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Funding from The Parkinson Alliance helped to finance the following Parkinson's research. Grantees were selected by scientific review committees of participating organizations. Updates will be posted, when available.
Project Title: Cedars-Sinai Comprehensive Interdisciplinary Rehabilitation Treatment Program for Parkinson’s Disease
Investigators/Organizers: Jeffrey Wertheimer, Ph.D. and Stephanie Lewis, SLP
Rationale: Parkinson’s disease (PD) is a complex, debilitating medical condition that is comprised of a several motor and non-motor symptoms. There is extensive research regarding pharmacotherapy and neurologic surgery for PD, and research demonstrating the benefit of individual rehabilitation treatment approaches for specific symptoms of PD, such as physical therapy for disturbances in gait and balance, speech therapy for voice disturbance, and cognitive rehabilitation for executive dysfunction. There are limited comprehensive outpatient interdisciplinary rehabilitation treatment programs, however, that collaboratively address the array of symptoms associated with PD. Furthermore, there is an absence of evidenced-based outpatient interdisciplinary rehabilitation intervention for individuals with PD and their care providers that address both the complex motor and non-motor symptoms related to PD and the distress such an illness can have on the individual with PD and his/her care provider.
1. To provide a comprehensive and structured rehabilitative program for patients with PD and their care providers through a variety of therapy techniques, education and support.
2. Establish empirically-based practice for a comprehensive treatment program.
Methods/Design: The CIRT Program is designed for individuals with PD and their care providers. The program is designed to have 8 participants (4 individuals with PD and their respective care providers/significant others). The program is an 8-week program that meets 2 times per week, 3 hours per day. Week 1 and week 8 are designed for the initial evaluation and post-treatment evaluation, respectively, resulting in 6 weeks of formal intervention. There will be a one-month follow-up session after the completion of the program. There will be a wait-list control group. In other words, there will be a separate group of 8 participants (4 individuals with PD and 4 care providers) who will undergo evaluations at the same time periods as the group receiving treatment. This second group, however, will not receive their treatment until after the first group has completed their one-month follow-up. The rehabilitation team members include a Physical Therapist, Occupational Therapist, Speech Therapist, Neuropsychologist, and Social Worker. A Movement Disorder Specialist is also integral to the rehabilitation team, particularly as it relates to appropriate referrals and discharge planning.
Relevance to Treatment of Parkinson’s Disease: The CIRT Program was established to advance evidence-based treatment for individuals with PD with the goal to improve functionality and psychological well-being, and to assist care providers/significant others with coping with the physical, psychological, and psychosocial issues ensuing from PD.
Expected Outcome: The components of the group were conceptually derived and developed in response to the medical necessity to address the many facets of difficulties that individuals with PD and their care providers experience. Expected outcomes include functional improvement for the individual with PD and increased emotional well-being and adjustment for the person with Parkinson’s and the care provider. This program is also designed to serve as a preventive approach to the development of psychological distress (or worsening of) over time.
Project Title: What Patients Look at When Walking
Investigators/Authors: Mark Hallett, MD; Codrin Lungu, MD
Objective/Rationale: Difficulties with walking is often a significant problem for patients with Parkinson disease. Not only is walking slow, but there are also occasional falls and freezing (getting “stuck” in place). Freezing, in particular, is often refractory to medication and even Deep Brain Stimulation (DBS). Freezing is sometimes precipitated by visual stimuli (like encountering a doorway) or relieved by visual stimuli. One of the difficulties in understanding this is that there is no information on where patients are looking while they are walking. With this project, we will study where patients are looking and determine how that influences walking.
Project Description/Methods/Design: The aim is to see where patients with Parkinson disease look when walking. An eye tracking device will be used that allows patients to walk freely. The system will record a video of what is in front of the patient and then indicate exactly what the eyes are focused on in that scene. A comparison will be done between patients and age/sex matched healthy subjects. Exploratory studies will be done first to develop detailed hypotheses. We will study subjects walking in various situations including a plain corridor, a corridor with many objects, a corridor with horizontal lines on the floor, and a corridor with a door to go through. A door often makes walking more difficult, while horizontal lines on the floor might be helpful. Some variability of influence might depend on where the patient is looking.
Relevance to Treatment of Parkinson’s Disease: It is clearly critical in walking to know what lies ahead and how to deal with it. If it is determined that there are systematic abnormalities in where patients are looking, then it might be possible to improve walking by training patients to look differently. The biggest impact could be on freezing of gait where visual stimuli are known to be important.
Expected Outcome: The first outcome is basic knowledge about the coupling of vision and walking in patient with Parkinson disease. Certain types of visual-motor coordination are known to be impaired in patients, and this might be another example, with bad consequences. The second outcome is a set of ideas of how to improve physical therapy gait training. It might also be possible to develop new ideas for devices that would aid vision to help improve gait.
Project Title: Speech and Deep Brain Stimulation: Treatment Options
Investigators/Authors: Elina Tripoliti, PhD; Lorraine Ramig, PhD, CCC-SLP; Cynthia Fox, PhD, CCC-SLP
Objective/Rationale: Speech can be adversely affected by bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with significant impact on patients’ Quality of Life. The information available to speech clinicians who assess and treat the speech disorders related to STN-DBS is not well-consolidated or presented for the practicing clinician. Further, information regarding the array of treatment options for speech disorders following STN-DBS are not well categorized. This online course will serve to educate speech clinicians, physicians, researchers and patients on key variables related to speech and DBS.
Project Description/Methods/Design: This course will discuss three areas of the speech-DBS literature including: 1) A brief overview of basal ganglia anatomy and physiology and description of deep brain stimulation as a treatment for PD; 2) The various clinical and surgical factors that can affect speech as well as predictive factors on speech response; and 3) Treatment options, classified in two broad categories: behavioral theories (such as the Lee Silverman Voice Treatment) and biofeedback, and multidisciplinary team work coordinating adjustment of electrical parameters (frequency or amplitude of stimulation) and /or repositioning of the electrodes. The paramount importance of team work when working with patients post STN-DBS will be emphasized.
Relevance to Treatment of Parkinson’s Disease: Educating professionals who work with people with PD post STN-DBS is an important step to improving the care of speech following this surgery. This education course may impact treatment management of speech following STN-DBS in a positive way. Further, this course may encourage clinicians to seek further knowledge and/or professional collaborations in their care of people with PD post DBS.
Expected Outcome: We anticipate that speech clinicians, physicians, researchers, and people with PD from around the world will have access to this ONLINE educational course. This will help improve the quality of care of speech following DBS.
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