Rome, 28 Nov. – Parkinson’s disease is a movement disorder that includes three fundamental symptoms: slowing and lack of motor initiative (bradykinesia); this can be associated with tremor (mainly at rest) and muscle rigidity. It typically begins in adulthood (it is the second most common neurodegenerative disease), after the age of 50, although there is no shortage of early-onset forms.
“It is a progressive disease – explains Professor Anna Rita Bentivoglio, Director of the Movement Disorders Unit of Fondazione Policlinico Gemelli Irccs and Associate of Neurology at the Catholic University, Rome campus – but the name ‘Parkinson’s disease’ refers to many different forms; for this reason, when we neurologists communicate the diagnosis, we recommend the patient not to rely on the Internet because there he can find stories that will never belong to him. Being a movement disorder – continues the expert – the therapy aims to restore a neurotransmission that has been reduced, by administering levodopa-based drugs, we must also work to restore movement by making the patient move, with rehabilitation interventions in the different phases of the disease disease. And occupational therapists and speech therapists with specific training for Parkinson’s must also intervene in these patients. Rehabilitation is a non-pharmacological complementary therapy. Those who do high intensity sports not only have a symptomatic benefit, but promote release in the brain of trophic factors, which improve some aspects of neurodegenerative diseases and slow down aging”.
“The approach to the patient with Parkinson’s disease – states Professor Paolo Calabresi, Professor of Neurology at the Catholic University of the Sacred Heart and director of the Uoc of Neurology, Fondazione Policlinico Gemelli Irccs – must be holistic. It is not just the pill : around this there must be someone who integrates and facilitates the patient’s interaction with the surrounding environment, engaging him in interventions that do not only aim to be together with others to avoid loneliness of how fundamental physical activity is, especially in the initial stages of Parkinson’s disease.”
People with Parkinson’s are welcomed at Gemelli in a multidisciplinary clinic that works alongside geriatricians to manage the many comorbidities and consequent possible pharmacological interactions. “We take care of fragile patients – states Maria Rita Lomonaco, head of the Neurogeriatrics Unit, Gemelli Polyclinic and professor at the Catholic University – and the patient with Parkinson’s disease is in fact fragile, for whom prevention must be carried out against the possibility of suffering from disability; and much can be done to prevent progression to disability.”
Physiotherapists, speech therapists and occupational therapists are the team that must assist the neurologist in the management of people with Parkinson’s disease but except for rare examples of excellence, such as the Netherlands, there is a lack of specifically trained figures for the treatment of these patients.
“The degree course in physiotherapy – recalls Dr. Francesca Di Caro, physiotherapist, coordinator of high intensity rehabilitation at the Gemelli Polyclinic, director of the professional teaching and internship activities of the Degree Course in Physiotherapy at the Catholic University – provides basic training on a whole series of pathologies, from pediatric musculoskeletal ones, to neurological ones in adults and children; but to date there is a lack of ad hoc courses and specialized training on Parkinson’s”.
But things could soon change for the better. In fact, Gemelli takes part in a European project aimed at training physiotherapists, occupational therapists and speech therapists dedicated to Parkinson’s disease, within the Horizon Europe Programme. “It’s called Action PD (Accelerate The Implementation Of Networkcare for Parkinsons Disease) – explains Dr. Danilo Genovese, neurologist at the Gemelli Polyclinic, doctoral student in Neuroscience at the Catholic University – and it is a European project coordinated by the Netherlands which proposes an integrated care model , focused on people with Parkinson’s. For about twenty years, the Parkinson Net institution has been training specialists dedicated to this disease, also providing education and training for patients and caregivers. The aim of the European project is to disseminate their experience and culture to train ad hoc specialists in the participating countries (Italy with Fondazione Policlinico Gemelli Irccs and the University of Padua; France with the University of Toulouse and Poland with the University of Silesia, Katowice. By 2025). 50 physiotherapists, occupational therapists and speech therapists dedicated to Parkinson’s disease will be trained at Gemelli”.
But in the meantime the work at Gemelli continues. “Rehabilitation assists pharmacological therapy and is precious – states Doctor Diego Ricciardi, physiotherapist, responsible for the rehabilitation activity in people with Parkinson’s disease at the Gemelli Polyclinic – Our program combines motor activity with the rehabilitation aspect; it is personalized in based on the patient’s age, functional abilities and stage of the disease. Rehabilitation activities are carried out in groups because socialisation, discussion and not feeling alone helps patients and motivates them; exercises are the same for everyone, then it is up to the therapist to personalize each patient.”
But physiotherapy is only one of the three pillars. Occupational therapy and speech therapy are also essential.
“In people with Parkinson’s – recalls Dr. Giordana Ratto, speech therapist, Policlinico Gemelli – we deal with dysphonia (voice problems) and dysarthria (articulation of speech), but also with dysphagia (swallowing) problems and patients with Parkinson’s and cognitive problems”.
“In these people, who have difficulties especially in fine manual skills – explains Dr. Martina Antonacci, occupational therapist at the Gemelli Polyclinic – we try to facilitate the carrying out of daily activities, relating both to personal care (e.g. fastening buttons) and to work and free time, leveraging his residual functionality and finding a strategy to overcome obstacles. For example, a patient who has difficulty tying his shoes can overcome the obstacle with a verbal strategy that gives him a rhythm (e.g.
repeat a nursery rhyme out loud while tying his shoes) or we teach him to use aids (e.g. cutlery with a particular handle). This improves patients’ autonomy and quality of life.”
Finally, the Neurology group involved in Parkinson’s is also carrying out, together with Sports Medicine, a project financed by the Ministry of Health on high intensity physical activity in patients with Parkinson’s disease. “After an accurate functional, cardio-metabolic evaluation of these patients – explains Dr. Gloria Modica, Sports Medicine doctor at the Gemelli Polyclinic, PhD student in Neuroscience at the Catholic University, Rome campus – we establish the individualized vigorous training thresholds. This project will enroll a total of 25 ‘active’ and 25 ‘sedentary’ patients (controls)”.
(Red)
