Perampanel Therapy, Cognitive Behavioral Term Paper

Pages: 9 (2857 words)  ·  Bibliography Sources: 9  ·  File: .docx  ·  Level: Master's  ·  Topic: Disease


These mobility deficits are difficult to treat with drugs or neurosurgery, yet physical therapy has the potential to improve these aspects by training patients in the use of pure or compensatory movement (Keus et al., 2007, p. 453).

Clinical trials settled for six targeted areas of focus during physical therapy for antiparkinsonian purposes, namely transfers, posture, reaching and grasping, balance, gait, and physical capacity; and four specific treatment recommendations were derived from them, namely cueing strategies designed to improve gait, cognitive movement strategies designed to improve transfers, exercises for balance, and active exercise for joint mobility, muscle power, and an improved physical capacity (Keus et al., 2007, p. 451). Several methods, such as mobility exercises, motor and gait training with external cues, training of daily activities, relaxation techniques, karate exercises, have been employed in these trials, but specific delimitations are scant in the absence of any general consensus regarding a rehabilitation program specific for Parkinson's disease patients (Pellecchia et al., 2003, p. 597).

Balance disturbance represents one of the most prevalent signs in Parkinson's disease. After adopting a long-term therapy comprised of sessions where a sequence of specific physical therapy exercises are aimed at cognitive and motor stimulation, positive values can be observed at the implementation of the Berg Balance Scale and the Timed Get Up and Go test for individuals with this condition, and finally the incidence of falls is diminished (Christofoletti et al., 2010, p. S58).Download full Download Microsoft Word File
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TOPIC: Term Paper on Perampanel Therapy, Cognitive Behavioral Therapy Assignment

Overall benefits of patients' undergoing physical therapy were observed in the functional status and quality of life related to physical mobility, but not in global quality of life or in the level of impairment (Ellis et al., 2005, p. 630). On the other hand, results indicate significant improvements in the sickness impact profile motor score, in the Unified Parkinson's Disease Rating Scale, Comfortable Walking Speed, with the most positive values in the field of gait speed and daily living activities, such as cooking, making coffee and outdoor activities like shopping (Kwakkel et al., 2007, p. S483). Improvements in stride length, step cadence, gait initiation, walking velocity, and daily living activities are consistently reported in the literature after patients' participation in a rehabilitation program (Ellis et al., 2005, p. 631).

Interestingly, subjects who took part in high-intensity sessions of physical therapy portrayed a post-exercise increase in gait speed, step and stride length, and improved weight distribution during sit-to-stand tasks, all of which lacked from low- and zero-intensity groups. A high-intensity session mostly consists of a gradual increase of treadmill exercise speed from self-selected velocity of comfortable values, to speeds above over-ground walking velocity (Fisher et al., 2008, p. 1221).

Subjects undergoing high repetition, velocity, or complexity physical programs also showed considerable lengthening of the cortical silent period, together with enhancing the neuroplasticity of the impaired brain, including the basal ganglia (Fisher et al., 2008, p. 1221). The actual mechanism that stands behind the lengthening of cortical silent period duration in people with Parkinson's disease who participate in high-intensity exercise is unclear. However, the cortical silent period is mainly mediated by ?-aminobutyric acid-B receptors, major inhibitory neurotransmitters in the basal ganglia. Abnormalities of GABAergic transmission are key aspects of the pathophysiology of movement disorders that involve the basal ganglia (Fisher et al., 2008, p. 1226).

In addition, an active form of physical therapy can increase levels of the brain-derived neurotrophic factor, which has neurotrophic and neuroprotective properties, can enhance brain plasticity, and appears to be responsible for the long-term benefits of physical exercise on the brain, while also potentiating synaptogenesis and neurogenesis. What is more, evidence has shown that BDNF modulates the level of functional inhibition in an activity-dependent manner by regulating the number of GABAergic interneurons. Despite the fact that the role of BDNF in modulating GABA-mediated inhibitory transmission is not yet entirely comprehended, it is feasible that the exercise-induced, prolonged cortical silence period is linked with an exercise-related increase in BDNF (Fisher et al., 2008, p. 1227).

Applied research in rehabilitation medicine has the disadvantage that the impacts of the individual components of the treatment programs remain unclear. For instance, the effects of various therapeutic applications, such as rhythmic cueing, are yet to be fully grasped. Recent fundamental neurophysiological investigations of basal ganglia function have provided a better theoretical basis for the therapeutic use of cues. It has been shown that the medial basal ganglia and supplementary motor area pathways are consistently hypoactive in Parkinson's disease. This circuitry is particularly active during internally generated, learned sequences of movement. Also, evidence points out that external movement guidance causes increased activation in the lateral parieto-thalamic premotor circuitry, and people with this condition may make use of these alternative pathways during cueing (Kwakkel et al., 2007, p. S486).

Individuals with early Parkinson's disease, within Hoehn and Yahr stage II or III, benefit in the long-term from physical therapy group treatment, with regard to function related to activities of daily living, and quality of life dependent to mobility. Yet, it ought to be taken into account that perhaps people who suffer from long-term chronic degenerative disease require that any kind of intervention occur over a long time span in order to see results. Therefore, instead of engaging in a bout of exercise for a short period of time, the patients may need to keep to the established treatment plan for several months (Ellis et al., 2005, p. 632). Moreover, a varied spectrum of physiotherapeutic methods is advisable when dealing with Parkinson's disease (Pellecchia et al., 2003, p. 597) because, at any rate, more research needs to be conducted in order to single out the best possible combination of treatment techniques.

All in all, it can be asserted that Physical Therapy is one of the most viable approaches towards Parkinson's disease, as it has the widely acknowledged potential to achieve sustainable improvements in the patients' motor skills, and hence it should serve as an indispensable auxiliary to the existent surgical, pharmacological and cognitive-behavioral practices, in view of the fact that most pharmacological treatments are able to reduce, but not eliminate the neurological deficits of bradykinesia, rigidity and freezing. In addition, pharmacological treatment is often insufficient to improve non-dopaminergic symptoms such as lack of balance control and resulting falls (Kwakkel et al., 2007, p. S478).

On top of that, cognitive behavioral therapy may, by itself, alleviate the psychological obstacles of depression and anxiety, yet it cannot impact the extent to which an individual accomplishes daily life activities independently. Therefore, regular physical exercise therapy sessions, conducted with a qualified physical therapist, are warranted for most patients with Parkinson's disease.


Christofoletti, G., Beinotti, F., Borges, G., Damasceno, B.P. (2010). PHYSICAL THERAPY IMPROVES THE BALANCE OF PATIENTS WITH PARKINSON'S DISEASE: A RANDOMIZED CONTROLLED TRIAL. Parkinsonism & Related Disorders, 16(S1), S58. doi: 10.1016/2Fs1353-8020-2810-2970204-2

Cole, K., & Vaughan, F.L. (2005) The feasibility of using cognitive behaviour therapy for depression associated with Parkinson's disease: A literature review. Parkinson and Related Disorders, 11, 269-276. doi:10.1016/j.parkreldis.2005.03.002

Eggert, K., Squillacote, D., Barone, P., Dodel, R., Katzenschlager, R., Emre, M., . . . Oertel, W. (2010). Safety and Efficacy of Perampanel in Advanced Parkinson's Disease: A Randomized, Placebo-Controlled Study. Movement Disorders, 25(7), 896-905. doi: 10.1002/mds.22974

Ellis, T., Goede, C.J., Feldman, R.G., Wolters, E.C., Kwakkel, G., Wagenaar, R.C. (2005). Efficacy of a Physical Therapy Program in Patients With Parkinson's Disease: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 85(4), 626-632. doi:10.1016/j.apmr.2004.08.008

Fisher, B.E., Wu, A.D., Salem, G.J., Song, J., Lin, C., Yip, J. . . Petzinger, G. (2008). The Effect of Exercise Training in Improving Motor Performance and Corticomotor Excitability in People With Early Parkinson's Disease. Archives of Physical Medicine and Rehabilitation, 89, 1221-1229. doi:10.1016/j.apmr.2008.01.013

Keus, S.H.J., Bloem, B.R., Hendriks, E.J.M., Bredero-Cohen, A.B., Munneke, M. (2007). Evidence-Based Analysis of Physical Therapy in Parkinson's Disease with Recommendations for Practice and Research. Movement Disorders, 22(4), 451-460. doi: 10.1002/mds.21244

Kwakkel, G., Goede, C.J.T., Wegen, E.E.H. (2007). Impact of physical therapy for Parkinson's disease: A critical review of the literature. Parkinsonism and Related Disorders, 13, S478-S487. doi 10.1016/2Fs1353-8020-2808-2970053-1

Pellechia, M.T., Grasso, A., Biancardi, L.G., Squillante, M., Bonavita, V., Barone, P. (2004). Physical therapy in… [END OF PREVIEW] . . . READ MORE

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