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International Parkinson and Movement Disorder Society
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Physiotherapy in Parkinson’s Disease: Clinical Implications of Current and Emerging Evidence

From the March 2020 issue of Moving Along
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On November 13 and 14, 2019, the Scientific Department of Physiotherapy in Movement Disorders of the Brazilian Association of Neurofunctional Physiotherapy (Associação Brasileira de Fisioterapia Neurofuncional - ABRAFIN) hosted a special educational session in Salvador, Bahia, Brazil for physiotherapists throughout the country working with Parkinson’s.  Support for the session was provided by the International Parkinson and Movement Disorder Society via the Developing World Education Program.

The event, led by course director Lorena Rosa Almeida, PT, PhD included a faculty comprised of MDS HP-SIG members Clynton Correa, PT, PhD, John Dean, MA CCC-SLP, Josefa Domingos, PT, MsC and Maria Elisa Piemonte, PT, PhD as well as movement disorders specialist, Guilherme Valença, MD, PhD.

Dr. Almeida began with a timely review of rehabilitation for individuals with Parkinson’s, highlighting current research on the topic and future directions. Dr. Almeida also had the opportunity to discuss her extensive research regarding falls in Parkinson’s, a topic of paramount importance within this population.

Dr Valença followed with an engaging discussion on the medical aspects of the Parkinson’s. In addition to being highly responsive to the numerous inquiries from the physiotherapists in attendance, Dr. Valença highlighted the influence of cognition on movement, belying his close work with the physiotherapy team at the Movement Disorders and PD Clinic at Roberto Santos General Hospital in Bahia and his close work with Dr. Almeida in particular.

Dr. Correa presented a solid overview of the neurobiology of physical exercise in Parkinson’s disease, including his earlier research on animal models and applications within the clinical environments, highlighting his recent work on functional assessments of cognition and intervention.

Dr Piemonte, who also serves as one of the co-chairs of the Health Professionals Special Interest Group (HP SIG), presented a lecture about interprofessional care in Parkinson's disease based on ICF model, laying out the essential elements for interdisciplinary teams and development for optimal care in Parkinson’s and related disorders.

Portuguese physiotherapist Josefa Domingos delivered a lecture that was a deep dive into the emerging hot topic of dual task interventions that combine movement, voice and cognition. These slides were complemented throughout by Ms. Domingos’ extensive library of videos featuring her direct clinical implementation of these approaches with individuals with Parkinson’s in addition to careful implementation with individuals with multiple system atrophy and even progressive supranuclear palsy, the significance of which was further bolstered by Dr. Valença’s second lecture on atypical parkinsonism.

Ms. Domingos, currently completing her PhD at Radboud University under Professor Doctor Bastiaan Bloem, also presented an in-depth review of the European guidelines for physiotherapy in Parkinson’s, of which she was one of the coeditors, working on the Portuguese translation with Dr. Almeida (Movement Disorders and PD Clinic, Roberto Santos General Hospital) and Tamine Capato (of the University of São Paulo). 

John M. Dean, the sole speech language pathologist at the event, presented a lecture highlighting how to incorporate breath, voice and language components into cognitive and physical interventions. His lecture also included a discussion of “cross-pollination” among the rehab clinicians, integrating aspects of each discipline’s intervention approaches into the different sessions in order to “prime” key concepts and enhance carryover while reinforcing goals specific to each discipline.  Mr. Dean also presented a session on rehab technologies in Parkinson’s, focusing on free and inexpensive tools that clinicians can implement in the clinical environment to improve outcomes and engagement with their patients.

One of the highlights of the two-day program was a practical session that included individuals with Parkinson’s, allowing the clinician to implement some of the concepts from the lectures. Not only was this an opportunity for collaboration and hands-on application of learning from the session, the demonstration segment engendered a lively discussion among the clinicians in attendance with valuable feedback the volunteers in their care partners. 

The program, which was attended by 44 physiotherapists from all over Brazil, represents the strength of partnerships between the International Parkinson and Movement Disorder Society and national entities such as ABRAFIN as a tool for increasing expertise and clinical competence among allied health professionals in the field of Movement Disorders.

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