Effects of Rehabilitation Therapy on Parkinsonians' Disability and Functional Independence

In two single-blind studies, we evaluated the effects of a four-week intensive personal ized physical rehabilitation program in moderately advanced inpatients affected by Parkinson's disease (PD). Patients' functional performances were evaluated according to a standard protocol at admission, at the end of physical and occupational therapy sessions, and periodically thereafter. We used: 1) timed motor tasks; 2) standard assess ment of PD severity [by the Unified Parkinson's Disease Rating Scale (UPDRS), the Webster Rating Scale (WRS), the Northwestern University Disability Scale (NUDS)]; 3) activities of daily living by the Barthel Index (BI); 4) level of functional indepen dence by the Functional Independence Measure (FIM); and 5) parameters of motor function. The examining neurologist was blinded to the physical rehabilitation status of the patient. Despite the fact that the average daily dose of antiparkinsonian med ication did not change over the course of both studies, significant improvements were noted at the end of rehabilitative treatment in the functional independence of patients, as well as in dressing, personal hygiene, and UPDRS scores. Mean amplitude and speed of step were also significantly enhanced by the rehabilitative treatment. Timed tests were less sensitive to the treatment. The salutary effect wore off during the six months following the physical rehabilitative treatment. The patients evaluated at six months were still improved compared to their baseline state. Our results suggest that a short, intensive, multidisciplinary, personalized, inpatient rehabilitation program, possibly repeated twice per year, can produce a substantial improvement in the functional abil ities of PD patients.