Complementary therapies are sometimes prescribed for the treatment of Parkinson’s disease.
Physiotherapy: In Parkinson’s there is an alteration in the generation of internal rhythm and internal cues to perform repetitive acts. Some authors suggest rehabilitation through the use of rhythm. The improvement obtained is accompanied by a metabolic increase in several brain areas involved in sensorimotor processes in the positron emission tomography (PETscan diagnostic technique). Learning the use of internal and external cues is very useful.
Speech therapy: The presence of speech and voice disorders in Parkinson’s disease manifests itself throughout the course of the disease and, above all, in its advanced stages. However, in the early stages, articulatory difficulties or lack of voice power may already appear. In a study of 230 patients conducted by Logemann in 1978, 70% were found to have speech and/or voice disorders, 29% of whom stated that these disorders were the major disability of the disease. Several studies have demonstrated the efficacy of speech therapy in Parkinson’s patients and, in some of them, the maintenance of the benefit between six and twelve months post-treatment. Even when good articulation is achieved, the lack of facial expression and the decrease in blinking typical of Parkinson’s disease affect both the emission of information and its reception and interpretation. Therefore, Parkinson’s patients not only show difficulty in making changes in facial expression in accordance with the content of the message, but also in interpreting these changes when they are made by the interlocutor. On the other hand, the existence of language disorder is recognized in Parkinson’s disease. This means that, in Parkinson’s disease, the true intention of the speaker may not be correctly interpreted. An important part of this intention is conveyed through the so-called prosodic aspects such as rhythm, intonation and melody.
In addition, Parkinson’s patients may manifest oropharyngeal dysphagia affecting any of the three phases of the swallowing process: oral, pharyngeal and/or esophageal. It has been described that the incidence of these disorders to a greater or lesser extent is 95%, but the number of patients who recognize difficulties of this type is much lower. Thickener, a substance added to liquids to thicken them, can minimize the consequences of dysphagia, but is little known and little used.
Psychological therapy: As for the psychosocial impact, it can be said to be immediate. Following the diagnosis of Parkinson’s disease, there is an impact on the lives of affected individuals and their families, which will induce a series of changes both immediately and over the years. Sometimes the adjustment to these changes is not easy and the high prevalence of depression and anxiety in this disease does not help the process. Psychological counseling can provide the appropriate guidance for an easier and less painful adaptation and the application of psychoeducational programs such as the Edupark program, in early stages, is of great interest.
Cognitive rehabilitation: Most Parkinson’s patients develop some type of cognitive impairment (CA). In a study of 125 patients, 24% had evidence of cognitive dysfunction, with attention and executive functions being the prominent impairments in newly diagnosed Parkinson’s disease. Advanced age, late onset of the disease, duration of motor symptoms (i.e., more than 10-15 years of motor symptoms), severity of motor symptoms (rigidity and akinesia), rapid deterioration of executive functions, presence of hallucinations, and depression (30-50%), are predictors of further cognitive impairment in Parkinson’s disease. Cognitive alterations have functional repercussions: they affect quality of life, aggravating functional disability, favoring motor decline and increasing caregiver stress. Cognitive rehabilitation (CR) has been shown to be an effective treatment in different neurological diseases. It promotes brain plasticity, facilitates neuronal growth and induces functional reorganization. To date, there are few studies on the benefit of cognitive rehabilitation that highlight the improvement of executive functions and that the benefit is maintained six months later.
Parkinson’s disease: Objectives of complementary therapies
All complementary therapies aim to improve the quality of life of Parkinson’s patients by contributing to their independence and reintegration into social and family life.
Physiotherapy: Aims to delay and/or minimize the functional implications caused by the primary pathology or to correct and re-educate secondary complications, optimizing the patient’s resources to the maximum. Physiotherapy is responsible for: maintaining or improving ventilation; maintaining or improving articular arches; preserving muscular trophism, strengthening the musculature and preventing edema. Efforts will be made to re-educate posture; improve facial and body expression; straightening reactions, balance and coordination. In addition, strategies will be offered on how to proceed in the event of a blockage, training in the application of external or internal cues, and how to react to falls. Also, together with the occupational therapist, re-educate the execution of transfers or position changes.
Speech therapy: Speech therapy aims to make patients aware of their communication difficulties and to teach them techniques and strategies to improve speech intelligibility. Speech therapy also prevents and treats swallowing disorders.
Occupational therapy: Occupational therapy is a discipline that promotes the readaptation of the person who presents any handicap or disability, to access the maximum autonomy in their environment. Its main objectives are: to re-educate in order to improve the deficient functions, to readapt through the development of residual capacities taking into account the demands of daily life and the autonomy needs of the person and to advise the affected person and his or her family environment on practical solutions to favor the integration of the person in his or her environment.
Psychological intervention: In any of its modalities, the objective of psychological intervention is to improve the well-being of the person affected by Parkinson’s disease, reduce the emotional discomfort of the informal caregiver, promote personal autonomy and normalize the different areas of life. The purpose of cognitive-behavioral psychotherapy is to acquire self-management skills to effectively solve problems and to generalize the changes experienced during the sessions to daily life. This orientation is based on the assumption that most problem behaviors, emotions and thoughts are learned and can be modified through relearning.
Cognitive rehabilitation: The main objective is the development of strategies to improve the cognitive deficit produced by the brain dysfunction associated with Parkinson’s disease. It is proposed within the framework of a comprehensive rehabilitation plan that can begin with cognitive function training and end with training in problem solving.