Update on the Management of Parkinson’s Disease for General Neurologists

Table 5

Some key members of a Movement Disorders Team, and the activities they may perform as non-pharmacological support for the patient and the attending neurologist.

Specialized nurse [80]	(i) Nurse specialized in Parkinson’s Disease; (ii) Often central coordination role in multidisciplinary team; (iii) Usually in closest contact with the patient and his family; (iv) Participates in clinical monitoring and adjustment of medicines; (v) May be a reliable source of information about clinical and social matters of concern to the attending neurologist
Physiotherapist [81]	(i) Uses a range of techniques and strategies to help in maintaining good posture, balance and fitness through exercise; (ii) Trains the patient in external cueing for improving gait and balance, helping to prevent falls: Individual rehabilitation session 2–3 times weekly may reduce the risk of falls; (iii) Trains the patient for maintaining effective breathing and helping with pain relief
Speech therapist	(i) Should be involved as soon as the patient starts experiencing difficulties with communication and/or swallowing; (ii) May provide intensive and efficient interventions, e.g.: (1) Lee silverman voice treatment [82, 83], shown to reduce hypophonia & hypokinetic dysarthria; (2) Training for expiratory muscle strength to reduce incidence of aspiration [84]; (3) Techniques for improving swallowing and facial expression
Occupational therapist [85]	(i) Should be consulted on aspects of daily living, such as finding ways to continue working, keeping up with hobbies and leisure interests. These interventions may improve functional activities; (ii) May help with creating safer environments or providing equipment to maintain independence
Psychologist	(i) Participates in the diagnostic set-up; (ii) Key for advising patients and caregivers about psychological problems and how to cope with the emotional burden of the disease
Social worker	(i) Assesses social conditions and helps with psychosocial adjustments; (ii) Instrumental in educational interventions for the patient and caregivers; (iii) Provides support and information when the patient needs to be transferred to a nursing home