What is the role of physiatry in a hospital patient's plan of care for Parkinson's disease?

Role of Physiatry in Hospital Patient Plan of Care for Parkinson's Disease

Physiatrists play a crucial role in the multidisciplinary management of hospitalized Parkinson's disease patients by providing specialized rehabilitation services that improve functional status, quality of life, and prevent complications.

Core Components of Physiatric Management

Assessment and Monitoring

• Regular assessment of functional status and health-related quality of life should be performed as part of longitudinal follow-up for Parkinson's disease patients during hospitalization 1
• Standardized assessment of motor function, including mobility, balance, and gait should be conducted to track disease progression and response to interventions 1
• Evaluation for dysphagia is essential, as swallowing dysfunction occurs in 60-80% of PD patients and requires specialized management 1

Physical Rehabilitation Interventions

• Both endurance and resistance exercises should be implemented as they slow disease progression and improve quality of life in Parkinson's disease patients 1
• Inspiratory muscle training using an inhalation trainer should be incorporated to increase respiratory muscle strength and improve quality of life as an adjunct to standard physical therapy 1
• Mobility and balance training are essential components to address postural instability and gait difficulties that characterize Parkinson's disease 2

Nutritional Management Collaboration

• Physiatrists should collaborate with dietitians to monitor nutritional status, as 15% of PD patients have malnutrition and another 24% are at medium or high risk 1
• Regular monitoring of body weight changes is crucial, as weight loss is associated with disease progression and increased energy expenditure from dyskinesias and rigidity 1
• Vitamin status monitoring, particularly vitamin D, folic acid, and vitamin B12, should be incorporated into the rehabilitation plan 1

Coordination of Multidisciplinary Care

Team Composition

• The physiatrist should coordinate with neurologists, physical therapists, occupational therapists, speech-language pathologists, and dietitians to provide comprehensive care 1, 3
• Quality improvement programs should include representatives of all disciplines involved in patient care, including physicians, nurses, social workers, and dietitians 1
• A designated point of contact with specialist rehabilitation services should be established for people with Parkinson's disease during hospitalization 3

Medication Management Support

• Physiatrists should work with the medical team to ensure patients receive their Parkinson's medications on time when hospitalized, as medication timing is critical for symptom control 3
• Awareness of potential medication side effects, particularly impulse control disorders from dopaminergic therapy, should be incorporated into the rehabilitation plan 3

Specific Rehabilitation Approaches

Motor Symptom Management

• Computer-based learning for attention functions and cognitive therapy should be implemented for patients with cognitive impairments 1
• Robot-assisted movement training, standing, and gait training may be considered as adjunctive therapies, though more evidence is needed 1
• Tailored exercise programs should address the specific motor symptoms of tremor, rigidity, and bradykinesia 2

Dysphagia Management

• Standardized assessment of swallowing function should be performed before oral nourishment is initiated in patients with suspected dysphagia 1
• Fiberoptic endoscopic evaluation of swallowing (FEES) should be considered for bedside assessment in patients with cognitive and/or motor impairment 1

Common Pitfalls and Challenges

• Medication Timing: Failure to administer Parkinson's medications on time during hospitalization can lead to significant symptom exacerbation and complications 3
• Underrecognition of Non-Motor Symptoms: Non-motor symptoms like insomnia, orthostatic hypotension, and gastrointestinal dysfunction may be overlooked but require specific rehabilitation approaches 4
• Inadequate Nutritional Support: Weight loss in PD is associated with disease progression and may be exacerbated during hospitalization if not properly managed 1
• Insufficient Interdisciplinary Communication: Poor coordination between specialists can lead to fragmented care and suboptimal outcomes 1

Follow-up and Transition Planning

• Physiatrists should develop a home care plan that includes medication management, condition monitoring, and rehabilitation training to effectively slow disease progression 5
• Periodic clinical evaluation and reassessment of functional status should continue after discharge to maintain continuity of care 1
• Telehealth can be considered as an alternative mode for follow-up evaluation and management when appropriate 1