Rehabilitation in Neurodegenerative

Disorders: Parkinson’s Disease, ALS &

MS

Dr. Saidkomol Khursandov

Sports Medicine
School of Medicine, CAU
Objectives of the
presentation

• Understand rehabilitation goals for PD, ALS, and MS

• Review key international guidelines and evidence
• Compare intervention strategies
• Agenda:
o Introduction to neurorehabilitation
o Detailed overview of PD, ALS, and MS
o Rehabilitation goals and interventions
Introduction to Definition & Purpose:
Neurorehabilitation
• Rehabilitation is a multidisciplinary,
patient-centered process designed
to maintain or improve function,
delay disability, and enhance
quality of life in chronic
neurodegenerative conditions.

Importance:

• Utilizes a team approach to

address physical, cognitive, and
psychosocial challenges.
Overview of Parkinson’s Disease (PD)
• Epidemiology & Pathophysiology:
o PD is a common neurodegenerative disorder characterized by loss of
dopaminergic neurons in the substantia nigra and the presence of Lewy
bodies.
• Key Symptoms:
• Motor: Tremor, bradykinesia, rigidity, postural instability.
• Non-motor: Cognitive changes, mood disturbances, sleep
problems.
 Types of
meds for PD
Challenges of PD management
Rehabilitation Goals for
PD

Primary Goals:

• Improve and maintain mobility and balance.

• Enhance speech, swallowing, and activities of
daily living (ADL).
• Reduce risk of falls and manage non-motor
symptoms.

Approach:

• Patient-centered and individualized goal setting.

PD Rehabilitation Interventions
• Physical Therapy:
o Gait training (e.g., treadmill, cueing techniques) and strength/flexibility
exercises.
• Occupational Therapy:
o ADL modifications and training with adaptive equipment.
• Speech Therapy:
o Techniques like LSVT LOUD for dysarthria.
• Cognitive Strategies:
o Similar to AD
LSVT LOUD - Speech Therapy for Parkinson’s Disease and
Similar Conditions

While LSVT LOUD treatment

has helped people in all
stages of PD, the majority of
research has been on those
in moderate stages of the
disease.
International Guidelines for PD Rehabilitation

Key Guidelines: Recommendations:

European Physiotherapy Guidelines for Emphasis on regular aerobic, resistance, and
Parkinson’s Disease (Keus et al., 2014) flexibility training.
NICE Guidelines for Parkinson’s Disease in Session frequency and intensity tailored to
Adults (NICE, 2017) individual needs.
MDS Movement Disorder Society (Insert a table or graphic summarizing
guideline recommendations)
 • European Physiotherapy Guideline (2014/2022 Update) :
o Core Focus : Structured exercise programs (aerobic,
resistance, flexibility) to improve gait, balance, and
transfers.
o Individualization : Tailor intensity/frequency to

Key Guidelines for

disease stage and patient goals.
o Evidence : Demonstrates positive impacts on
functional mobility and reduces disability.
Parkinson’s • NICE Guidelines (2017):

Disease o Exercise Emphasis : Recommend regular physical

activity to address motor/non-motor symptoms.

Management o Multidisciplinary Care : Integrate physiotherapy,

occupational therapy, and mental health support.
o Education : Provide resources for patients/caregivers
to manage symptoms.
• Visual Aid : Side-by-side comparison table highlighting
overlapping recommendations (e.g., exercise,
personalization).
 • Exercise as Medicine :
o High-intensity aerobic training improves VO₂
consumption and motor function.
o Resistance/flexibility training complements aerobic
regimens to address balance/falls.
• Personalized Care :
o Early intervention delays disease progression;
programs must adapt to individual needs.
Clinical • Multidisciplinary Approach :

Implications & o Collaboration across specialists ensures holistic

management (e.g., neurologists, PTs, psychologists)

Conclusion
2017.
• Patient Empowerment :
o Education and structured plans enable self-
management of symptoms.
• Call to Action : Prioritize exercise prescription and
longitudinal support for optimal outcomes.
• Visual Aid : Flowchart illustrating patient-centered exercise
plan development (e.g., assessment → goal-setting →
progress tracking).
Overview of
Amyotrophic
Lateral Sclerosis
(ALS)
 • Primary Goals:
o Maximize remaining function and prolong
independence.
o Delay symptom progression (e.g., prevent
Rehabilitation contractures, reduce pain).

Goals for ALS o Enhance respiratory function through

pulmonary physical therapy.
o Support communication with speech-
language interventions.
ALS Rehabilitation Interventions
• Gentle aerobic exercise, range-of-motion, and
Physical Therapy: stretching exercises.

Occupational • Adaptive equipment use, home modifications,

Therapy: and energy conservation strategies.

Speech-Language • Techniques for maintaining speech clarity and

Pathology: alternative communication devices.

• Inspiratory muscle training, lung volume

Pulmonary Therapy: recruitment, and manual assisted cough therapy.
Ref: Movement Disorder Society
Rehabilitation Therapies
for Multiple Sclerosis
Overview of Multiple Sclerosis (MS)
• MS is a chronic, immune-mediated disease affecting the central
nervous system.
• Rehabilitation is a key component of MS management to
maximize function and quality of life.
• This presentation outlines evidence-based rehabilitation
therapies as recommended by the National MS Society.
 • Improve physical function (mobility,
strength, balance).
• Enhance performance in activities of
daily living (ADLs).

Rehabilitation • Manage fatigue and pain while conserving

energy.

Goals for MS
• Optimize cognitive function and
communication skills.
• Promote overall quality of life and patient
self-management.
Impact of MS on Functionality
• MS affects mobility, balance, strength, and cognitive abilities.
• Symptoms such as fatigue, spasticity, and coordination
difficulties can limit daily activities.
• Early and ongoing rehabilitation helps reduce disability and
promotes independence.
Multidisciplinary Approach
• Successful MS rehabilitation relies on a coordinated team that
may include:
o Physical Therapists
o Occupational Therapists
o Speech and Language Pathologists
o Cognitive Rehabilitation Specialists
o Psychologists/Counselors
Physical Therapy in MS
• Focus Areas:
o Aerobic training to improve endurance
o Resistance and strength training to boost muscle power
o Balance and flexibility exercises to reduce fall risk
• Benefits:
o Increased mobility, improved gait, and enhanced overall physical function
Detailed Physical Therapy Strategies

Gait Training: Balance Exercises: Endurance Training:

Treadmill walking, Use of balance boards, Progressive aerobic
overground practice, stability exercises, and exercise programs
and use of assistive proprioceptive tailored to individual
devices if needed. training. capacity.
Occupational Therapy in MS

Enhancing independence in ADLs (dressing, bathing, cooking)

Focus: Energy conservation strategies and task simplification
Home and workplace environmental modifications

Benefits: Improved safety, reduced fatigue, and sustained participation

in daily life
Speech and Language Therapy
• Areas of Focus:
o Addressing dysarthria and communication difficulties
o Managing swallowing difficulties if present
o Cognitive-communication strategies to support social interaction
• Benefits:
o Enhanced speech clarity and improved quality of communication
Cognitive Rehabilitation

Strategies: Goals:
Memory and attention exercises Maintain and improve cognitive performance
Problem-solving and executive function Support everyday decision-making and task
training management
Computer-based cognitive programs and
structured tasks
Fatigue Management and Energy Conservation

• Techniques:
o Scheduling and prioritizing tasks
o Incorporating rest breaks and pacing activities
o Use of adaptive strategies and energy-saving devices
• Outcome:
o Reduced fatigue and improved participation in rehabilitation activities
Assistive Technology and
Adaptive Equipment

• Examples:
o Mobility aids (canes, walkers,
wheelchairs)
o Adaptive devices for ADLs (grab bars,
dressing aids)
o Computer access tools and
communication devices
• Impact:
o Enhances independence and safety
o Supports sustained engagement in daily
tasks
Integrative & Complementary
Approaches

• Additional Modalities:
o Mindfulness and stress reduction techniques
o Yoga or Tai Chi for balance and flexibility
o Aquatic therapy as a low-impact exercise option
• Benefits:
o Improved mood, reduced stress, and enhanced overall well-being
Psychological Support and Counseling

• Importance:
o Coping with the emotional impact of MS
o Addressing depression, anxiety, and social isolation
• Approaches:
o Individual counseling and cognitive-behavioral therapy (CBT)
o Support groups and patient education programs
Patient- • Key Points:
o Involve patients in developing

Centered Goal personalized rehabilitation goals

o Consider individual needs,
Setting preferences, and lifestyle
o Monitor progress with regular
assessments and adjust treatment
plans
• Outcome:
o Empowerment and improved
adherence to the rehabilitation
program
 Common Tools:
• MS Functional Composite (MSFC)
Outcome • Multiple Sclerosis Quality of Life
(MSQOL-54)
Measures and • Timed Up and Go (TUG) and 6-
Monitoring Minute Walk tests

Purpose:
• Track progress and adjust
therapies accordingly
MSFC
• The Multiple Sclerosis Functional Composite (MSFC) is
a standardized measure used to assess changes in three
key functional areas commonly affected by MS:
• Leg function/ambulation (often tested by the Timed 25-
Foot Walk),
• Arm/hand function (frequently measured by the 9-Hole
Peg Test), and
• Cognitive function (commonly evaluated using a test
such as the Paced Auditory Serial Addition Test, or PASAT).
MSQOL 54 & 29
The Multiple Sclerosis Quality of Life-54
(MSQOL-54) is a self-report
questionnaire specifically designed to
evaluate health-related quality of life in
individuals with MS. It combines the
general SF-36 Health Survey (which
assesses physical and mental health
domains) with 18 additional MS-specific
items, addressing issues such as
energy/fatigue, cognitive function, and
overall well-being. This approach
provides both physical and mental
summary scores
Barriers and Challenges

Limited access to specialized multidisciplinary care

Common Financial and insurance constraints
Barriers:
Patient adherence and variability in disease progression

Tele-rehabilitation and remote monitoring

Strategies to Advocacy for improved funding and support
Overcome:
Tailored, flexible treatment plans to meet individual needs
Summary and References
• Key Takeaways:
o Rehabilitation is vital for managing MS, PD and ALS and optimizing
function.
o A multidisciplinary approach tailors therapies to address physical,
cognitive, and emotional needs.
o Ongoing monitoring and individualized goal setting ensure effective
outcomes.
Major References

• Movement Disorder Society

• National MS Society, “Rehabilitation Therapies”
(https://www.nationalmssociety.org/for-professionals/for-healthcare-
professionals/managing-and-treating-ms/rehabilitation-therapies)
• Canadian Physical Activity Guidelines for MS
• ChatGPT