Current developments and new trends were the focus of this year’s congress on Parkinson’s disease and movement disorders. In view of the enormous growth in knowledge from preclinical and clinical research, it is becoming increasingly difficult to maintain an overview in everyday clinical practice. For example, technical methods are increasingly finding their way into the clinic, offering better opportunities to individualize therapy management.
A new concept is being pursued by TIZIAN, a telemedicine-assisted day hospital [1]. Patients with Parkinson’s syndromes and other movement disorders require highly specialized multimodal treatment. Within the existing supply structures, these are not satisfactorily represented. The concept thus refers to patients with a worsening of defined target symptoms who, due to the chronicity of an existing neurological disease, require medical treatment and high-frequency, target-oriented therapies and benefit from sports therapy measures from a secondary or tertiary preventive point of view. Both must be performed regularly and continuously to achieve sustained effectiveness. In TIZIAN, medical therapy, exercise and sports therapy procedures, and motivation for sustained self-training are provided via a combination of therapy in the clinic and telemedicine treatment at home. Traditional inpatient therapy is complemented by interactive, asynchronous digital platforms, synchronous video consultation and teletherapy – monitoring of therapy is possible in inpatient and home settings. The combination of analog therapy in the day clinic and digital therapy at home enables individualized treatment appropriate to everyday life. In this context, telemedicine services serve to expand the range of inpatient treatment options. Increased patient involvement from the start of treatment supports this concept in its mode of action. All therapies must be performed at high frequency, regularly and continuously. In this context, accompanying motivation support and training for self-training is essential in order to maintain the changes achieved during therapy and long-term therapy and sports adherence. The goal, higher therapy intensity and frequency, is achieved via a daily alternation of therapy in the day clinic and telemedical digital treatment at home. Empowering self-training via asynchronous video therapy and prompting therapists to contact them when needed or provide feedback, promotes patient empowerment. Patients are thus actively involved in the treatment process.
The concept was tested in 60 patients who received symptom- and indication-specific medical-therapeutic treatment in the clinic and telemedical care at home [2]. The latter included synchronous visits and therapies and an asynchronous therapy program for independent training. For this purpose, a prepared tablet with apps especially for patients with mobility impairments was handed out and, in addition, comprehensive instruction was given on how to interact with the tablet, as well as support if necessary. To assess the feasibility of the concept, the asynchronous self-training as well as the implementation and possible complications of the teletherapies and televisits were documented and evaluated. The evaluation showed positive results regarding the feasibility of telemedicine-assisted interventions. However, the feasibility of such a concept is closely associated with training of the persons concerned as well as their support also during the telemedicine-assisted intervention. With the help of patient-oriented instruction in the technology and support, it was possible to carry out 919 synchronous teleconsultations. 85.6% of tele-therapies and 61.5% of tele-visits could be performed. Those with advanced PD or low affinity for technology benefited most from the technical support. High training times with up to 86 minutes per week could also be generated by means of asynchronous self-training. A prerequisite, however, is good usability, which, together with data protection, has repeatedly presented developers with challenges.
Speech production in Parkinson’s disease
While the effects of Parkinson’s disease (PD) on the motor aspects of language production are well described, changes in the logical architecture of language are much less studied. There is evidence of basal ganglia involvement in higher cognitive processes such as language development, which is why basal ganglia dysfunction such as PD has an impact on language production effects. The goal of one study was to investigate changes in syntactic complexity in the spontaneously produced speech of [3]. For this purpose, 15 native-speaking Parkinson’s disease patients in on-levodopa status and 15 healthy control subjects were analyzed with regard to their ability to tell a story. Beforehand, all participants underwent a neuropsychological examination. It has been observed that Parkinson’s patients use fewer syntactically complex structures, shorter words and sentences, and fewer turns of phrase in conversation. Sentences with subordinate clauses also had longer dependency intervals. Dependency distance is the linear distance between two syntactically related words in a sentence and an index of sentence complexity. This suggests that the affected individuals have difficulties not only with subordinate clauses per se, but also with syntactic structures. The assessment of syntactic complexity has not been represented in standard tests and rating scales for the diagnosis of PD. However, the results suggest that measurement could be useful.
Movement and voice
In another research project, the voice was also the focus of the investigation: The aim was to find out to what extent the resource-oriented group intervention “Movement and Voice” has an influence on the subjective well-being of people with Parkinson’s [4]. The background is that voice and communication disorders in particular have a negative impact on well-being. Therefore, the interdisciplinary group offer of the departments of psychomotricity and speech therapy is aimed at mildly to moderately severely affected persons. Positive back reports suggest that the course is having an impact on well-being. To test this assumption, a mixed-methods design was developed and quantitative and qualitative data were collected. For this purpose, the WHO-5 questionnaire on well-being, the Brief Questionnaire on General Well-Being (FAHW-12), parts of the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39) and the Parkinson’s Well-Being Map, and a guided interview were used. In the experimental group, the WHO5 questionnaire showed an increase in subjective well-being. The control group showed no significant change. The course participants expressed that they feel good in the course and can forget their illness for a moment. As a conclusion it can be deduced that the course offer “Connection of movement and voice” strengthens the confidence in one’s own abilities and the subjective well-being increases at least for a certain time.
Cognitive training also has an effect on physical activity
The diagnosis of mild cognitive impairment (MCI) is associated with a decrease in activity and increased sedentary behavior (e.g., sitting, lying down) in individuals with Parkinson’s disease (PD). This leads to impairments in the activities of daily living. Now, we investigated whether cognitive training positively influences activity in the home environment of individuals with PD, collected using motion sensors [5]. The aim was to explore short-term effects of cognitive multi-domain training (KT) compared to physical control training (PT) on physical activity and sedentary behavior (recorded by accelerometry in the home setting) in patients with PD-MCI. Over a six-week period, patients received either KT or an exercise program with two sessions per week and 90 minutes of exercise each. Physical activity and sedentary behavior were recorded pimarily, and cognitive domain scores and clinical parameters were recorded secondarily. It was found that the patients with KT had significantly more active periods than sufferers with exercise program. It can be concluded that KT have the potential to increase physical activity in PD-MCI patients. Accordingly, measures to promote an active lifestyle could counteract or prevent cognitive performance impairments and limitations in the activities of daily living. This is because cognitive impairment and limitations in activities of daily living are related to a more inactive lifestyle.
Corona in view
The Covid 19 pandemic presented new challenges to populations worldwide. However, people with neurodegenerative diseases may suffer particularly from, for example, contact restrictions and isolation. Therefore, the aim of one paper was to investigate whether a difference in the severity of the psychosocial and physical effects of the pandemic on PD patients could be detected compared to a healthy control group [6]. Data from 179 Parkinson’s disease patients were compared with those from 774 non-Parkinson’s disease patients. The results show that there were few differences between PD patients and non-PD patients in terms of psychosocial outcomes. The severity of PD symptoms slightly influenced the psychosocial impact of the pandemic within the PD cohort. The change in physical activity before and during the pandemic was not significantly different between the two cohorts. In both cohorts, nearly half of the subjects had reduced levels of physical activity. It is thought that people with PD may be comparatively more crisis-tested and flexible because of their condition, and may have a larger support network, so that they are no less able to cope with the limitations and changes of the pandemic.
Congress: Highlights Digital 2023
Literature:
- Grotherr J, Kirchner A, Gausepohl M, et al.: TIZIAN – Das Konzept einer telemedizinisch-gestützten Tagesklinik für Parkinson und Bewegungsstörungen. Poster 01-007. Highlights Digital 2023.
- Grotherr J, Gausepohl M, Kirchner A, et al.: Machbarkeit von synchronen und asynchronen telemedizinisch gestützten Interventionen für Parkinson-Patient*innen. Poster 01-002. Highlights Digital 2023.
- Tang K, Mirkhaef SZ, Henkel J, et al.: Language production in Parkinson’s Disease: Measuring Syntactic Complexity. Poster 01-009. Highlights Digital 2023
- Hunziker E, Degen U: Was haben Bewegung und Stimme mit Wohlbefinden zu tun? Studie zu einem zeitlich begrenzten Kursangebot. Poster 01-008. Highlights Digital 2023.
- Bode M, Sulzer P, Schulte C, et al.: Kognitives Training verbessert die körperliche Aktivität von Personen mit Morbus Parkinson und leichter kognitiver Beeinträchtigung. Poster 01-004. Highlights Digital 2023
- Chidex LM, Sünkel U, Kudelka J, et al.: Comparison of a Parkinson’s disease cohort with a non-Parkinson’s disease cohort regarding psychosocial and physical effects of the COVID-19 pandemic. Poster 01-005. Highlights Digital 2023.
InFo NEUROLOGIE & PSYCHIATRIE 2023; 21(2): 22–23
HAUSARZT PRAXIS 2023; 18(5): 46–47
