Motor rehabilitation for Parkinson’s disease • 2025 MDS Congress

Prof. Alice Nieuwboer: Thank you for inviting me here. That's very nice.

Dr. Michele Matarazzo: I think that the topic that we are going to discuss about is finally gaining momentum, finally is attracting a lot of attention. And I think that's very important for the field, and it's very important, especially for our patients because it can change the quality of life of a lot of patients.

So, what is happening in the field of rehabilitation and what has happened over the last year that you think it's worth mentioning?

Prof. Alice Nieuwboer: Okay a lot is happening in the field of rehabilitation, and maybe I have to qualify [00:01:00] that first. I'm a representative of motor rehabilitation, so I'm a physiotherapist, and I'm less familiar with what is going on in speech therapy, occupational therapy, et cetera. So I'm only talking shop today, which is motor rehabilitation.

First of all, it is really nice to see the way that we are now in the main platform presentations. Exercises now being seen as a regular therapy that everybody should get. And that was very different from 10 years ago. So it is very exciting to be part of that development and I feel very lucky to be in the close witness of that.

Now, what I suppose is the most new in our field is the fact, of course, that we see that technology is invading rehabilitation. And that is a very good thing, in the sense that maybe [00:02:00] physiotherapists will become more obsolete. And will be replaced, to a certain extent, of course, by technology that helps patients to become motivated, to walk more, to be more active, but also to walk with better quality. So it's not only about more, but also about better movement, can be helped by technological devices. So that is, I think, a new development that, that I'm seeing.

And the second thing is that also technology is informing much more accurately how patients move when we are not looking at them.

So, we are getting more and more access now to free-living gait detection, free-living activity detection. And that still needs to fully invade the field, of course. But once it will, and I'm sure it will, we will get [00:03:00] much more precise information about what patients are actually doing at home, how they actually walk, whether they do have freezing or not.

So I think those two developments, in terms of measurement and in terms of therapy assistance by technology, are the most exciting developments I think in our field.

Dr. Michele Matarazzo: Oh, thank you very much. And actually, I think the first plenary session was about the treatment of Parkinson's disease. And I think a lot of attention was specifically on the physical activity. And I think one key term you were mentioning is motivation. A lot of times patient, even though they're aware that the importance of physical activity and moving, the motivation is something very important. 

Prof. Alice Nieuwboer: Well, that's critical. Exercise and physical activity is only useful for patients if you can do it at an good and high level [00:04:00] and at a good dose, and an appropriate dose. If patients do not reach moderate to intense doses of activity or exercise, then it won't work. So you have to make sure that patients, do what you ask. And for that, motivation of course is provided by therapists and neurologists. So I think neurologists have to play an important role in there as well. And nowadays, I have the feeling that neurologists actually do ask patients about whether they engage in exercise and what they actually do as well. So I think we are witnessing an enormous improvement there. So motivation is started there. If patients here that their neurologist is interested in their exercise, then they will be more likely to do it.

But of course the problem is that they have to do it for a long time because they facing a long disease duration, and that [00:05:00] is very challenging, and becomes more and more challenging when disease severity is getting worse. Because of course people will not feel like moving. They're tired, there is a risk of falling. So they have lots of reasons for why they prefer to sit in their chair, and they won't expose themselves to danger.

So then it becomes very challenging to make sure that people still move sufficiently and, and motivate them to do a lot of activity and to do it well.

Dr. Michele Matarazzo: In general, the field, but I think also the Movement Disorder Society, is putting the focus on those aspects. And I think this is helping the community. And as you were mentioning, ask neurologists to pay attention to those things. Probably the neurologists of 15, 20 years ago, they would just, give medication and forget about all the rest. But now we know that there are so many things that are as important as medication for how the patients are and how they will [00:06:00] be in the future. And definitely physical activity, rehabilitation in more advanced stages, also, is very important.

Prof. Alice Nieuwboer: Can I just add to that? I think another very important motivating factor is if the neurologist then finally sends a patient or refers a patient onto a physiotherapist. It is very important that physiotherapist has expertise in Parkinson's disease because then patients feel recognized.

They know that the therapist understands their problems and then they are helped by a physiotherapist. But if it is a therapist that has no real sense of what Parkinson's means, and has more of a musculoskeletal approach to mobility, then people will not be motivated. So expertise is very important in that process.

Yeah.

Dr. Michele Matarazzo: And the reality is that it varies a lot across the world and across geographical regions. [00:07:00] But definitely there is a huge need for education of physiotherapists that must be more and more expert in movement disorders in general, and specifically in Parkinson's disease. And well, of course there are some areas of the world where this is more common.

Some other areas where maybe there does is even one, physiotherapy expert in Parkinson's disease in the whole country. There's a huge need for education and I think you'll be working on that as well. 

Prof. Alice Nieuwboer: Absolutely, yes. I'm engaged in the Train the Trainer programs, which gives a sort of first start of the dissemination of that expertise. But I definitely think that is a very important priority for this area of work and for the Movement Disorder Society.

Dr. Michele Matarazzo: Now, when we do these interviews to wrap up what has happened over the last year, we also try to understand what is going to happen. In the next year and in the future, of course, you've been touching upon some aspects that are happening right now and that are gonna happen in the future, the technology.

Is there [00:08:00] anything else that you want to add to that list? Anything that you think we are going to discuss about when and if we meet one year from now?

Prof. Alice Nieuwboer: Oh yes. I think in the next year. I'm looking forward to a project that is ongoing at the moment in seven countries around the world, whereby we are trying to develop an outcomes measurement for freezing of gait. And yesterday, I gave a talk here at the conference and was talking about what can we do for freezing of gait. And often, we don't have enough evidence yet for what we can do for freezing of gait, because we cannot measure it very well. And therefore in the next year, we are going to see an enormous new development whereby there is a patient-reported outcome that is on the table that will be starting to consolidate.

We have a clinical, Clin-RO, as we call it, a clinical measure of the severity of freezing. And of course, very [00:09:00] importantly, we will have technological measures of freezing, because freezing detection is possible with variable sensors. But it is still in its infancy when it comes to measuring freezing in the home situation. And that is a really tough call to be able to develop algorithms that can do that very accurately. But we are on the way of achieving that.

So in the next year, I think we will make a jump ahead. And if we can measure freezing better, we can then also test rehabilitation strategies for freezing of gait much, much better. So I think that will be an exciting development in the next year. 

Dr. Michele Matarazzo: All of this is exciting and it's great to see your energy when talking about this. So keep up the good work. Thank you very much Alice, for being with us today. It's been a pleasure.

Prof. Alice Nieuwboer: Same. It was a pleasure for me too. Thank you. [00:10:00]