Rehabilitation improves dyskinesias in Parkinsonian patients: A pilot study comparing two different rehabilitative treatments

Article type: Research Article

Authors: Frazzitta, Giuseppe^{a; *} | Bertotti, Gabriella^a | Morelli, Micaela^{c; i} | Riboldazzi, Giulio^d | Pelosin, Elisa^e | Balbi, Pietro^a | Boveri, Natalia^a | Comi, Cristoforo^f | Turla, Marinella^g | Leva, Serena^h | Felicetti, Guido^a | Maestri, Roberto^b

Affiliations: [a] Department of Neurorehabilitation, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy | [b] Department of Biomedical Engineering, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy | [c] Department of Toxicology and Centre of Excellence for Neurobiology of Dependence, University of Cagliari, Cagliari, Italy | [d] Center for Parkinson's Disease, Macchi Foundation, Varese and Department of Rehabilitation, “Le Terrazze” Hospital, Cunardo, Italy | [e] Department of Neurosciences, University of Genoa, Genoa, Italy | [f] Department of Neurology, University of the Eastern Piedmont, Novara, Italy | [g] Department of Neurology, Valle Camonica Hospital, Esine, Italy | [h] Department of Neurology, University of Insubria, Varese, Italy | [i] CNR Institute for Neuroscience, Section of Cagliari, Italy

Correspondence: [*] Corresponding author: Giuseppe Frazzitta, Department of Neurorehabilitation, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Via per Montescano, 27040 Montescano (PV), Italy. Tel.: +39 03852471; Fax: +39 038561386; E-mail: [email protected]

Abstract: Goal and objectives:The present study was devised: (a) to test whether an intensive (60 hours in 4 weeks) multidisciplinary rehabilitation treatment (involving physiotherapy, exercises to improve gait and balance using treadmill and stabilometric platform, occupational therapy) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 hours in 4 weeks involving physiotherapy only); and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage. Material and Methods:Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an intensive multidisciplinary (Group1) and 20 for a non-intensive non multidisciplinary rehabilitation treatment (Group2). The rating scales used for the clinical evaluation were: Unified Parkinson’s Disease Rating Scales (UPDRS) II, III, IV, Parkinson’s disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS). Results:All outcome measurements improved in both groups of patients, but patients Group1 presented better results: UPDRS II was reduced by 33% in Group1 and by 22% in Group2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg (p < 0.0001) in Group1 and was virtually unchanged (30 mg reduction, p = 0.08) in Group2. Conclusion:Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive.

Keywords: Parkinson's disease, intensive rehabilitation, dyskinesias

DOI: 10.3233/NRE-2012-0758

Journal: NeuroRehabilitation, vol. 30, no. 4, pp. 295-301, 2012