introduction: To date, only very few series have aimed to assess the outcomes of botulinum toxin injections in patients with Parkinson's Disease (PD). The aim of this study was to assess the safety and efficacy of intradetrusor onabotulinum toxin A injections for the treatment of overactive bladder (OAB) in patients with PD.
Method(s): All PD patients who underwent intradetrusor injections of onabotulinum toxin A (BoNT-A) for storage symptoms between 2010 and 2017 were included in a retrospective study. A 100 U dose of BoNT-A (Botox, Allergan Irvine, CA) was used for the first injection in all patients. The primary endpoint was clinical success defined as any subjective improvement in OAB symptoms self-assessed by the patients four weeks after the injections.
Result(s): Out of 24 patients analyzed, 19 reported improvement of their OAB symptoms four weeks after the first injection (79.2%) with complete resolution of urgency urinary incontinence in 7 patients (29.1%; p<0.001). The average post-void residual (PVR) increased significantly after the first injection from 17.6 to 125.3 ml (p<0.001). Three of the patients had to start clean intermittent catheterization (CIC) after the first injection (12.5%). Out of 49 injections in total, only five caused incomplete bladder emptying requiring the use of CIC (10.2%). Higher pre-injection PVR was significantly associated with both a lower chance of symptomatic improvement (p=0.04) and a higher risk of incomplete bladder emptying with institution of CIC (p=0.047).
Conclusion(s): Botox appeared effective in PD patients with a relatively low rate of retention requiring CIC. Higher preoperative PVR was the stronger predictor of both treatment failure and postoperative urinary retention requiring CIC while urodynamic obstruction was also associated with treatment failure in male patients. Intradetrusor injections of BoNT-A 100 U appeared as a safe and effective option in PD patients with OAB symptoms and a low PVR before the injection
EMBASE:628915378
ISSN: 1520-6777
CID: 4060362