Deep-Brain Stimulation and Intensive Rehabilitation in a Patient with Parkinson Disease: A Case Report

BACKGROUND Parkinson disease (PD) is a common neurodegenerative disease. Intensive rehabilitation programs improve motor and non-motor symptoms in people with PD. Quite recently, deep-brain stimulation (DBS) has become an established therapeutic tool for treating patients with a disease who have troublesome motor fluctuations and dyskinesias refractory to best medical therapy. CASE REPORT A 56-year-old man affected by PD with motor complications was admitted to undergo deep-brain stimulation. After the operation, he was transferred to the Intensive Rehabilitation Department and received multidrug therapy. First, we tried to optimize the pharmacological therapy. To achieve this goal, we performed a physiatric evaluation with the device turned off. We set up an Individual Rehabilitation Project with active kinesitherapy for maintaining the strength and muscular resistance of the shoulder and pelvic girdle, upper limbs, and lower limbs, exercises to improve trunk stability and balance reactions, exercises to improve motor coordination and static and dynamic balance, gait training with gait pattern, training for climbing and descending stairs, and functional re-education. For the headache, we requested a magnetic resonance imaging (MRI) of the brain, that showed the correct positioning of the electrodes bilaterally, with the identification of a moderate amount of air (pneumocephalus). At the same time, adjustment/switching on of the stimulator was carried out, which was well tolerated, adjusting the stimulation parameters of the sensors both on the right and left during hospitalization and gradually modifying the pharmacological therapy. CONCLUSIONS The combination of internal-geriatric expertise together with the collaboration between neurologist and physiatrist are fundamental for management of these patients. Intensive rehabilitation is ideal for these subjects before discharge and subsequent post-procedural follow-up.